ASO Author Reflections: Can Medical Maximizing–Minimizing Preferences Inform De-implementation Efforts for Low-Value Breast Cancer Services in Older Women?

Excerpt

Most older women with breast cancer have early-stage, hormone receptor-positive (HR +) tumors, a favorable biology with an excellent long-term prognosis. At the same time, older women are more vulnerable to toxicities of cancer treatment. In this setting, several studies have investigated the safety of omitting previously routine therapies. In 2013, the Cancer and Leukemia Group B (CALGB) 9343 trial demonstrated that women ≥ 70 years of age who underwent post-lumpectomy radiotherapy with or without axillary staging experienced no additional survival benefit compared with women treated with lumpectomy and endocrine therapy alone.1 As part of national campaigns to reduce low-value services, organizations, including the Society of Surgical Oncology (SSO) and the National Comprehensive Cancer Network (NCCN), have recommended against the routine use of SLNB and post-lumpectomy radiotherapy since at least 2016 in these patients. …