By Ashish A. Deshmukh and Anna Likhacheva
Women with breast cancer have long faced complicated choices about the best course of treatment.
One particular concern has been the daily radiation therapy many women with breast cancer receive for six weeks after surgery. This form of therapy, also known as conventionally fractionated external beam radiation, has generally been recommended for most women undergoing breast conservation therapy. The goal has been to rid the body of any remaining cancerous cells that the surgeon’s tools could not remove.
A Patient’s Guide to Breast Cancer
Radiation, however, can be time-consuming and expensive for the patient and society. It also carries a small risk for late complications, such as heart disease.
New therapies have been tested that would shorten the length of radiotherapy from six weeks to three weeks, or deliver a single dose at the time of the lumpectomy procedure in the operating room.
A shorter course of radiation means more convenience, perhaps, fewer side effects and fewer out-of-pocket expenses. And a single dose of radiation is much cheaper than whole breast radiation therapy delivered over multiple weeks, but is associated with a slightly higher risk of local recurrence. So which option should patients and physicians choose?
In our recently published paper in the Journal of the National Cancer Institute, we came up with what we think is an answer. We showed through computer modeling that there is a better way for women – and one that can save our health care system nearly US$100 million every year.
Problem and Possible Solutions
For decades, breast cancer was considered such a formidable foe that doctors who treated it and women who had it wanted to use everything in their arsenal to fight it.
That included the radical Halsted mastectomy, which often took out chest muscles along with the breast and left women disfigured.
It also included lengthy radiation treatments, sometimes for as long as seven weeks (known as conventionally fractionated radiation), given every day Monday through Friday after surgery. This form of radiation comes at great cost to women and causes hardships for those who live far away from radiation clinics.
In recent years, doctors studied new therapies for breast cancer. Halsted radical mastectomy has been replaced with a lumpectomy procedure that is usually performed on an outpatient basis. The radiation course has been shortened and is now delivered using sophisticated equipment, sparing unnecessary dose to the heart and lungs.
The better equipment also began to allow researchers to look at ways to shorten treatment. Hypofractionated radiation, in which a portion of the breast is treated for a shorter time, was one result.