Journal Article

Effectiveness of Radiation Therapy in Older Women With Ductal Carcinoma In Situ

Benjamin D. Smith, Bruce G. Haffty, Thomas A. Buchholz, Grace L. Smith, Deron H. Galusha, Justin E. Bekelman and Cary P. Gross

in JNCI: Journal of the National Cancer Institute

Volume 98, issue 18, pages 1302-1310
Published in print September 2006 | ISSN: 0027-8874
Published online September 2006 | e-ISSN: 1460-2105 | DOI: http://dx.doi.org/10.1093/jnci/djj359
Effectiveness of Radiation Therapy in Older Women With Ductal Carcinoma In Situ

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Background: For women with ductal carcinoma in situ (DCIS), radiation therapy after conservative surgery lowers the risk of recurrence. However, emerging evidence suggests that radiation therapy confers only a marginal absolute benefit for older women with DCIS. In a cohort of older women with DCIS, we sought to determine whether radiation therapy was associated with a clinically significant benefit. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database from January 1, 1992, through December 31, 1999, we identified 3409 women aged 66 years or older treated with conservative surgery for DCIS. A proportional hazards model tested whether radiation therapy was associated with a lower risk of a combined outcome, defined as a subsequent ipsilateral in situ or invasive breast cancer reported by SEER and/or a subsequent mastectomy reported by Medicare claims. The 5-year event risk was determined for patients without and with high-risk features, which were defined as at least one of the following: age 66–69 years, tumor larger than 2.5 cm, comedo histology, and/or high grade. All statistical tests were two-sided. Results: Radiation therapy was associated with a lower risk for each component of the combined outcome (hazard ratio = 0.32, 95% confidence interval [CI] = 0.24 to 0.44). For high-risk patients, the 5-year event risk was 13.6% without radiation therapy versus 3.8% with radiation therapy (difference = 9.8%, 95% CI = 6.5 to 13.2; P<.001). For low-risk patients, the 5-year event risk was 8.2% without radiation therapy versus 1.0% with radiation therapy (difference = 7.2%, 95% CI = 3.6 to 10.9; P<.001). Among healthy women aged 66–79 years, the number needed to treat with radiation therapy to prevent one event in 5 years was 11 for high-risk patients and 15–16 for low-risk patients. Conclusion: For older women with DCIS, radiation therapy appears to confer a substantial benefit that remains meaningful even among low-risk patients.

Journal Article.  7439 words.  Illustrated.

Subjects: Medical Oncology

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