Treatment Options for Early-Stage Breast Cancer Patients
Last week I had a consult with a woman newly diagnosed with breast cancer. Besides her fear of the diagnosis, which is understandable, she expressed concern about the treatment options given to her by her doctor. It seems that she was offered an extremely long course of radiation therapy. She expressed to me that she remembered hearing a story on NPR some months ago that there were shorter treatment options for women with early-stage breast cancer. I assured her that she was correct, there are shorter courses of radiation treatment.
Mastectomy vs. Lumpectomy
For women diagnosed with early-stage breast cancer, breast-conserving therapy is the standard of care that should be offered to every woman. What does this treatment entail?
1) Breast-conserving therapy means just that: the breast is conserved. There is no mastectomy performed. Mastectomy is total removal of the breast. A recent study followed women for 20 years after breast-conserving therapy. Their rates of local tumor control (that means recurrence of the breast cancer) and survival were similar to women who had a mastectomy (1, 2)
2) When breast-conserving therapy is performed, the lump is removed (called a lumpectomy) and radiation is given after this surgery
Whole Breast Radiation vs. Breast Brachytherapy
1) Radiation therapy can be given to the whole breast, which happens over the course of 5 – 6.5 weeks. In this type of whole breast radiation, the woman is placed on a gurney and a beam of radiation is sent from the machine to the breast where the cancer was discovered.
This long course of treatment may not be ideal for working women, therefore some women may skip or have high absenteeism rates during their radiation treatments. This can reduce their chances of long long-term survival and increases risk of recurrence, as the referenced studies below have shown.
2) Breast brachytherapy is a type of radiation where the radiation is placed inside of the breast for a short period of time (3 – 10 minutes). Instead of 5 – 6.5 weeks of treatment there is only 5 days of treatment. This might be a better option for working women and increases adherence to this important part of the treatment course
Does breast brachytherapy work the same as whole breast radiation? Yes. There are 7 randomized trials (which are the “gold standard” of clinical studies) that show that breast brachytherapy works just as well as whole breast radiation when it comes to local tumor control and survival rates (3).
If you’ve been diagnosed with early-stage breast cancer, ask your doctor about treatment options for radiation. Which doctor do you ask? It’s best to ask both the breast surgeon AND Radiation Oncologist to see if you’re a candidate for breast brachytherapy.
Here’s to your best health!
Dr. Dee Grace, PhD
Scientist │Cancer Patient Advocate
770-229-7129
Conquer Cancer │Thrive│Prevent. Bedside Manners provides health advocacy and education so cancer patients get good bedside manners and healthcare. We focus on 3 things: 1) educating patients on science-backed natural ways to improve their quality of life; 2) empowering patients and survivors with a “survivorship game-plan”; and 3) ensuring patients receive quality healthcare that improves their chances of survival.
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References: 1) Fisher B, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233e1241; Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143e1150
2) Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227e1232.
3) Strnad V, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomized, phase 3, non-inferiority trial. 2016; 387:229)