title: Association between access to accelerated partial breast irradiation and use of adjuvant radiotherapy.
abstract: The current study was performed to determine whether access to facilities performing accelerated partial breast irradiation (APBI) is associated with differences in the use of adjuvant radiotherapy (RT).
  
  
  
  Using the National Cancer Data Base, the authors performed a retrospective study of women aged ≥50 years who were diagnosed with early-stage breast cancer between 2004 and 2013 and treated with breast-conserving surgery (BCS). Facilities performing APBI in ≥10% of their eligible patients within a given year were defined as APBI facilities whereas those not performing APBI were defined as non-APBI facilities. All other facilities were excluded. The authors identified independent factors associated with RT use using multivariable logistic regression with clustering in the overall sample as well as in subsets of patients with standard-risk invasive cancer, low-risk invasive cancer, and ductal carcinoma in situ.
  
  
  
  Among 222,544 patients, 76.6% underwent BCS plus RT and 23.4% underwent BCS alone. The likelihood of RT receipt in the overall sample did not appear to differ significantly between APBI and non-APBI facilities (adjusted odds ratio [AOR], 1.02; P = .61). Subgroup multivariable analysis demonstrated that among patients with standard-risk invasive cancer, there was no association between evaluation at an APBI facility and receipt of RT (AOR, 0.98; P = .69). However, patients with low-risk invasive cancer were found to be significantly more likely to receive RT (54.4% vs 59.5%; AOR, 1.22 [P<.001]), whereas patients with ductal carcinoma in situ were less likely to receive RT (56.9% vs 55.3%; AOR, 0.89 [P = .04]) at APBI facilities.
  
  
  
  Patients who were eligible for observation were more likely to receive RT in APBI facilities but no difference was observed among patients with standard-risk invasive cancer who would most benefit from RT. Cancer 2017;123:502-511. © 2016 American Cancer Society.
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Elyn H
authors.initials: EH
authors.lastname: Wang
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
authors.forename: Henry S
authors.identifier: 0000-0002-9366-8514
authors.initials: HS
authors.lastname: Park
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rutter
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Yale School of Medicine, Yale University, New Haven, Connecticut.|Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.|Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
keywords: access; breast cancer; breast conservation therapy; guidelines; partial breast irradiation