Family Health: Breast cancer treatments bring new choices

Breast cancer treatment has come a long way from the days when nearly every woman, regardless of the size of her tumor, was treated with a radical mastectomy. Doctors at the time believed this surgery gave women their best chance for survival, and there was little reason for a discussion with the patient about what treatment she might prefer.

Today, women are considered part of their own treatment team. They are included in decisions from the start, with doctors and other caregivers sharing information and recommendations about the latest treatments, research and likely outcomes for their particular cancer. And with advances in medicine and technology, women have far more options than even just 15 or 20 years ago.

That’s a good thing, but it can mean difficult choices. A good example is a treatment called brachytherapy, which dramatically shortens the duration of radiation treatment. Designed for women who have had breast-conserving surgery -- also called lumpectomy -- for early-stage cancer, brachytherapy also spares much of the breast from exposure to radiation by focusing it on the area where the tumor was removed instead of the whole breast. With this treatment, doctors surgically insert a catheter with a specialized tip into that space. The catheter remains in place over the span of treatment, allowing doctors to place a radioactive “seed” into the tip for a few minutes at a time, twice a day. A number of devices can deliver brachytherapy, including the SAVI, Mammosite and Contura.

Brachytherapy shortens radiation therapy to just five days -- spread over eight to 10 days, since treatments aren’t given on weekends -- compared with five to seven weeks for traditional whole-breast radiation. This shortened time makes brachytherapy an attractive choice, especially for women who need to travel to receive treatment.

But brachytherapy isn’t right for everyone. Guidelines list factors such as the size of the tumor (less than 3 centimeters is best), its position in the breast (not too close to the skin or the chest wall), and whether the cancer has spread to the lymph nodes (which would rule out brachytherapy). Women older than 60 are considered better candidates for brachytherapy, while those with certain types of cancer or with gene mutations known as BRCA 1 or 2 are not.

Brachytherapy for breast cancer offers important advantages, but it’s still new enough that conclusive research on its effectiveness is not yet available. Some studies suggest that women who receive brachytherapy are more likely than those who get traditional, whole-breast radiation to have complications after treatment, and even to have their cancer recur in the same breast. To be safe, doctors may not recommend breast brachytherapy for women who don’t fit all the guidelines for this treatment.

You can find out more about brachytherapy and other breast cancer treatments by visiting the American Cancer Society at cancer.org.


Shawn Lake and Dr. Michelle Proper write for Community Medical Center.