Improving patient education and emphasizing the favorable prognosis directing national recommendations for de-escalation may reduce breast cancer overtreatment in women aged 60 years and older, according to a study published in JAMA Network Open (2020;3[9]:e2017129. doi:10.1001/jamanetworkopen.2020.17129).
Despite previous information citing the safety of omitting sentinel lymph node biopsy and postlumpectomy radiotherapy, physicians continue to use these treatments at high rates.
“Physicians cite patient preference as one factor associated with overuse. However, little is known about how women view potential de-escalation of therapies,” wrote Ton Wang, MD, University of Michigan, Ann Arbor and colleagues.
In a qualitative study, older women not diagnosed with breast cancer were interviewed and given a hypothetical scenario in which they were diagnosed with low-risk, hormone receptor–positive breast cancer. Their perspectives on breast cancer treatment options in accordance with current guidelines were analyzed.
Overall, the women agreed that current age-based guidelines were acceptable on the basis of decreased recurrence risk and increased frailty in older patients. Many stated that they should not apply to healthy older women with a long life expectancy.
The study participants also expressed difficulty in understanding that treatment de-escalation is a favorable, not poor, prognosis.
Of the women interviewed, 40% would undergo sentinel lymph node biopsy because it is viewed as low risk and provides peace of mind but 70% of participants were in favor of omitting postlumpectomy radiotherapy because of the perceived risks, lack of benefit, and inconvenience.
“Positive reframing of the excellent prognosis driving national recommendations for de-escalation may reduce breast cancer overtreatment in older women. Strategies for reducing SLNB use will likely require education on the risks vs benefits and addressing patient preferences for peace of mind. In contrast, efforts to reduce radiotherapy use may need to address clinician or organizational factors,” concluded Dr Wang and colleagues. —Lisa Kuhns
