Black women experience longer breast cancer treatment times and may have less access to essential radiation technology, according to a recent study published in the journal Cancer.(1) In response, the TARGIT Collaborative Group (TCG), a national cancer advocacy organization of doctors and scientists working to improve cancer patient care, endorses single-dose radiation as a potential solution to address barriers to care that disproportionately affect black women with early-stage breast cancer in the United States.
The traditional approach to treating stage one or two breast cancer is tumor removal surgery followed by three to six weeks of daily External Beam Radiation Therapy (EBRT). Missing multiple daily treatments, having an unplanned break in treatment, or not completing the treatment course can result in a higher incidence of breast cancer recurrence and decreased long-term survival.(2)
“Transportation challenges, lack of childcare assistance, and inability to take time off work to attend radiotherapy appointments are just some of the obstacles we see across several underserved patient groups, including black women,” said Dr. Karen Godette, a radiation oncologist and associate professor at Emory University Hospital Midtown in Atlanta, GA. “The arduous EBRT model is no longer necessary for many early-stage breast cancer cases. By not offering more tenable options, we risk women falling through the cracks due to poor compliance. Targeted intraoperative radiotherapy can remove many of these barriers: patients are happier, and it provides women with the ability to complete all necessary treatment with less interruption to their daily schedules.”
TARGIT Intraoperative Radiation Therapy (TARGIT-IORT) is a single dose of targeted radiation delivered from inside the breast during surgery immediately following the removal of the tumor while the patient remains asleep. The 20-year TARGIT-A international clinical trial compared TARGIT-IORT to EBRT, and long-term data consistently demonstrated no difference in local and distant breast cancer control, breast preservation, or breast cancer mortality.(3) For 8 out of 10 patients, no further radiotherapy was needed, possibly eliminating the potentially fatal risks posed by EBRT noncompliance.
“There is an abundance of data demonstrating that prolonged EBRT treatment duration is a problem. However, there is also an abundance of data validating that IORT is the solution, and overall survival rates are the same whether the patient receives one targeted treatment versus up to 30 separate treatments,” said Dr. Valery Uhl, radiation oncologist and president of the TCG. “The EBRT treatment model is outdated and needs to change for early-stage breast cancer. TARGIT-IORT is an important step in providing greater health care equality for all women.”
The Cancer study, which assessed nearly 3,000 women enrolled in the Carolina Breast Cancer Study Phase III, found that nearly one third of all Black women have a “prolonged treatment duration” (>56 days) for EBRT, while just over a fifth of White women were in that same group. These findings are consistent with several other studies, which show that compared to White women, Black women are diagnosed with breast cancer at a lower rate and at more advanced stages;(4) receive post-surgical radiation therapy less frequently;(5) report greater breast cancer-related financial impact;(6) and suffer higher overall mortality.(4)
“Targeted intraoperative radiation eliminates the no-win scenario of a patient choosing between going to work and going to treatment; deciding between childcare and cancer care; or opting for mastectomy over saving her breast,” said Dr. Rogsbert Phillips, surgical oncologist at Emory University Hospital Midtown in Atlanta, GA and founder of Sisters By Choice, a non-profit organization that supports women diagnosed with breast cancer and their families. “Single-dose treatment can ensure that a woman, regardless of her racial background, experiences less interruption to her daily schedule and gets back to her work and to her family sooner.”
The Cancer study also looked at women across different socioeconomic strata and found that lower-income patients encountered more barriers to completing post-surgical EBRT in the time prescribed than women of higher incomes. However, within both of those income groups, Black women still experienced longer treatment durations than White women.
The TARGIT Collaborative Group (TCG) is a national organization of radiation oncologists, cancer surgeons, physicists, and other experts in intraoperative radiotherapy working collaboratively to improve cancer patient care through education, patient advocacy, mentorship, and collaborative research.
- “Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women,” Cancer, September 21, 2020
- “[Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center](https://link.edgepilot.com/s/f2fb7aed/E1R6XdqRSUyKK0I_amBKkA?u=https://www.redjournal.org/article/S0360-3016(16%2900064-X/abstract),” International Journal of Radiation Oncology, Biology, Physics, January 29, 2016
- “Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomized clinical trial”, BMJ, August 19, 2020
- “Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality -- United States, 1999-2014,” MMWR and Morbidity and Mortality Weekly Report (CDC), October 14, 2016.
- “[Impact of Race, Ethnicity, and Socioeconomic Factors on Receipt of Radiation After Breast Conservation Surgery: Analysis of the National Cancer Database](https://link.edgepilot.com/s/cba3def3/BZWBrBHsO0aF80D2X7lJ5w?u=https://www.redjournal.org/article/S0360-3016(17%2932636-6/fulltext),” International Journal of Radiation Oncology Biology Physics, October, 2017.
- “Financial Impact of Breast Cancer in Black Versus White Women,” Journal of Clinical Oncology, April 18, 2018.