In
the new study, published Wednesday in JAMA, The Journal of the American
Medical Association, two University of Pennsylvania doctors, Ezekiel J. Emanuel
and Justin E. Bekelman, and their colleagues analyzed data from 14
commercial insurance plans involving 15,643 women who had their breasts
irradiated after lumpectomies.
Radiation is used after women have lumpectomies because it reduces the odds that another cancer will arise in the breast, and it improves the chances of survival.
The
researchers considered two groups of women who had radiation therapy
and asked how many had received the shorter course. One group closely
matched women in the previous randomized studies that evaluated the
conventional treatment versus the shorter one. These women were older
than 50 and had early-stage cancers. Practice guidelines published in
2011 by the American Society for Radiation Oncology recommend the
shorter radiation therapy for this group.
The other group differed from participants in the previous studies because they were younger, had had prior chemotherapy or had cancer
cells in their lymph nodes, indicating a more advanced cancer. The
practice guidelines neither endorse nor discourage the shorter therapy
for these women.
Use
of the shorter course of radiation increased in both groups of women
from 2008 to 2013, but still only a minority received this treatment. In
the group that should have received the shorter therapy under the
guidelines, 10.6 percent received it in 2008 and 34.5 percent in 2013.
In the group that received no recommendation for or against the shorter
treatment, the percentage who used it rose from 8.1 percent to 21.2
percent over that time.
In
Canada and Britain, the statistics were far different. At least
two-thirds of women in both groups received the shorter therapy.
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