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.
