By Richard Asinof
PROVIDENCE – The use of radiotherapy in older women with a low risk of breast cancer recurrence may not be necessary, but it has had little effect on actual clinical decisions, according to an editorial written in the current issue of the Journal of Clinical Oncology by Dr. David E. Wazer, chief of the department of radiation oncology at Rhode Island Hospital.
“If an older patient has been treated for breast cancer, and has a low risk of recurrence, there may be no clinical reason to subject them to radiation therapy,” Wazer said. “It’s simply not necessary – it will not improve their quality of life, nor increase their chance of survival.”
Breast-conserving therapy has shown to have comparable outcomes to mastectomy, allowing women to preserve their breast without compromising their chance of being cured of cancer, according to Wazer. It has also been associated with improved quality of life, as compared to mastectomy.
Radiation therapy is an integral part of breast-conserving therapy, and its benefit is clearly dependent on the baseline risk of ipsilateral breast tumor recurrence after surgical excision alone, according to Wazer.
Multiple trials have shown that the risk decreases with age, and has prompted analysis of the benefit of radiotherapy for older patients with breast cancer.
In his editorial, Wazer argued that oncologists must look at the big picture in whether or not to use radiation therapy. “Will the radiation therapy truly help that patient in her 70s who is at a very low risk of tumor recurrence? Not likely,” he said. “It is perplexing to see that despite high-quality clinical trial evidence supporting the omission of breast radiotherapy in select older patients, the pattern of clinical practice in the United States seem to show little change.”