Adjuvant radiotherapy for breast cancer

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2843 (Published 30 December 2008) Cite this as: BMJ 2008;337:a2843
  1. Crispin Hiley, Cancer Research UK clinical research fellow1,
  2. Andrew Tutt, reader in breast oncology and director2,
  3. Mylin Torres, attending physician3,
  4. Carlo Palmieri, clinician scientist4
  1. 1Institute of Cancer, Barts and London School of Medicine, London EC1M 6BQ
  2. 2Breakthrough Breast Cancer Research Unit, Guy’s Hospital Campus, King’s College London, London SE1 9RT
  3. 3Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
  4. 4Cancer Research UK Laboratories, Department of Cancer Medicine, Imperial College, London W12 0NN
  1. Crispin.Hiley{at}cancer.org.uk

    Changes in delivery must be driven by evidence from ongoing clinical trials

    The incidence of breast cancer is rising worldwide, particularly in women over 50—it increased by 30-40% between 1973 and 1997.1 In the United States it has decreased by around 10% in line with the reduced use of hormone replacement therapy, but globally the problem is growing.

    Since the publication of the landmark National Surgical Adjuvant Breast and Bowel Project B-06, breast preserving treatment consisting of lumpectomy and postoperative radiation has become a widely accepted alternative to mastectomy.2 The UK Department of Health’s 2007 cancer reform strategy underscores the lack of resources allocated to radiotherapy and estimates that an 80% increase in service capacity will be needed by 2016.3 Lack of equipment and personnel can lead to protracted periods between lumpectomy and breast radiotherapy.4 5 To implement the strategy, we need to optimise current treatment regimens, adequately invest in radiotherapy infrastructure, develop more efficient radiotherapy techniques, and define when radiotherapy is not needed.

    One way of tackling the scarcity of radiotherapy services …

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