"My sister, diagnosed with early stage breast cancer, has chosen to have a lumpectomy followed by radiation. Can you explain the pros and cons of lumpectomy?"
Bridgeport Hospital–affiliated physicians Mary Pronovost, MD, breast surgeon and Medical Director of the Norma F. Pfriem Breast Care Center; and Susan Dunbar, MD, radiation oncologist, respond:
Dr. Pronovost: There are many issues to consider when deciding what types of surgery and radiation are best. A woman diagnosed with breast cancer should discuss her options with her physicians. However, here are some issues to consider regarding lumpectomy:
Lumpectomy (removal of the cancer, as opposed to mastectomy—removal of the whole breast) can generally be done as an outpatient procedure with local anesthesia; and it allows the woman to keep most of her breast. However, lumpectomy usually requires follow-up radiation treatments.
Dr. Dunbar: For women diagnosed with early stage breast cancer, a lumpectomy followed by radiation has been proven to be equal, in terms of survival, to a mastectomy. The standard of care is a seven-week course of daily radiation therapy after the lumpectomy site has healed.
Modern radiation therapy equipment is extremely sophisticated. Each patient receives treatment based on an individual plan mapped out by a computer. This allows us to deliver the dose precisely to the target tissues while largely avoiding nearby normal tissue. The point is to sterilize scattered tumor cells that remain after surgery so that they are unable to grow and reproduce, which is what a tumor cell is most interested in doing.
Radiation therapy to the breast is quite well tolerated. Side effects may include skin irritation and redness, and for some patients, moderate fatigue.
Some women with early stage breast cancer may be candidates for a new type of radiation therapy called partial breast irradiation. This involves treatment of the tumor bed only. Patients are treated twice a day for five days, which is very attractive to patients who have a hard time committing to the standard seven-week course of treatment. The National Surgical Adjuvant Breast and Bowel Project, an international study group, has opened a new protocol: the NSABP–39 trial. This study will randomize women to either the seven-week standard of care course, or partial breast irradiation over a five-day period. Bridgeport Hospital is participating in this study under the sponsorship of Bridgeport Hospital's Norma F. Pfriem Breast Care Center. Participants will be followed throughout their lives — and the results will be compared. Within ten years, researchers expect to know whether the five-day course is equivalent to the seven-week standard of care.
Dr. Pronovost: Not all patients are candidates for this trial, but those who are interested in taking part should call me at the Norma F. Pfriem Breast Care Center (toll free, 1-877-692-HOPE), to find out if they qualify.