Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs

K. Han, M. L. Yap, J. H E Yong, N. Mittmann, Jeffrey S Hoch, A. W. Fyles, P. Warde, E. Gutierrez, T. Lymberiou, S. Foxcroft, F. F. Liu

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Aims The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2– and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. Materials and methods The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2– breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. Results In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2– breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. Conclusion There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer.

Original languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalClinical Oncology
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Keywords

  • Breast cancer
  • cost savings
  • Ki-67
  • luminal A
  • omission
  • radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Han, K., Yap, M. L., Yong, J. H. E., Mittmann, N., Hoch, J. S., Fyles, A. W., Warde, P., Gutierrez, E., Lymberiou, T., Foxcroft, S., & Liu, F. F. (2016). Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs. Clinical Oncology, 28(9), 587-593. https://doi.org/10.1016/j.clon.2016.04.003