title: RETRACTED: Impact of Cooperative Trial and Sociodemographic Variation on Adjuvant Radiation Therapy Usage in Elderly Women (≥70 Years) with Stage I, Estrogen Receptor-Positive Breast Cancer: Analysis of the National Cancer Data Base.
abstract: The Cancer and Leukemia Group B (CALGB) 9343 trial demonstrated that adjuvant radiation therapy (RT) can be omitted in women aged 70 years or older, with small, estrogen receptor (ER)+ breast cancer. We postulated that RT usage after CALGB's publication should have decreased over time.
  
  
  
  We evaluated a cohort of 205,860 women aged 70 years or older, with stage I, ER+/progesterone receptor (PR)+ breast cancer with lumpectomy, diagnosed between 1998 and 2012, in the National Cancer Data Base. Clinicopathologic and sociodemographic variables were compared between pre-CALGB and post-CALGB publication (circa 2004). Univariate and multivariate analysis were used.
  
  
  
  Radiation therapy usage decreased by only 2.95% after CALGB publication (68.71% vs 65.76%; p < 0.0001). Almost one-third of women with short life expectancy (≥85 years) received RT in the post-CALGB group. Significant predictors (p < 0.01) of lowest RT use include advanced age, increased great circle distance, academic research program, East South Central region, rural population < 2,500 not adjacent to a metropolitan area, low income level, high comorbidity index, small tumor, well-differentiated histology, residual tumor, and lack of receipt of anti-hormonal therapy.
  
  
  
  The CALGB trial had a minimal impact on the rate of adjuvant RT use among elderly women with small, hormone positive breast cancers. Significant variation in RT usage exists across sociodemographic strata.
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA. Electronic address: qchu@lsuhsc.edu.
authors.forename: Quyen D
authors.initials: QD
authors.lastname: Chu
authors.affiliation: Louisiana Tumor Registry and Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA; School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Kaelen L
authors.initials: KL
authors.lastname: Medeiros
authors.affiliation: Louisiana Tumor Registry and Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA; School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Meijiao
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA; Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Peddi
authors.affiliation: Louisiana Tumor Registry and Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA; School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008408:Mastectomy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D011960:Receptors, Estrogen