JACKSONVILLE BREAST CANCER TREATMENT OPTIONS

Women with early stage breast cancer often don’t know what to do when offered multiple choices of treatment. In the 1960s, it was well accepted that a woman had to undergo removal of the whole breast (mastectomy) to save her from breast cancer. However, that is not true today.

Several landmark clinical trials done in the 1980s showed that with radiation to the whole breast, it was possible to save a woman from the disfiguring consequences of removal of the whole breast. Breast conservation therapy (BCT), involving removal of just the breast lump (lumpectomy) followed by 6 weeks of radiation to the whole breast, was found to be at least as effective (and possibly more effective) than removing the whole breast in fighting the cancer. Specifically, breast conservation was as good as mastectomy in eradicating the cancer and saving a woman’s life from breast cancer. Moreover, this approach saved a woman’s natural breast to preserve a sense of wholeness and well being for the woman and her family. In the modern era of breast cancer treatment, more recent studies have shown that breast conservation actually delivers a higher survival than a mastectomy.

In the early 2000’s, radiation oncologists were faced with a new approach which treated only part of the breast with radiation, and do so over a period of 1 week. While accelerated partial breast irradiation (APBI) saved time, there were concerns that this treatment might be more toxic, might not control disease elsewhere in the breast, and might result in more mastectomies if treatment failed, or possibly even worse survival.

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. 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.