Breast Cancer

Breast Cancer

Radiation Therapy for Breast Cancer

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Facts About Breast Cancer

  • This year, 190,000 women and 2,000 men will learn they have breast cancer.
  • Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.
  • Another 68,000 women will learn they have noninvasive (also called in situ) breast cancer.
  • Breast cancer is often cured by timely application of appropriate treatment that may involve surgery, drug therapy, radiation therapy, or a combination of these.
  • However, breast cancer is not always cured: it may spread elsewhere in the body and can prove fatal. Breast cancer is the second leading cause of cancer death among women, exceeded only by lung cancer.

ASTRO Response to Revised Screening Guidelines

The United States Preventative Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) issued two separate screening recommendations for women in 2009.

Specifically, the USPSTF recommendations suggest women aged 40 to 49 without risk factors can avoid yearly mammography screenings for breast cancer until age 50. The ACOG guidelines advise that women can begin receiving Pap tests to look for cervical cancer starting at age 21 and then be screened every other year until age 30, at which time women should receive the test every three years.

ASTRO is a society of radiation oncologists who use X-ray technology to treat cancer rather than diagnose it. As an organization, we intend to work with our diagnostic radiology colleagues to look closely at the latest screening guidelines and issue a statement of our findings, if necessary.

In the meantime, we believe that women of every age should talk to their doctors about when and how often they should undergo screening tests, including the Pap test and mammography, as well as other screening tests like the colonoscopy to look for colon and rectal cancers. Your doctor is the best person to help you make these decisions.

We encourage women to ask their primary care physician the following questions:

  • Based on my general health and family history, should I receive screening tests, such as mammograms for breast cancer, the Pap test for cervical cancer and the colonoscopy for colon and rectal cancers?
  • How will screening benefit me?
  • Are there any risks to these screenings?
  • Where can I get screened?
  • How are these screenings performed?
  • When and how will I learn the results?
  • Who will explain the results to me?
  • Is there anything I can do to lower my risks of cancer?
  • Based on my health and family history, would you recommend other screenings?

Treating Breast Cancer

Breast cancer is often cured by timely application of appropriate treatment that may involve surgery, radiation therapy, drug therapy (chemotherapy and/or hormone blocking therapy) or a combination of these.

  • Surgery is necessary for all patients with breast cancer and will involve one of two major approaches:
    • Removal of the breast. This is called a mastectomy.
    • Removing just the tumor. This is called breast conservation therapy. It is also called a lumpectomy as only the cancerous lump is removed.
  • Surgery is also necessary to assess for possible spread of the cancer to nearby lymph nodes.
  • Additional treatments beyond surgery are often necessary. Your treatment team will assess your risk that your cancer may return or spread.
  • Several factors are part of this assessment including your age, menopausal status, other medical conditions, tumor type, tumor size and number, tumor grade (i.e., how malignant does the cancer look under the microscope), the scope of the surgery, surgical margins (i.e., how close was the cancer to the edge of the tissue removed by surgery), lymph node involvement, hormone receptors, and other tests.
    • Chemotherapy with anticancer drugs or hormone blocking drugs may be indicated after surgery. A medical oncologist, a physician skilled in the use of prescribing powerful medications for treating cancer, will help you make this assessment.
    • Radiation therapy will often have an important role after surgery as well. A radiation oncologist, a physician specially trained to use radiation treatments, will help you decide if you need radiation therapy.

External Beam Radiation Therapy

Painless radiation treatments are delivered in a series of sessions Monday through Friday, for three to eight weeks. Each treatment lasts less than 30 minutes. The radiation beam usually comes from a machine called a linear accelerator or a linac.

  • Before beginning treatment, you will be scheduled for a simulation to map out the area being treated. This will involve having X-rays and/or a CT scan. You may also receive tiny marks on your skin, like a tattoo, to help the radiation therapist precisely position you for daily treatments.
  • The usual course of radiation treats only the breast, although you may need to have nearby lymph node areas treated also.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. Doctors are still studying IMRT for the treatment of some types of breast cancer. Talk to your radiation oncologist for more information.
  • More about external beam radiation therapy

Accelerated Partial Breast Irradiation

External beam radiation therapy to the whole breast for several weeks after a lumpectomy is the standard of care for early-stage breast cancer. In national clinical trials, doctors are studying if accelerated partial breast irradiation (also called APBI) — where radiation is delivered to only part of the breast over one to five days — works as well. Many of these techniques are only available in a few clinics and then only to a select group of patients.

  • Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Twice a day for five days, the catheters or the balloon are connected to a brachytherapy machine, also called a high-dose-rate (HDR) afterloader. Your radiation oncologist then directs a special computer to guide a small, radioactive seed into the breast tissue near where the tumor was removed. The radiation is left in place for several minutes. After the end of the five days, the catheters or balloon are removed.
  • 3-D conformal partial breast irradiation is a type of external beam radiation therapy where only part of the breast receives external beam radiation. The long-term results of these techniques are still being studied. Talk with your radiation oncologist for more information. This is the most widely used APBI technique in the ongoing Radiation Therapy Oncology Group/National Surgical Adjuvant Breast and Bowel trial.
  • For intraoperative radiation therapy (IORT), radiation oncologists deliver radiation to the place where the tumor was removed while the patient is in surgery. In some cases, doctors insert a small device to where the cancer was removed. Radiation is then applied through the tip of the device for 20 to 40 minutes. In other centers with shielded operating rooms, electron beam or HDR IORT is used. The advantage of this technique is the radiation can be given all at once instead of over several days or weeks.

In 2009, a panel of radiation oncology breast experts published a consensus statement on APBI in ASTRO’s official journal, the International Journal of Radiation Oncology*Biology*Physics.

Radiation After Mastectomy

After a mastectomy, your doctor may suggest radiation therapy for the chest wall and possibly nearby lymph node areas.

  • Many patients treated with mastectomy will not require radiation therapy afterwards.
  • The role for post-mastectomy radiation therapy is limited to people who are at high risk of the cancer returning to the lymph nodes or to the chest wall (where the breast lived before being removed surgically).
  • Whether you are considered at high risk for the cancer returning to the chest wall or lymph nodes depends on several factors. These include your age, whether you have experienced menopause, other medical conditions, tumor type, tumor size and number, tumor grade (i.e., how malignant does the cancer look under the microscope), the scope of the surgery, surgical margins (i.e., how close was the cancer to the edge of the removed tissue), whether the lymph nodes were affected by the cancer, hormone receptors and other tests.
  • Many people needed radiation therapy after a mastectomy also need chemotherapy. For breast cancer, these two treatments are usually done one after the other instead of at the same time. However, your medical oncologist and radiation oncologist will discuss their recommendations with you.
  • Radiation therapy after a mastectomy usually starts six weeks after surgery or after you complete chemotherapy.
  • Radiation therapy treatments then usually last six weeks with treatments every day, Monday through Friday.

Possible Side Effects

  • Side effects are usually temporary and should go away after treatment ends. However, ask your doctor what you can expect from your specific treatment.
  • Skin irritation similar to sun burn.
  • Mild to moderate breast swelling.
  • Mild fatigue that generally gets better a month or two after treatment ends.Some women describe this as an overall "blah" feeling.
  • A few women report mild tenderness in the breast or chest wall. This will slowly get better over time.
  • Scarring of a small part of the lung just under the breast. This generally does not cause side effects.
  • Many of these side effects can be controlled with medications. Tell your doctor or nurse if you experience any discomfort so they can help you feel better.

Caring for Yourself During Treatment

  • Get plenty of rest during treatment, and don’t be afraid to ask for help.
  • Follow your doctor’s orders. Ask if you are unsure about anything. There are no stupid questions.
  • Tell your doctor about any medications or vitamins you are taking, to make sure they are safe to use during radiation therapy.
  • Try to eat a balanced diet. If food tastes funny, or if you are having trouble eating due, tell your doctor, nurse or dietician. They might be able to help you change the way you eat. Radiation therapy to the chest should not affect your appetite so definitely tell your doctor or nurse if you experience this.
  • Treat the skin exposed to radiation with special care. Stay out of the sun, avoid hot or cold packs, only use lotions and ointments after checking with your doctor or nurse and clean the area with warm water and mild soap.
  • Battling cancer is tough. It may help to seek out help from support groups and friends.

Additional Online Resources:
Learn More About Breast Cancer on the Blog (Includes Video Clips, Images, Latest Cancer News and Cure Rates, News Clips, Patient Testimonials, Cancer Doctor Testimonials)

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