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FREQUENTLY ASKED QUESTIONS


 

   
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Breast Cancer Frequently Asked Questions

 

Why is radiation recommended after the tumor is surgically removed?

Senior Couple looking at computer

Surgery to remove the tumor and preserve the remaining breast tissue is called a lumpectomy. Radiation treatment is given to destroy any remaining microscopic deposits of cancer in and around the site of surgery. The combination of lumpectomy followed by radiation therapy is considered equal or better than a mastectomy, which is a major surgery removing the entire breast. If radiation is not done following a lumpectomy, there is a high likelihood of cancer growing back in the breast and a lower survival.

How can I save my breast and have better results?

Many women are surprised to learn that breast cancer research has already shown us that mastectomy offers no survival advantage (and may even be worse) compared to lumpectomy and radiation. Many women also do not appreciate that even the best possible reconstruction after a mastectomy can not match the excellent appearance of a breast treated with lumpectomy and radiation. We would be more than happy to educate you further about current breast cancer research during your consultation.

Can I avoid major surgery like a mastectomy?

Yes, absolutely. Our mission is to educate women about this and improve their lives as a result. Mastectomy is disfiguring and totally unnecessary for the vast majority of women today. This is especially true since many women who are getting regular mammograms are uncovering tumors that can be easily removed while sparing the normal breast. Even women who are told they have 'large' tumors or cancerous lymph nodes can still spare their normal breast because of research demonstrating excellent results including survival and appearance, making a mastectomy 'obsolete' in all but the most extreme cases.

What are the common side effects of radiation therapy to the breast?

Side effects can include fatigue, skin irritation similar to a moderate sunburn, and mild to moderate breast swelling. These changes are temporary and can be treated by skin creams and/or medications. Tell your radiation oncologist or nurse about any discomfort you may feel, we will help you through it. Most women are surprised how quickly and easily they complete radiation.

Why is modern radiation successful in decreasing side effects and improving cancer control?

Modern radiation involves computer controlled dose modulation that can actually reduce extremes in radiation in the breast and on the skin such that the dose is much more homogenous and you experience less skin burning. More importantly it allows for better heart and lung protection. The breast also has less areas of under dosing so tumor control is expected to be higher.

What is accelerated partial breast irradiation (APBI) and who is a candidate?

Accelerated partial breast irradiation is the delivery of radiation to only part of the breast over four to five days. By treating a smaller area of the breast, treatment can be completed in just one week.

Randomized clinical trials are being conducted to evaluate the effectiveness of this treatment, and until then, only women who are not candidates for the clinical trial should be considered for APBI off-study. Selected women who are at the lowest risk of recurrence (recurrence means the cancer coming back) may be offered APBI. Researchers at MD Anderson Cancer Center showed a higher rate of cancer recurrence using APBI, requiring a mastectomy. We await the results of more definitive studies being conducted throughout the world to get the final word on this. You can read about these various experimental techniques of APBI here. Randomized clinical trials are being conducted to evaluate the effectiveness of this treatment, and until then, only women who are not candidates for the clinical trial should be considered for APBI off-study. Selected women who are at the lowest risk of recurrence (recurrence means the cancer coming back) may be offered APBI. Researchers at MD Anderson Cancer Center showed a higher rate of cancer recurrence using APBI, requiring a mastectomy. We await the results of more definitive studies being conducted throughout the world to get the final word on this.

Who is a candidate for accelerated partial breast radiation and what are the disadvantages versus whole breast radiation?

Selected women who are at the lowest risk of recurrence (recurrence means the cancer coming back) may be offered APBI. This includes women who are older than age 60, with small cancers under 1 inch in size, located in just one spot of the breast, which were removed with wide margins of cancer-free tissue surrounding it, and those that do not have certain features when looking at the cancer under the microscope. While women fitting these criteria may do well, in general, about 1 in 3 women have cancer cells in the rest of the breast that is best treated with radiation to the whole breast. Whole breast radiation is like an insurance policy that these other cells will be killed once and for all, and studies may very well show superiority of this approach.

Women who are concerned about cosmetic outcome should be aware that whole breast radiation has been shown to have better cosmetic outcomes than APBI. This data was presented at a national meeting (ASTRO) in the end of 2012.

What is accelerated whole breast radiation?

This is a relatively new method for giving radiation to the whole breast developed and used in Canada and England. It has gained popularity in the USA since it provides the advantages of whole breast radiation but saves two to three weeks of time on average compared to traditional whole breast radiation. Not all women are ideal candidates for this technique, for example younger women less than 70 and women with triple negative breast cancer. Most clinical trial data show that the cosmetic results are excellent with this technique, in contrast to APBI above where some women have been noted to suffer serious cosmetic late effects such as significant scarring and occasionally requiring surgery to remove dead breast fat causing pain (called 'fat necrosis').

How does the newest technology we have help to get better results compared to centers with older equipment?

Modern radiation involves computer controlled dose modulation that can actually reduce extremes in radiation in the breast and on the skin such that the dose is much more homogenous and you experience less skin burning. More importantly it allows for better heart and lung protection. The breast also has less areas of under dosing so tumor control is expected to be higher.

Should I consider Proton Beam radiation?

No. Proton beam is actually an older technology developed in the 1950’s for very specialized types of tumors. There is no clinical data to support the use of proton beam therapy over conventional radiation treatment in breast cancer.

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