Does persistent use of radiation in women > 70 years of age with early-stage breast cancer reflect tailored patient-centered care?

Lauren J. Taylor, Jennifer S. Steiman, Bethany Anderson, Jessica R. Schumacher, Lee G. Wilke, Caprice C. Greenberg, Heather B. Neuman

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose: Randomized controlled trials demonstrate that omission of radiation therapy (RT) in older women with early-stage cancer undergoing breast conserving surgery (BCS) is an “acceptable choice.” Despite this, high RT rates have been reported. The objective was to evaluate the impact of patient- and system-level factors on RT rates in a contemporary cohort. Methods: Through the National Cancer Data Base, we identified women with clinical stage I estrogen receptor-positive breast cancer who underwent BCS (n = 84,214). Multivariable logistic regression identified patient, tumor, and system-level factors associated with RT. Joinpoint regression analysis calculated trends in RT use over time stratified by age and facility-type, reporting annual percent change (APC). Results: RT rates decreased from 2004 (77.2%) to 2015 (64.3%). The decline occurred earliest and was most pronounced in older women treated at academic facilities. At academic facilities, the APC was − 5.6 (95% CI − 8.6, − 2.4) after 2009 for women aged > 85 years, − 6.4 (95% CI − 9.0, − 3.8) after 2010 for women aged 80 − < 85 years, − 3.7 (95% CI − 5.6, − 1.9) after 2009 for women aged 75 − < 80, and − 2.4 (95% CI, − 3.1, − 1.6) after 2009 for women aged 70 − < 75. In contrast, at community facilities rates of RT declined later (2011, 2012, and 2013 for age groups 70–74, 75–79, and 80–84 years). Conclusions: RT rates for older women with early-stage breast cancer are declining with patient-level variation based on factors related to life expectancy and locoregional recurrence. Facility-level variation suggests opportunities to improve care delivery by focusing on barriers to de-implementation of routine use of RT.

Original languageEnglish (US)
Pages (from-to)801-807
Number of pages7
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - Apr 1 2020
Externally publishedYes


  • Breast cancer
  • Breast conserving therapy
  • De-escalation
  • Elderly
  • Lumpectomy
  • Radiation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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