Radiotherapy after breast-conserving surgery has been shown to reduce the risk of breast cancer recurrence. However, although younger women tend to have more aggressive tumors and have higher risks of recurrence than older breast cancer patients, they are less likely to receive radiotherapy after breast-conserving surgery, according to a new study. Although treatment patterns among older breast cancer patients have been well studied, factors affecting noncompliance among younger women are not well known.
To compare radiotherapy use in women over different ages, family structures, and regions of residence, I-Wen Pan, PhD, formerly a research scientist at the research group led by Ya-Chen Tina Shih, PhD, at The University of Chicago, in Chicago, Illinois, and currently at the Health Economics and Outcome Research Department of McKesson Specialty Health, in The Woodlands, Texas, and colleagues, used a nationwide database to review medical and prescription records of 21,008 patients with insurance coverage who had invasive breast cancer and who received breast-conserving surgery between January 2004 and December 2009.
The researchers excluded patients with a prior history of breast cancer, radiotherapy before breast-conserving surgery, mastectomy within 12 months of breast-conserving surgery, and distant metastasis. Their study was published in the Journal of the National Cancer Institute (2013; doi:10.1093/jnci/djt434).
They found that patients age 50 years or younger were less likely to receive radiotherapy than those in older age brackets. They also found that a woman was less likely to receive radiotherapy if she had at least one child younger than 7 years, compared with women who had no children or whose children were older. Although other factors such as insurance type, receiving breast-conserving surgery further from home or in an outpatient setting, and living in a region with lower education level could be potential barriers to receiving radiotherapy at any age, the association between young children and lower utilization of radiotherapy was statistically significant only for women age 20 to 50 years.
The authors pointed out that, “The receipt of radiotherapy after breast-conserving surgery represents one aspect of quality cancer care.” They concluded that improving overall quality of breast cancer care could improve radiotherapy compliance, but that “additional work is needed to … develop robust interventions tailored to the unique needs of younger cancer patients.”