title: Adoption of intensity modulated radiation therapy for early-stage breast cancer from 2004 through 2011.
abstract: OBJECTIVE
  Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer.
  
  
  METHODS
  We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were ≤65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT).
  
  
  RESULTS
  We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT.
  
  
  CONCLUSIONS
  The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status.
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Elyn H
authors.initials: EH
authors.lastname: Wang
authors.affiliation: Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Mougalian
authors.affiliation: Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.affiliation: Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut. Electronic address: james.b.yu@yale.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000532:radiotherapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data* / Q000639:trends; D015276:Health Care Rationing / Q000191:economics* / Q000639:trends; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D055815:Young Adult