Many studies have affirmed that a newer, shorter course of radiation therapy for early-stage breast cancer works just as well as a longer course. A new report has found that two-thirds of women who undergo lumpectomies for breast cancer might be receiving excessive radiation therapy.
The research, published Wednesday in the Journal of the American Medical Association, found that three to four weeks of intensive radiation therapy are just as effective as the more common five- to seven-week treatment. The shorter therapy schedule is also cheaper, and most women preferred it when given the option.
"It should be a win-win-win and yet we're not using it," co-author Dr. Ezekiel Emanuel of the University of Pennsylvania's Perelman School of Medicine told NBC News.
Most women with early stage breast cancer opt to have breast-conserving surgery, or lumpectomy. Studies show that this surgery combined with radiation gives women the same chance of survival as if they were to choose a mastectomy, in which the whole breast is removed.
The analysis of data, involving millions of women, found that two-thirds of breast cancer patients who've had breast-conserving surgery (lumpectomy) undergo six to seven weeks of radiation therapy.
However, multiple studies suggest that an alternative course of only three weeks of higher-dose radiation called hypofractionated whole breast radiation is just as effective, more convenient and cheaper than longer, conventional radiation therapy, according to the study authors.
The newer type of radiation therapy is supported by four studies and practice guidelines from the American Society for Radiation Oncology, the researchers noted.
The New York Times, though, predicts that the shorter courses won't catch on among doctors, because it will take time to "change ingrained medical practices, especially when a procedure has been used for decades." There's also no medical benefit to incentivize doctors the benefits lie only in patients' time and health insurers' wallets.
The reasons behind the continued overuse of the longer course of radiation treatment "need to be investigated to further elucidate why there has been a slow transition to the shorter course of therapy," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.
"In the meantime, women need to raise the issue with their radiation oncologist to see if they qualify for the three-week course of radiation," she said.
So why are women still getting the longer treatment? "The motivations are complex," said Dr. Ben Smith, a radiation oncologist at MD Anderson. "For decades, radiation oncologists were taught to give low daily doses of radiation treatment over a prolonged period of time to limit the long-term side effects of their treatment. This higher daily dose makes a lot of radiation oncologists nervous given prior teaching, and I think this feeling accounts for the reluctance to embrace the newer, shorter approach to breast radiation."
