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Jul 30

Avoiding Radiation Therapy after Breast Cancer Surgery

breast cancerModern laparoscopic surgery techniques have made surgical breast cancer treatment a far more acceptable choice for thousands of women. Because of this and other advances in breast cancer treatment, the prognosis for women with breast cancer has improved dramatically. A vital key to this progress is the early detection and prompt treatment of breast cancer.

Early detection makes lumpectomy (as opposed to mastectomy) the usual course for many breast cancer treatments. You may sometimes hear lumpectomy referred to as “breast conserving surgery,” “partial mastectomy” or “wide excision.” All of these terms refer to a surgery (often a laparoscopic surgery) that removes only the tumor and a narrow rim of tissue around it. Most of the breast tissue is left intact, and with lumpectomy, the breast looks as close as possible to how it did before surgery.

That fact alone made the idea of breast cancer surgery far more appealing to many women. However, the requirement of post-surgery radiation therapy remained for many patients, and this could be a major burden. Given after lumpectomy, radiation therapy is intended to rid the area of any cancer cells that may remain. Those cells are too small to be seen or detected by scans or to measure with lab tests. Many careful studies have confirmed that following lumpectomy, radiation therapy lowers the risk of breast cancer recurrence and breast cancer death. In fact, in appropriate patients, the results of breast cancer treatment using lumpectomy plus radiation therapy appear to be as good as with total mastectomy. Using laparoscopic surgery techniques, lumpectomy may be a one day procedure.

All of this sounds great, but the down side in many cases is the post-surgery radiation treatments. Post-surgical radiation breast cancer treatment can involve treatment that extends over several weeks. Patients must return to the breast cancer treatment center numerous times, typically five times a week for five to six weeks. A highly-trained staff and expensive medical equipment are required, meaning that this treatment is available only in larger medical centers. If the patient lives far from such a center, the problem of just getting to the treatment is a major obstacle.

A relatively new procedure called IORT can eliminate this problem for some breast cancer patients. IORT stands for “Intraoperative Radiation Therapy,” a procedure that can provide an alternative that is effective in preventing the return of cancer. During an IORT procedure, the radiation part of breast cancer treatment is delivered as a concentrated dose in the operating room. The need for weeks of follow up radiation therapy is eliminated.

This is obviously a great patient advantage and a cost saving measure as well, but there is a down side too. In order to be a candidate for IORT, the tumor must be detected early in the disease. If the tumor is too large, if there is more than one tumor or if there is involvement in the lymph nodes, Intraoperative Radiation Therapy is not available, and weeks of post-operative radiation cancer treatment must follow. This imposes a considerable social, psychological and economic burden on a patient who has already been treated for a serious disease.

In some cases, there are outside organizations that can offer some help with practical matters like child care, elder care, local or long-distance transportation and lodging. However, the best option is to avoid the need for post-lumpectomy radiation by keeping strictly to the guidelines for breast cancer detection. Women at average risk of breast cancer should have a mammogram once a year after age 40 to 45. If the patient falls into a higher risk group, she should have yearly mammograms along with an MRI starting at age 30.

Early detection screening exams for breast cancer identify abnormalities as early as possible, making more breast cancer treatment options (including IORT and lumpectomy) available. The odds of complete recovery are increased; if breast cancer is detected at an early stage, there is a 93 percent or higher survival rate after five years. The Daytona-Volusia-Flagler area has many fine early detection programs including those offered by Florida Hospital Memorial Medical Center, so by all means, follow the guidelines.

If you have any question about IORT or any area of general surgery, especially bariatric surgery, please contact our office. You may use Contact Dr Birkedal or phone us at (386) 231-3530. Our offices, located in Daytona, New Smyrna and Palm coast are all part of the Florida Hospital Network.

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