Certain therapy options for early-stage breast cancer have fewer associated complications and are much less expensive than others, according to a study published in the Journal of the National Cancer Institute (2017;109[1]:1-9).
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According to guidelines for local therapy for early-stage breast cancer, safe and effective options include lumpectomy plus whole-breast irradiation, lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone.
Benjamin Smith, MD, associate professor, department of radiology, University of Texas MD Anderson Cancer Center, and colleagues conducted a comparative examination of each treatment’s complications and cost to assess their relative values. Researchers sampled 105,211 women with early-stage breast cancer diagnosed between 2000 and 2011. Using diagnosis and procedural codes, researchers identified treatment complications within 24 months of initial diagnosis and compared complications by treatment. Mean total and complication-related costs were estimated from a payer’s perspective.
Results of the comparison showed that lumpectomy plus whole-breast irradiation was the most commonly used treatment option and was associated with the least complications and lowest costs. Mastectomy plus reconstruction was associated with approximately double the complication risk of lumpectomy plus whole-breast irradiation treatment (54.3% vs 29.6% among younger women with private insurance, 66.1% vs 37.6% among older women with Medicare) and was also associated with higher adjusted total cost (average $22,481 more for younger women; average $1,748 greater for older women with Medicare) and complication-related cost (average $9,017 greater for the younger cohort; $2,092 greater for the Medicare cohort).
Brachytherapy had significantly higher total cost and complications than whole-breast irradiation. Lumpectomy alone showed lower cost and complications, but only in the older patients with Medicare.
“We believe that this research is helpful to frame the conversation between a woman and her physicians regarding the trade-offs between lumpectomy with whole-breast irradiation and mastectomy with reconstruction,” said Dr Smith in a press release (April 12, 2017). “While mastectomy with reconstruction is sometimes the best treatment for an individual patient, it is important for patients to understand the potential for complications, some of which can be quite significant.” – Zachary Bessette
