Q.) I had a lumpectomy and they cut out all my cancer. Why do I even need radiation for my breast?
A.) First of all, congratulations on coming this far. You’ve already experienced the harrowing experience of being diagnosed with a breast cancer. You’ve undergone a number of needles put into your poor innocent breast. And then you underwent a significant surgery. You may have also already received chemotherapy too.
The reason why you need radiation treatments is based upon studies of thousands of women from all over the world over the past several decades who have been in your same shoes. Some women received radiation after surgery, and some did not.
The results conclusively have shown that the chance of the breast cancer coming back was significantly decreased when compared to women who did not receive radiation. (1) There has even been some data that showed that these women had a survival benefit from radiation. (2)
There are some special circumstances where some people would argue that the benefit from radiation is so small, that skipping radiation therapy may be deemed acceptable. One circumstance is for women who are over the age of 70, have an early stage breast cancer with favorable features, and are on tamoxifen or another kind of hormonal therapy. If you feel that you may belong in this special group, discuss this option further with your oncologist or surgeon.
Q.) Do I really really really have to have my whole breast treated with radiation?
A.) The answer is yes…for now.
That’s a great question that’s being looked at right now at radiation oncology centers nationwide.
Partial Breast Irradiation– or, just treating the area where you had the lumpectomy with radiation– has been explored in some centers around the world, with acceptable results. So now, the Radiation Therapy Oncology Group, in conjunction with the National Surgical Adjuvant Breast and Bowel Project– two national consortiums whose previous studies have defined the standard of care for millions over the decades– is currently conducting a major study, randomizing women to getting whole breast radiation and comparing them to those who are getting partial breast irradiation.
Is PBI just as effective? Stay tuned.
References:
(1)Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. Fisher B; Anderson S; et al. N Engl J Med 2002 Oct 17;347(16):1233-41.
Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Clarke M; Collins R; et al. Lancet. 2005 Dec 17;366(9503):2087-106.
Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists’ Collaborative Group. N Engl J Med 1995 Nov 30;333(22):1444-55.
(2) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Clarke M; Collins R; et al. Lancet. 2005 Dec 17;366(9503):2087-106.
Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. Vinh-Hung V; Verschraegen C. J Natl Cancer Inst 2004 Jan 21;96(2):115-21.