February 1, 2008 Ralph Moss, PhD has written an extended article on radiation and all stages of breast cancer, entitled: "Radiation and the treatment of breast cancer - A Cancer Decisions Report". "Radiation has now become so much a part of breast cancer treatment that it is extremely unusual to see its usefulness or its contribution questioned. Yet it may surprise you to know that there are still many unanswered questions concerning what (if any) long term benefit patients can reasonably expect to gain from radiation therapy following surgery for breast cancer. Why is this? How much is really known about the use of radiation in the treatment of breast cancer? Is there really a survival advantage to be gained from receiving radiation following breast cancer surgery? What are the risks of radiation therapy, and are patients typically given information concerning those risks at the time treatment decisions are being made? How can there still be uncertainties surrounding a treatment that – after a quarter of a century – has become such a universal part of breast cancer therapy? In this report we shall take a close look at the scientific evidence that underpins the use of radiation in the treatment of local and regional (stages 0, I, II and operable stage IIIC) breast cancer, and shall discuss both the good and the harm that radiation can do". Ralph Moss, PhD. Ann's NOTES: I chose not to have radiation to treat an early stage breast cancer (in 1993) because I read the results of the 8-year follow up of the National Surgical Breast and Bowel Project Protocol B06 which directly compared mastectomy with lumpectomy with and without radiation. At that time, and ongoing, overall survival was the same in each arm - indicating that radiation did NOT impact overall survival. It is important to note that it definitely limits local recurrence 35% vs 10% without. Although I experienced five years of local recurrence culiminating in a mastectomy (after three lumpectomy - biopsy excisions), I believe I made the correct choice for me. I had a large breast and the area mapped out for radiation therapy was HUGE. Additionally the hospital I was being treated at had a 'new' machine and an 'old' machine. Patients received treatment from whichever one was available at the time of scheduled appointments. I was not comfortable with that concept either. Dr. Moss has brought together a large body of research and discusses the findings in a way that makes a complete picture of results. All too often we are bombarded with the results of the moment, with almost no regard to past studies, and sometimes little mention of the downside effects. 11/04 An advocate persuaded us that some institutions are using better equipment, more targeted radiation and thus reducing risk of vascular or cardiovascular events as a result of radiation therapy. Ask your institution what type of radiation they use. If you hear conformable or targeted, ask some more questions. And take a look at the article to be found below on breathing devices to protect the heart during radiation. It comes from Beaumont Hospital in Michigan. Friday May 19, 1999 Treatment with radiation can help prevent breast cancer from returning, but for older women and those who have a low risk of a relapse, the risks of radiation may outweigh its benefits in the long run, researchers report. Even though radiation can reduce the risk of dying from breast cancer, it may increase the risk of dying from other causes, particularly heart disease, results of a study suggest. Radiation has been shown to prevent breast cancer from returning in the short term, but the long-term benefits of the treatment have been less clear, according to a team of researchers led by Dr. Rory Collins, from the Clinical Trials Services Unit at Radcliffe Infirmary in Oxford, England. To see whether women who undergo radiation fare better decades after treatment, the researchers reviewed 40 studies that followed nearly 20,000 women. Overall, radiation prevented breast cancer from returning in about two thirds of the women, Collins told Reuters Health in an interview. When the results of all studies were combined, radiation did not improve the death rate from breast cancer during the first 2 years after treatment, but afterwards, women who underwent radiation were about 13% less likely to die from breast cancer each year than women who did not have the treatment. The findings are published in the May 20th issue of The Lancet. But the benefits of radiation came with a cost, the authors note. The death rate from causes other than breast cancer was actually higher in women who underwent radiation. Beginning 2 years after treatment, the annual rate of deaths not related to breast cancer was about 21% higher in women treated with radiation. According to Collins, most of this increased risk was heart-related, probably caused by radiation damage to the heart and arteries. Overall, the 20-year survival rate was about 1% higher in women treated with radiation, 37.1% versus 35.9%. In the interview, Collins said that the benefits and costs of radiation varied among different groups of women. Referring to women whose cancer has spread to the lymph nodes, he said, ''There's a modest benefit (of radiation) for younger women with node-positive disease under age 50.'' But for women whose cancer has not spread to the lymph nodes, whose risk of a relapse of breast cancer is low, the benefits of radiation are small, improving survival odds by less than 1%, according to Collins. For older women whose cancer has spread to the lymph nodes, making a decision about radiation is difficult, Collins said. He noted that older women already have a greater risk of heart disease, so radiation treatment may increase this risk even more, possibly outweighing any benefits of the treatment. In an accompanying editorial, Dr. John M. Kurtz from University Hospital in Geneva, Switzerland, states that the report may actually be ``good news'' for radiation therapy, since it shows that the treatment can prevent breast cancer from returning and reduce breast cancer deaths. As for the increased risk of heart-related deaths, Kurtz notes that newer radiation techniques that spare the heart and arteries as much as possible have not been shown to damage the heart. But in the interview, Collins said that most of the increased heart risk does not appear until 20 years or so after treatment, and the effects of heart-sparing radiation have not yet been followed for that long. SOURCE: The Lancet 2000;355:1739-1740, 1757-1770. Reported by Reuters Health |
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