Women who undergo breast-conserving surgery (BCS) are less likely to receive radiation therapy afterwards if they have at least one child younger than 7 years old, a recent study showed.
Lower use of radiation after BCS was also associated with other demographic, insurance and clinical factors.
Background and Reason for the Study
Radiation therapy given after BCS, most commonly lumpectomy, is effective at lessening the chance of the cancer coming back and increasing survival in those with early-stage invasive disease. A greater benefit from radiation after BCS is seen in younger women than in older women. Yet studies show that women age 40 and younger receive radiation therapy after BCS less often than do women in their 50s or beyond.
Young women’s underuse of radiation after BCS has not been closely studied. The trial team conducting this study wanted to identify factors associated with radiation use in young women and find out whether lower use related to the demands of caring for children.
Using a nationwide database of insurance claims, researchers looked at the treatments women ages 20 to 64 received. The study group was limited to those with
- continuous health insurance for 12 months before and after BCS
- no prior breast cancer history
- no radiation therapy before BCS
- no mastectomy within 12 months of BCS
To gauge the need for childcare, women were put into four groups by the age of their youngest child. Those with no children were grouped with women whose children were older than 18. Other demographic and insurance information was also assessed.
Researchers studied 18,120 women who received radiation therapy after BCS. In that group, 4.25 percent had one or more children younger than 7 years old.
There was a statistically significant increase in women’s use of radiation therapy as their children aged. Radiation treatment rate was
- 80.61 percent – women with at least one child < 7 years old
- 84.34 percent – women with all children older than 6 and at least one child aged 7-12 years
- 85.07 percent – women with all children older than 12 years and at least one child aged 13-17 years
- 86.89 percent – women with no children or all older than 18 years
Researchers believe the underuse of radiation in women with very young children may be due to the daily time demands of radiation therapy, which can last for 7 weeks.
The Pacific census area had the lowest radiation therapy use (79.52 percent) compared with the highest (89.57 percent) in the West-North-Central states.
Other factors related to less use of radiation therapy included
- being enrolled in a health maintenance organization (HMO) or capitation (payment per patient, not per service) preferred provider organization (PPO)
- travelling across census divisions for surgery or having outpatient surgery
- living in an area with a lower percentage of college-educated people
- having a diagnosis of ductal carcinoma in situ (DCIS)
The researchers note that some academic physicians in California advocate for decreased radiation therapy for DCIS, an influence that may affect how radiation is used geographically.
Radiation use was positively associated with having other care, as appropriate: chemotherapy, staging imagery and surgery to remove lymph nodes from the armpit for study.
What This Means for You
You may be concerned about how to budget time and related costs of a radiation therapy schedule with childcare, job or school demands and other commitments.
Talk with your radiation oncologist about whether you can receive treatment on a shortened schedule, at a convenient time or at a location near to where you live or work. If you need transportation, ask about shuttle services from the cancer center or hospital, or about groups offering rides to treatment sites.
Learn more about managing radiation therapy in our Guide to Understanding Treatment Decisions.
Pan, IW, Smith, BD, Shih,YCT. Factors Contributing to Underuse of Radiation Among Younger Women With Breast Cancer. Journal of the National Cancer Institute. 2013; doi: 10.1093/jnci/djt340.
This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.