title: Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs.
abstract: The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2- and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients.
  
  
  
  The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2- breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing.
  
  
  
  In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2- breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada.
  
  
  
  There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Han
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: M L
authors.initials: ML
authors.lastname: Yap
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: J H E
authors.initials: JH
authors.lastname: Yong
authors.affiliation: HOPE Research Centre, Toronto, Ontario, Canada; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute of Clinical Evaluative Studies, Toronto, Ontario, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A W
authors.initials: AW
authors.lastname: Fyles
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Warde
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Lymberiou
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Foxcroft
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. Electronic address: fei-fei.liu@rmp.uhn.on.ca.
authors.forename: F F
authors.initials: FF
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D018714:Radiotherapy, Adjuvant / Q000191:economics*
keywords: Breast cancer; Ki-67; cost savings; luminal A; omission; radiotherapy