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Comment & Response
July 22, 2021

Omission of Radiotherapy in Older Adults With Early-Stage Breast Cancer

Author Affiliations
  • 1Roswell Park Comprehensive Cancer Center, Buffalo, New York
JAMA Oncol. 2021;7(9):1397-1398. doi:10.1001/jamaoncol.2021.2404

To the Editor In their recent Viewpoint in JAMA Oncology, Chowdhary et al1 provide a thorough overview on radiotherapeutic considerations for older adults with early-stage breast cancer. The authors suggest that shorter radiotherapy options could alter our recommendations in the spirit of “patient-centric care.” I respectfully disagree, and I believe that the authors are taking a paternalistic view without considering all the inputs of the decision-making process. While such options will change the calculus for individual patient decision-making, I do not believe that these emerging data will change our approach.

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    1 Comment for this article
    Stop overtreating
    Jennifer Marti, MD | Weill Cornell Medicine
    I couldn't agree more. We have numerous studies (CALGB 9343, PRIME II, BASO) supporting omission of RT has no survival benefit with potential harms; it is time to engage in shared decision making with women, and be frank about the possible harms of RT (angiosarcoma a major one, 1/1000 risk is not insignificant: https://jamanetwork.com/journals/jamaoncology/fullarticle/2722616). We need to acknowledge that at least 30% of breast cancers are overdiagnosed and stop the harms of overtreatment.