Oncologists and researchers are discovering that when it comes to treating breast cancer, “doing less does more” for patients. Kill the cancer while improving cure rates and decreasing the chance of the cancer returning is the goal. If we can spare patients the damaging side effects of treatment caused by toxic chemotherapy, less-precise radiation therapy, unnecessary diagnostic radiology, and surgery, all the better! These are the four areas of “less-is-more” trends that we’re focusing on now at SCCA.
Spare the chemo but not the cancer: Thanks to genomic testing of breast tumors to determine their receptivity or resistance to treatment, up to 50 percent of women can forego traditional chemotherapy for a less toxic alternative called targeted drug therapy.
“Because chemotherapy is the most toxic of all the therapies, the fact that we can offer an effective alternative, hormonal therapy, is a very good thing for patients,” SCCA medical oncologist Julie Gralow, MD, says.
Spare the radiation treatment but not the cancer: Radiation oncologists at SCCA are working on two new methods for delivering less radiation to certain breast cancer patients, including one that may also spare the need for some women to undergo a mastectomy.
The first is “accelerated partial breast irradiation” where the “tumor bed” is treated with high doses of radiation twice a day for only five days. If it works, the result is less surgery and radiation for the patient while still killing the cancer.
GPS-like tracking system protects the heart during radiation therapy: To reduce radiation exposure to the heart during radiation therapy, breast cancer patients with tumors in the left breast can hold their breath, which moves the heart away from the chest wall, out of the radiation beam path. This method must be precise to ensure that the heart is maximally protected.
Spare the lymph nodes but not the cancer: Nearly all women diagnosed with breast cancer will require some kind of surgery to remove the tumor. How much surgery and what kind depends upon the type and extent of the cancer. Our surgeons offer a number of options for breast cancer patients including those that spare as much tissue as possible and maintain the shape and feel of the breast after a tumor has been removed. Removing fewer nodes means a significantly reduced risk of lymphedema, or swelling of the arm.
Spare the nipple but not the cancer: For women undergoing mastectomy with reconstruction, surgery to spare the nipple has increased in use. Previously used most often for women at high risk of breast cancer who chose to have one or both breasts removed as a preventive measure, some early-stage cancers whose tumors are located well away from the nipple also qualify for nipple-sparing surgery.
Spare the diagnostic radiation but not the cancer:“Image gently and image wisely are concepts born from the recognition that we want to focus on achieving the best patient outcomes while reducing any potential harm and keeping costs down,” says Constance Lehman, MD, PhD, director of radiology at SCCA and an international expert on the use of advanced imaging tools such as MRI and ultrasound.
Such advanced imaging tools show promise for identifying women diagnosed with noninvasive cancer, such as ductal carcinoma in situ (DCIS), who can be treated with more individualized therapies.