Many U.S. Women Can’t Get a Lower-Cost, Less-Invasive Breast Cancer Treatment

Intraoperative radiation therapy (IORT), a technique that delivers a single, targeted dose of radiation to the breast immediately after tumor removal, can spare eligible patients weeks of post-surgery treatments and associated costs.

The approach has existed for decades: the Intrabeam system that enables IORT received U.S. Food and Drug Administration clearance in 1999.

Despite its efficiency, IORT is hard to find in many American hospitals. One reason, critics say, is economics. Medicare’s 2022 estimates show radiation oncologists are reimbursed about $525 for an IORT treatment, far less than roughly $1,300 for five sessions of whole-breast radiation or $1,730 for 15 sessions, figures that do not include additional facility fees patients incur with each visit.

Clinical evidence paints a nuanced picture. Randomized TARGIT-A trial publications report that, in carefully selected early-stage cases, risk-adapted single-dose IORT can offer cancer control comparable to external-beam whole-breast radiation, with fewer non-breast-cancer deaths and the practical benefit of completing radiation at the time of surgery.

Breast Cancer Treatment

Yet professional guidance remains cautious. The American Society for Radiation Oncology (ASTRO) supports partial-breast irradiation for selected patients but warns that delivering IORT at the time of surgery can lead to a subset later needing whole-breast radiation and that some studies show higher local recurrence when IORT is used outside strict criteria.

IORT is not appropriate for everyone. Typical candidates are postmenopausal patients with early-stage disease, small tumors, and no lymph-node involvement—profiles aligned with selection frameworks used in Europe and elsewhere, where IORT has been employed for decades.

The debate over access in the U.S. therefore sits at the intersection of evidence, economics, and patient convenience: IORT can reduce time in care and out-of-pocket burden for appropriately selected patients, but uneven availability, and lingering clinical reservations, keep it far from routine.

As hospital systems weigh adoption and payers review incentives, patients may need to ask explicitly whether IORT is offered and if they qualify under their center’s protocols