No difference in mortality, no difference in cancer spread, and a very low overall recurrence rate — for intermediate-risk patients, radiation didn't meaningfully change the outcomes that matter most.
A New York Times article today highlighted a study just published in the New England Journal of Medicine — and as a plastic surgeon who takes care of breast cancer patients, I am genuinely thrilled about it.
The trial enrolled women who had:
This is exactly the group that would traditionally be recommended to receive post-mastectomy radiation therapy. In the study, these women were randomized into two groups:
The median follow-up was nearly 10 years — meaningful long-term data, not a snapshot.
At a decade out, the comparison between the two groups was striking:
In other words: for this intermediate-risk group, getting radiation didn't meaningfully change the outcome that matters most — survival.
In the United States, the majority of mastectomy patients go on to have an implant-based breast reconstruction. And radiation — while a powerful cancer treatment — is extremely challenging for breast implants.
Even when we do this all the time, radiation adds:
So any time radiation can be safely avoided without compromising cancer care, it's a huge win for the patient's long-term reconstruction.
What's also exciting is what may be coming around the bend.
For chemotherapy, we already have sophisticated tools like:
These tests look at the genetics of your individual tumor and give us a personalized estimate of your recurrence risk — which helps us decide whether or not you actually need chemo. It's a huge leap beyond the old one-size-fits-all approach.
Similar testing is on the horizon for radiation recommendations — the ability to look at your specific tumor biology and get a more personalized answer on whether radiation will actually help you.
If you've seen my previous video on it, the test gaining traction in my area for post-mastectomy radiation decisions is called AidaBreast. It's now available locally, and I'm excited to be able to offer that kind of individualized guidance to patients.
The goal of all of this is simple: use these therapies in the patients who will actually benefit — and spare the patients who won't.
That means:
For intermediate-risk breast cancer patients who've had a mastectomy and chemotherapy, a major new trial suggests that radiation may not improve long-term outcomes — and tools like AidaBreast and MammaPrint-style radiation tests are moving us toward personalized recommendations.
If you're a breast cancer patient navigating decisions about radiation, bring this up with your oncology team. The landscape is changing fast, and you may have more options — and more data behind those options — than the standard recommendation suggests.
Your local plastic surgeon, I can promise you, is very happy about it.