A month ago, after extensive diagnostic tests I had surgery to remove suspicious tissue in my breast. One out of three areas in my breast which were identified as having "atypical hyperplasia" came back malignant upon biopsy of the tissue. The cancerous growth was very small and "encapsulated" as described by my oncologist.
My doctor said that because the growth was very small (I believe he said 2mm) and encapsulated, he is not recommending radiation therapy. He also advised me that other doctors might recommend radiation but he does not under these circumstances. He will be following me closely of course and I am due to see him and have another mammo three months post-lumpectomy.
What is your take on when radiation is called for after removal of such a lesion? Where can I get more information about the results and statistical chances of recurrence of cancer with/without radiation?
I would like to get as much information as possible so that I can make a choice about future treatment.
Dear Ellen, The current standard of care is surgical removal of the tumor followed by radiation therapy to the remaining breast tissue. This significantly reduces the chances of additional cancer developing in the same breast.
The definitive study showing the benefits of radiation therapy after lumpectomy was published in the New England Journal of Medicine, November 30, 1995 (first author Bernard Fisher, M.D.). In the article, the authors reanalyze and give the results of patients comparing total mastectomy with lumpectomy with or without radiation in the treatment of breast cancer. The results showed no significant differences in overall survival, disease-free survival, or survival free of disease at different sites between those who had mastectomy, lumpectomy alone or by lumpectomy plus breast radiation. However, after 12 years of follow-up recurrence of tumor in the same breast was 35% in the group treated with lumpectomy alone and 10 percent in the group treated with lumpectomy and breast radiation, which is a statistically significant finding. Their conclusions were that lumpectomy followed by breast radiation is appropriate therapy for women with either negative or positive lymph nodes and breast tumors 4 cm or less in diameter. Based on the findings of this study (Protocol B-06) by the National Surgical Adjuvant Breast and Bowel Project (NSABP) lumpectomy followed by radiation has become the standard of care.
You might want to check out some of the work being done by Mel Silverstein at Norris Breast Center. His (and others) belief is that the single most important factor in reducing/eliminating ipsilateral recurrance is surgical margin width. Radiation therapy represents overtreatment for many women with DCIS in whom margin widths >1 mm have been achieved.
There are also those in the field who believe that the percieved benefit from irradiation is negated by an increase in occurence in the contralateral breast.
Many of the current treatments for "in situ" breast cancer are needlessly aggressive. Personally, I would be grateful for a Physician who wasn't afraid to take a conservative approach
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