Radiation Oncology in Breast Cancer Therapy

Courtesy photo Advocate Radiation Oncology
Dr. Garton reminds women and men to perform monthly breast self-exams.

Affecting one in eight women in the U.S., breast cancer is the second most diagnosed cancer and the second leading cause of cancer death, according to the American Cancer Society. Although more common in women, breast cancer can affect men as well. Breast cancer is typically treated by physicians in multiple specialties, including surgery and medical oncology. The latter includes chemotherapy and radiation oncology, which uses high-energy rays or particles to kill cancer cells. “Radiation therapy is often used as a primary treatment when the aim is to preserve the breast,” notes Graciela R. Garton, MD, FACRO, a board-certified radiation oncologist at Advocate Radiation Oncology. “Usually, that entails completing a resection (tissue removal) of the cancer followed by radiation therapy to the breast. “This combination has proven to provide the same local control and survival rate as the previously more often used mastectomy, which involves the removal of the entire breast.” When there are multiple tumors in the breast, or if the patient has small breasts that cannot be conserved, mastectomy is usually recommended. It is also recommended in young women who are positive for a BRCA gene mutation, which can lead to breast cancer. In those patients, doctors typically recommend prophylactic mastectomy of the uninvolved breast. Radiation therapy is also indicated in certain cases after a mastectomy, Dr. Garton notes. “In cases where the breast tumor is large, the margins of the tumor resection are involved or very close, or the tumors are growing through the skin, radiation therapy is generally recommended following surgery,” she details. “It is also recommended if the cancer has spread to the lymph nodes that drain the breast. “Regarding the timing of treatment after surgery, chemotherapy is typically given first followed by radiation therapy. If the patient presents with estrogen- or progesterone-positive breast cancer and requires hormone therapy, that therapy is usually given a week after completion of radiation therapy.”

New Technique

According to Dr. Garton, a significant advance in the field of radiation oncology is the ability to deliver radiation therapy to people with left-sided breast cancer and still protect the heart. This is accomplished by administering the treatment using the breath-hold technique. “Patients take a deep breath and hold it for 10 to 12 seconds, which fills the lungs with air and causes the chest wall to expand. As a result of this expansion, the breast moves away from the heart, which does not change during respiration,” Dr. Garton explains. “This allows us to provide the treatment with very minimal radiation to the heart.” The radiation oncologist reminds everyone to take steps to prevent breast cancer or detect it in its early, more treatable stages. “It is important for people — women and men — to perform careful breast self-exams at least once a month while taking a shower,” Dr. Garton asserts. “If they notice any changes in the way their breasts feel or look, they should consult their physicians. “Mammograms are recommended yearly for women ages 45 to 54. After age 55, women may start getting mammograms every two years. If something is felt on the self-exam but the mammogram is normal, we typically perform a breast ultrasound or MRI to look for tumors.”

Graciela R. Garton, MD, FACRO

Radiology

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