With Early Breast Cancer, Targeted Radiation Shows Promise

With Early Breast Cancer, Targeted Radiation Shows Promise

Especially for women with early stage breast cancer, targeted doses of radiation therapy may be as effective as standard radiation treatment of the entire breast, a new British study suggests. The research only tracked women for five years, so it isn’t definitive. Still, “this contributes to a growing body of evidence that a large proportion of women over 50 years old with small breast cancers can avoid whole breast radiotherapy,” said study co-author Dr. John Yarnold. He is a professor of clinical oncology with the Institute of Cancer Research in London.

At issue: What is the best treatment for low-risk early breast cancer? Many studies have shown that surgery to remove the cancerous lump — but not the entire breast — followed by radiation of the whole breast reduces the chance of breast cancer returning, said Dr. Reshma Jagsi, who was not involved with the new study. Jagsi is an associate professor in the department of radiation oncology at the University of Michigan Health System.

Research also suggests that women who undergo this more intensive treatment survive somewhat longer, Jagsi added. But side effects can include breast shrinkage, firmness and tenderness, Yarnold said. That raises the question of whether partial radiation could be a better option. 

The researchers behind the new study randomly assigned just over 2,000 women with breast cancer in the United Kingdom to undergo one of three radiation therapy approaches after having small cancerous tumors surgically removed. Two of the approaches focused the radiation around the tumor, exposing the rest of the breast to little or no radiation. 

According to Yarnold, the study revealed that three weeks of partial breast radiation therapy produced fewer side effects but seemed just as effective as whole breast radiation over five years. Besides very low rates of relapse among all three groups, the rate of side effects from the target therapy was minimal, the study authors said.

On the other hand, Yarnold and Jagsi disagree over whether doctors should embrace the more limited form of radiation treatment now. He predicted that partial breast radiation treatment will become standard for large numbers of women with breast cancer over the next five years.

But he cautioned that the treatment isn’t appropriate for all patients. Physician opinions vary, he said, but in general, the treatment seems best for women over 50 with low- to medium-grade tumors who’ve had the entire primary tumor removed and didn’t show signs of the cancer spreading to axillary nodes (lymph nodes in the armpit region). The findings are promising, said Jagsi, who added that the technology to deliver partial breast radiation is available in the United States.

However, the study isn’t strong enough to warrant changing the traditional approach, at least for women with longer life expectancies, Jagsi said. More follow-up is needed to determine whether less radiation is effective over the long term, she added. 

Moreover, in the case of this ongoing study, additional results will be reported in another five years. For now, “physicians and patients should have detailed discussions about the expected risks and benefits of radiotherapy in each particular case,” Jagsi said. “Many approaches to radiation treatment are now available, and informed deliberation and discussion of this and many other relevant studies is necessary to ensure that each patient can select the approach that is right for her.”

What You Need to Know About Breast Self-Exams

What You Need to Know About Breast Self-Exams

You know the drill: The breast self-exam (BSE) illustrations on those pamphlets usually show a woman with one arm up over her head, pushing the fingers of her other hand across her breast—in search of a lump or some other sort of change. Your ob-gyn may have talked to you about doing this every month at home, ideally at a time when your breasts don't feel tender or swollen. 

The truth is, even doing regular BSEs (without regular mammograms) may not protect you. A large study conducted in China by researchers from the Fred Hutchinson Cancer Research Center in Seattle made headlines in 2002 by suggesting that women who were taught to do regular BSEs didn't fare any better—or live any longer—than women who were not taught to do them. On average, they didn't find cancer any earlier. Still, many medical experts believe women should familiarize themselves with how their breasts feel.

However, BSEs can be tricky for women with dense breast tissue—which is common for younger women. "Mostly they don't know what they're feeling or are not confident," says Janet Wolter, MD, a medical oncologist and the Brian Piccolo Chair of Breast Cancer Research at Rush University Medical Center in Chicago. "The breast is constructed like an orange or a grapefruit; you'll feel segments, and that's scary, but it's normal."

For premenopausal women, "the easiest day to remember to do a BSE is the first day of your cycle, when you get your period," suggests Julia A. Smith, MD, director of the NYU Cancer Institute's breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at NYU in New York City. If you feel something, wait two weeks and then do another BSE. The odds are it'll be gone—breast tissue often changes throughout the menstrual cycle, says Dr. Smith. But if the abnormality persists, you should see your doctor. Furthermore, older women generally have easier BSEs, because after menopause the tissue gets much softer: "If you put a Ping-Pong ball in there, you'd feel it right away," as Dr. Wolter puts it.

A Breast Cancer Diagnosis Checklist

A Breast Cancer Diagnosis Checklist

It is true that it is helpful to carry around a checklist of all the information you want to gather about your breast cancer diagnosis, because you’ll be seeing results from the various tests at different times. Although you may have already had a biopsy, for instance, your doctor might still need to remove lymph nodes to determine whether the cancer has spread. 

Mary McHugh, MD, a pathologist at Mount Carmel St. Ann's hospital in Westerville, Ohio, and a member of the College of American Pathologists, recommends finding out the following. What type of cancer is it? The most common form is IDC. Other common types include DCIS, ILC, and LCIS. Click here for a detailed explanation of each type. Is it invasive? Says Dr. McHugh: "If the cancer breaks through the wall of the breast duct, it's considered invasive. If it hasn't broken through, though, it's called in situ or noninvasive cancer." Invasive cancer is more serious.

What size is the tumor? This is measured in centimeters. What stage is it? Ductal carcinoma in situ (DCIS) is stage 0, the most curable; cancer that has spread to other parts of the body is stage IV. What is the histopathologic grade? This is a total score combining three different characteristics of the tumor as it appears under the microscope. Scores range from 3 to 9; a higher score indicates more aggressive cancer. Your report will include a histopathologic grade of 1 if your combined score is 3 to 5; 2 if your score is 6 to 7; and 3 if the score is 8 to 9.

After surgery: Are the margins clear (aka negative) or positive? The surgeon removing the tumor tries to take a rim of cancer-free tissue around the tumor. "We're trying to confirm that the surgeon got it all out," explains Dr. McHugh. If the margins are positive, that may mean scheduling more surgery to get the rest out.

Do the lymph nodes or blood vessels show cancer? Is the cancer hormone receptive? "Some cancer cells have a higher number of hormone receptors in the nucleus and that can promote the growth of the cells," Dr. McHugh says. Your report will say you're ER-positive, or estrogen receptor-positive, and/or PR-positive, progesterone receptor-positive, or negative for one or both. This helps doctors determine if you're a candidate for hormone therapy, such as tamoxifen, which blocks these receptors and can slow down or stop the growth of tumors.

And finally, what is the cancer's HER2/neu status? "If tumor cells are HER2-positive, it means they're associated with a more aggressive tumor," says Dr. McHugh. Your HER2/neu status tells your oncologist whether the drug Herceptin (trastuzumab), which targets the HER2 protein, should be part of your treatment plan.