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Doctors Not Cutting Back On Radiation For Breast Cancer Patients


Breast cancer is the most common type of cancer among women. Growing scientific evidence shows that in most cases during treatment, women get more radiation than they actually need. But as NPR's Patti Neighmond reports, two new studies find that doctors are not reducing radiation.

PATTI NEIGHMOND, BYLINE: For breast cancer patients, radiation after surgery has been the standard of care for years. Justin Bekelman is a radiation oncologist at the University of Pennsylvania School of Medicine.

JUSTIN BEKELMAN: And for decades and decades, conventional whole-breast radiation lasted for five to seven weeks.

NEIGHMOND: But in the past decade, a number of large studies showed that three weeks of radiation at higher doses was just as effective as five to seven weeks at lower doses. There were no increased side effects, and the cost was thousands of dollars less.

BEKELMAN: Even though we found that using this shortened treatment saves 10 percent of total cost in the first year after breast cancer diagnosis, I actually think what's more important to patients with breast cancer is the fact that it saves three weeks of time - time when they could be with family, time when they could be at home, time when they could be at work.

NEIGHMOND: So in 2011, recommendations for treatment changed, but did doctors follow them? That's what Bekelman wanted to know. He compared breast cancer treatment before and after the new recommendations. He found that two-thirds of eligible patients were still getting the longer treatment.

BEKELMAN: Often in cancer care, both physicians and patients believe that more is better. And this is an example where less might be just right, especially in a case where less means equivalent cancer care and no increase in toxicity. This is a win-win. It's a win-win for patients. It's a win-win for the health system. It's an example of real high-value healthcare.

NEIGHMOND: Bekelman says it can be difficult for doctors to change entrenched practices. And it can be difficult for patients too, particularly when it comes to a scary, life-threatening disease.

RACHEL BLITZBLAU: I think in general, the overall approach to cancer has been a more is more approach.

NEIGHMOND: Rachel Blitzblau is a radiation oncologist at Duke University Medical Center. She looked at another area of radiation treatment, in this case, for women over 70 with early-stage breast cancer. Ten years ago, a large study found no difference in survival between older women who had radiation after surgery and those who didn't. So Blitzblau compared trends in breast cancer treatment before and after the study.

BLITZBLAU: Prior to publication of the study, approximately 67 percent of women were getting whole-breast radiation after a lumpectomy. And after the trial, still about 61 to 62 percent of women were getting radiation. So the change in practice resulting from publication of the study was very, very small.

NEIGHMOND: Which means the majority of older patients underwent radiation therapy every day, with potential side effects like fatigue, pain and scarring of breast tissue. This, despite the evidence that the treatment does not increase life expectancy.

BLITZBLAU: I think it's hard for patients to hear we used to always to do this, but I'm suggesting to you that we don't need to do this anymore. And I think that can be a hard decision to make - that they can be more fearful that they're not taking every step they could to have a good outcome.

NEIGHMOND: Blitzblau says this is where doctors can step in and make a big difference. They can discuss the studies and the evidence with patients and help them understand the actual benefits and risks before making treatment decisions.

Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.

Award-winning journalist Patti Neighmond is NPR's health policy correspondent. Her reports air regularly on NPR newsmagazines All Things Considered, Morning Edition, and Weekend Edition.