Promising breast-saving treatment

Many women with breast cancer have all of their breast removed unnecessarily, according to Dr Robert Kuske from Arizona Oncology Services in the US.

He says women are put off less radical breast-conserving surgery by the long and extensive radiation courses that are also required. According to Dr Kuske, a radiation technique called brachytherapy would eliminate these barriers. He spoke at a meeting of the Radiological Society of North America. Mastectomy involves removing the whole breast that contains the cancer. In breast conserving surgery, also known as lumpectomy, the cancerous tissue and some of the surrounding tissue is removed, leaving the rest of the breast intact. Several courses of radiation therapy, spread over weeks, are then given to kill any remaining cancer in the hope that it will not return. According to Dr Kuske, 80% of women with breast cancer would be candidates for breast conserving surgery. Previous research, involving 4,700 women with early breast cancer in 37 countries, found Britain has one of the lowest mastectomy rates. Overall, just over half the patients underwent a mastectomy, while the rest had some form of breast conserving surgery, the specialists from the University of Gdansk found. But Dr Kuske says too many women are having mastectomies. “I believe women choose mastectomy because of the inconvenience of six to seven weeks of conventional radiotherapy and the fear of irradiation to uninvolved breast, skin, ribs, lung and the heart,” he said. Choices Dr Kuske has looked at alternative options. He led trials investigating a radiation technique called brachytherapy. This involves placing a tiny radioactive seed inside the breast next to the tissue harbouring the cancer. In this way, the radiation is confined to the 1-2 centimetres of breast tissue. The rest of the breast and the surrounding organs are spared. The technique takes only four to five days, compared with the six to seven weeks that conventional radiation treatment is spread over, he said. In trials, the technique was well tolerated and breast cancer recurrence rates were low – only 3-4%. Dr Michelle Barclay from Breakthrough Breast Cancer says: “We very much welcome any developments that increase the options available for women diagnosed with breast cancer. “However, the decision to have a lumpectomy or mastectomy for any women is very difficult, and where this choice is available it has to be an informed one. “We know that some women choose a mastectomy so they feel they’ve done everything possible to reduce the risk of recurrence. “This is a significant part of the decision-making process, which should not be ignored.”(Source: Arizona Oncology Services, U.S.A, BBC News: July 2004)