Breast Cancer affects over 200,000 women in the United States every year. It is the most common cancer in women. Detecting early stage breast cancer has improved over the last 30 years in the United States due to increased public awareness and significant improvements in mammography and screening technology.
Receiving a breast cancer diagnoses can be a difficult time. The amount of information and the decision making that follows can be very confusion. Our goal is to help make understanding your diagnosis and the treatment options our priority. Your team will usually consist of a surgeon, a medical oncologist, and a radiation oncologist. In certain cases, a plastic surgeon, genetic counsellor, social workers and psychologists may be part of your team as well. We work very closely together to make sure your treatment is as comprehensive as possible.
The goal of surgery is to eradicate any gross tumor (via imaging or palpable) in the breast. This can be accomplished by removing the entire breast with a procedure called a mastectomy or removing a smaller area where the tumor is alone with a procedure called a lumpectomy. Many women elect to proceed with a lumpectomy and have breast conserving surgery. Your surgeon will usually remove 1-2 lymph nodes in the armpit area to see if the breast cancer has spread.
Your medical oncologist will be responsible for treating the rest of your body to eliminate cancer cells that may have spread but cannot be seen by physical examination of advanced imaging. This is called systemic treatment and it may be in the form of chemotherapy, targeted therapy or anti-hormonal therapy.
Your radiation oncologist is responsible for treating any microscopic cells that may remain in the breast or lymph nodes after your surgery. When you have a lumpectomy, the remaining breast is treated to reduce the risk of cancer coming back in the breast. After a mastectomy, radiation is not always needed. If there are involved lymph nodes or tumor cells in the area where the surgeon removed the breast (positive margin) or if the tumor in the breast is larger, the chest wall or reconstructed breast may need radiation therapy to reduce the risk of recurrence. Several radiation methods are used to treat breast cancer.
Whole Breast Radiation (WBI)
After a lumpectomy, your doctor will recommend delivering radiation to the whole breast and the area where you had surgery. This is known as whole breast irradiation. It is still consider the standard of care for the majority of women undergoing lumpectomy for breast cancer. Traditionally, a small dose of radiation is delivered to the whole breast 5 days a week for 6-7 weeks. This is known as conventionally fractionated whole breast irradiation. You are typically positioned on your back, and the radiation treatments are delivered with tangential beams. In the last 15 years, data has emerged that certain women can be treated in 3-4 weeks with slightly higher daily radiation doses. This shortened treatment is known as Hypofractionated whole breast irradiation.
Doctors at Precision Radiation Oncology use modern techniques such as prone breast treatments where you are place on your belly, image guidance, and breath-hold techniques to maximize radiation treatments and reduce side effects.
Partial Breast Radiation
Partial breast irradiation known as PBI or APBI is a breast cancer treatment technique that delivers radiation only to the region around where the breast tumor was removed. This allows the treatment to be delivered in 5 days over 10 treatments compared to 33. The evidence regarding PBI is still emerging but current data shows that outcomes are equivalent to WBI after 5 years. PBI can be delivered with several techniques including balloons placed inside the breast or other devices. At Precision Radiation Oncology we offer the most cutting-edge PBI treatments using CyberKnife. This technique is called stereotactic accelerated partial breast irradiation. Using the unique tracking features in the CyberKnife, we deliver an equivalent amount of radiation to 33 days of radiation in 5 single treatments. One of our physicians is a pioneer of this technique and is one of the most experienced radiation oncologists in this area. He is currently the principal investigator of a multi-institutional study on CyberKnife partial breast irradiation and Precision Radiation Oncology physicians @ Philadelphia CyberKnife are the only practice in Philadelphia area participating in this study.
For many women who undergo mastectomy for cancer treatment, radiation therapy may not be required. In some cases, radiation therapy is recommended to reduce the chances of cancer recurrence in the chest wall and regional lymph nodes.
Treatment is similar to WBI but is directed at the skin, chest wall and lymph nodes around the armpit and collar bone over 6-7 weeks.