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Variation Seen in Accelerated Breast Irradiation Use

APBI may be unsuitable for 1/3 of women who get it, with racial/ethnic variations

MONDAY, Dec. 19 (HealthDay News) -- In women with breast cancer, accelerated partial breast irradiation using brachytherapy (APBIb) after breast-conserving surgery varies by race, ethnicity, and region, particularly in patients who may not be suitable for the technique, according to research published online Dec. 16 in the Journal of the National Cancer Institute.

Jona A. Hattangadi, M.D., of Brigham and Women's Hospital in Boston, and colleagues analyzed data from 138,815 women treated with whole breast irradiation (WBI) or APBIb after breast-conserving surgery for cancer diagnosed between Jan. 1, 2000, and Dec. 31, 2007. The researchers classified each patient as suitable, cautionary, or unsuitable for APBIb based on American Society for Radiation Oncology consensus guidelines.

According to the researchers, 2.6 percent of the patients received APBIb, with 65.8 percent of them classified as cautionary or unsuitable. Among suitable patients, variables associated with APBIb use included other versus white race (odds ratio [OR], 0.51), region (OR, 2.60 to 8.62), and more recent year (OR, 20.3). Variables among cautionary patients included nonmetropolitan or rural location (OR, 0.53), other versus white race (OR, 0.57), Hispanic ethnicity (OR, 0.75), black versus white race (OR, 0.76), region (OR, 3.10 to 10.2), and more recent year (OR, 17.6). For unsuitable patients, variables included other versus white race (OR, 0.46), black versus white race (OR, 0.77), more recent year (OR, 12.7), and region (OR, 3.33 to 21.6). Overall, APBIb use increased between 2000 and 2007 from 0.4 to 6.6 percent, with large regional variation.

"The wide geographic disparity in use of APBIb suggests that unwarranted variation -- practice variation not explained by illness, patient preference, or evidence-based medicine -- may be present, which can have a profound impact on health care costs and patient outcomes," the authors write.

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