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Delaying Post-Surgical Radiation Increases Risk of Breast Cancer Recurrence in Older Women BOSTON -- March 4, 2010 -- Older women who have had breast cancer surgery have a greater risk of breast cancer recurrence if they delay their post-surgical radiation treatment, according to a study published online by the British Medical Journal. The study, which involved more than 18,000 women aged 65 years and older who had breast cancer, found that those who started radiation treatment more than 6 weeks after breast-conserving surgery were more likely to have a local recurrence than those whose radiation treatment started within 6 weeks of surgery. Rinaa Punglia, MD, Dana-Farber Cancer Institute, and Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues conducted the research to address scientifically the debate about the “appropriate interval between surgery and radiation treatment, or radiotherapy, and its impact on treatment outcomes.” Post-surgical radiotherapy is designed to destroy remaining cancer cells following the removal of a localized breast tumor. Dr. Punglia said 4 to 6 weeks after resection of tumour is widely viewed as a safe interval for beginning radiotherapy, which typically is administered 5 days a week for 6 weeks. The researchers reviewed Medicare database records of 18,050 women with early stage breast cancer to assess whether the timing of when radiotherapy started following surgery affected outcomes. These women were treated between 1991 and 2002 with lumpectomy and radiation, but not chemotherapy. Thirty percent of women began radiotherapy 6 or more weeks after surgery. For the overall group, slightly more than 4% of the women experienced a local recurrence. The risk increased to about 5%, approximately a 19% jump, when the surgery-radiotherapy interval was longer than 6 weeks. The researchers found that there was no “threshold” at which the risk suddenly rose -- it increased incrementally day by day. “There isn’t a large difference between 43 days instead of 41,” said Dr. Punglia. “The day-to-day risk increase is very small.” The rise in breast-conserving surgery in the past 2 decades has fueled greater demand for radiotherapy, and might be one cause of longer waiting times. The study revealed more delays in areas such as the Northeast, where the procedure is more common, and fewer delays in the southern states, where breast-conserving surgery is less common. Waiting times were also longer in cases involving African-American and low-income women, but the study did not pinpoint the exact source of the delay. “It could be factors such as access to care, the patients’ ability to navigate the healthcare system, or physician referrals,” said Dr. Punglia. Although the study focused on older women, the findings have implications for younger women. “It’s possible that the increased risk we identified in older women could be magnified in younger women, whose tumours are biologically different and tend to be more aggressive,” said Dr. Punglia. SOURCE: Dana-Farber Cancer Institute E-mail this page to a friend or colleague! To print, use this version