Advances in the management of breast cancer: Keeping your breast and curing cancer is possible

Breast cancer is not the same for every woman. Today we have many modalities available to fight breast cancer and a large number of women are unaware of that fact. Even when all the information that we have such available as the internet, social media and news, current and future breast cancer patients are unaware that cancer today even in more advanced stages is treatable and long term control is possible. Women need to know all of their options when making treatment decisions.

Recent data shows a growing number of women undergoing mastectomies when equally effective breast conserving surgery is available. It is unfortunate to see that due to lack of knowledge many women today undergo unnecessary mastectomies, perhaps afraid that if the tumor and the breast remain the chances for the tumor coming back are there forever; perhaps they feel that they can eliminate mammography from their life forever. It is important to look beyond what we know from friends and family and learn about medical innovations currently available that could potentially benefit from.

Women look upon radiation treatment for cancer as enemy even though the technique is quite useful against many types of cancers. Modern radiation therapy is producing better outcomes than ever regardless of tumor location and cancer stage. Medical technology using state of art techniques in radiation therapy has change the way that we deliver radiation. With proper tools using imaging, precision targeting of tumors, technological advances have diminished damage to normal structures and nearby organs. This is particularly meaningful for left breast cancer patients, whose vulnerable hearts need to be better protected by strategic treatment design.

Consider advances in radiation therapy similar to the shift in surgical approaches to breast cancer tumors.Whereas breast tumors once meant automatic mastectomy for millions of American women, today a lumpectomy is often all that is necessary to remove a mass when diagnosed at an early stage. Many precision radiation treatments focus only on the area at risk – the tumor – doing a better job of sparing normal breast tissues that were before either irradiated or removed altogether. Radiation is doing more with fewer negative effects and better long term outcomes.

Some of the changes and advances made treatments simpler, faster with fewer complications and saved lives. Now, radiation oncologists are able to treat some left breast cancer patients lying down on their stomach in the prone position. Treating a patient prone allows the breast to fall away from the chest wall, creating a greater separation between the targeted area and the heart. In patients who for different reasons cannot be treated in the prone position careful patient positioning aided by sophisticated anatomical imaging, coupled with state of the art treatment devices, make it possible to protect the heart from radiation exposure Normally the body shifts in place due to natural processes, including normal breathing. New beam shaping and image guidance technologies that rely on diagnostic images, are used in modern radiotherapy to fine tune the design of treatments and minimize exposure of surrounding healthy tissues. The targeted area might be in constant motion as the patient breathes, however today’s radiation cancer care offers respiratory gating, a process by which the radiation beam is turned on and off as the targeted area moves in and out of range, again, sparing more healthy tissues.

In more advanced cases radiation therapy serves as an insurance policy after chemotherapy and surgery eradicating any residual cancer cells that surgery leaves behind.

Brachytherapy, a targeted treatment that radiates from the inside out, gives less exposure to the body and decreases total treatment time. It works by inserting a radioactive pellet the size of a grain of rice temporarily into a catheter and then into the breast cavity left after a lumpectomy for a few minutes. This treatment has effective as surgery while providing favorable cosmetic results for many women. It is important that women with early stage breast cancer are well informed about their treatment options.

At study showed that among women with breast cancer surveyed, less than one in 10 knew the option of brachytherapy existed. A large number of women who would have been candidates for brachytherapy partial breast irradiation-APBI reported that they would have been interested in this option, however they were not offered this option.

Another recent concern come from a recent article in Time magazine, where women are going to react from a drastic double mastectomy to do nothing. That is a totally incorrect approach. In breast cancer “ one size fits all “ approach is not a good solution. When women are diagnosed as T0 or in situ or DCIS in the stage before tumors are invasive a good discussion with their doctors is in order. As these tumors come in many games of colors ranging from a very low grade growth that can be followed within a Trial using with hormones after lumpectomy and serial mammography to the ones that can be successfully treated with single dose RT to the extreme cases that if they are multicentric and high grade require bilateral mastectomies but never chemotherapy.

BUT patients do not know that…. they are scare that death is imminent when that is not the case. That is why education and second opinions come handy

It is important to know and be informed about the value of radiation in improving prognosis, protecting healthy tissues and extending life is worth exploring.

Dr. Beatriz Amendola is Director of Innovative Cancer Institute and participant of the B-C5 Project HTTP://BCSPROJECT.COM/.

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