Greenup RA, et al. J Oncol Pract. 2017;doi:10.1200/JOP.2016.016683.

March 14, 2017
3 min read

Shorter radiation could safely lower costs of breast cancer treatment


Greenup RA, et al. J Oncol Pract. 2017;doi:10.1200/JOP.2016.016683.

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Radiation treatment costs would have decreased 39%, or $164 million per year, if women with early-stage breast cancer were treated with the least expensive radiation regimen for which they were safely eligible, according to a study published in Journal of Oncology Practice.

Results showed that over half of women received more radiation therapy than what was necessary.

Rachel Adams Greenup

“There are opportunities in cancer treatment to provide excellent cancer care while simultaneously reducing the treatment burden for patients and the health care system,” Rachel Adams Greenup, MD, MPH, assistant professor of breast surgery at Duke University School of Medicine, told HemOnc Today. “Our study provides an example of a win–win, where evidence-based breast cancer treatment has the potential to translate into reduced health care costs without compromising quality for patients.”

NCI statistics project breast cancer treatments costs will reach $20 billion by 2020. A 2002 study showed that, at 10-year follow-up, women who received higher doses of whole-breast radiation (42.5 Gy in 16 fractions over 22 days) had equivalent OS rates as those treated with traditional 6-week radiation therapy (50 Gy in 25 fractions over 35 days), supporting the use of hypofractionated radiation in select patients.

Researchers used the hypofractionation eligibility criteria from the 2002 study and omission of radiation eligibility criteria from the CALGB 9343 trial to evaluate at what extent costs could be reduced through appropriate use of radiation.

Greenup and colleagues used the National Cancer Data Base to identify 43,247 women (median age, 63 years; median tumor size, 1.2 cm) with T1 to T2 N0 invasive breast cancers treated with lumpectomy during 2011.

Women received conventional 6-week radiation of 25 to 36 fractions at 45 Gy to 66 Gy (64%), hypofractionated 3-week radiation of 15 to 24 fractions at 40 Gy to 58 Gy (13%), or lumpectomy with no radiation therapy (22%).

Twenty-eight percent of women received the least expensive evidence-based radiation treatment for which they were eligible, and 57% of patients were treated with more costly regimens. Researchers also found that 15% of women received less radiation than they were safely eligible for.

Researchers used the Medicare Physician Fee Schedule to estimate radiation treatment costs.

The estimated cost per patient was $13,358.37 for 6-week conventional radiation treatments, $8,327.98 for 3-week hypofractionated treatments, and $0 for lumpectomy without radiation treatments. Actual treatment costs for the entire cohort amounted to $420.2 million.


If all women received the least expensive treatment regimens for which they were safely eligible, treatment costs would have been $164 million less yearly.

These findings support other reports that suggest many women with early-stage breast cancer continue to receive longer and more costly radiation treatments than may be medically necessary, the researchers wrote.

The researchers acknowledged limitations of their study, including that the use of Medicare costs may have underestimated the economic implications of additional treatment when compared with actual charges and patient out-of-pocket costs.

Another important limitation to the study was the researchers’ inability to estimate the costs of locoregional recurrence when comparing radiation treatments. Greenup and colleagues also noted that decisions made by treating teams were based on patient factors and features of disease that are not captured in large national databases.

“Of course, high-quality care is the priority in cancer treatment,” Greenup said, “but our study suggests that utilization of evidence-based radiation treatment can translate into reductions in health care spending without sacrificing quality. When patients can receive excellent cancer care that reduces the treatment burden and translates into decreased health care costs, that’s high-quality, high-value care.” – by Chuck Gormley

For more information:

Rachal Adams Greenup , MD, MPH, can be reached at Division of Surgical Oncology, Duke University School of Medicine 3513, Durham, NC 27710; email:

Disclosure: An award from Building Interdisciplinary Research in Women’s Health helped fund the study. Greenup reports honoraria from Novartis. Please see the full study for a list of all other researchers’ relevant financial disclosures.