Women's Imaging News

As of today, more available testing linked to breast cancer is enabling both better prevention and treatment plans. Various healthcare providers in Greeley offer the BRCA1/BRCA2 genetic testing and counseling in their offices. The Banner Women’s imaging department at North Colorado Medical Center at Summit View Medical Commons have also just incorporated a program to identify women at high risk at the time of their screening mammogram and provide the genetic testing and counseling services. Banner Medical Group diagnostic radiologist Dan Kreider, MD, mentioned that many women with a high-risk for breast cancer are unaware of the Hereditary Breast and Ovarian Cancer Syndrome (HBOC) and its repercussions. “The women getting a screening mammogram at the SVMC complete a questionnaire that details their personal and family health history. The radiologists follow the guidelines of the National Comprehensive Cancer Network (NCCN) to identify patients that should be tested for those genes. Patients have a 45 percent chance of getting breast cancer in their lifetime for the BRCA 1 gene mutation and as high as 65 percent to 87 percent risk for the BRCA2 gene mutation. The risk for ovarian cancer for these patients is about 44 percent. It’s critical to get these patients identified. If there is a strong enough family or personal history of breast or ovarian cancer, the genetic testing is recommended and performed.” said Kreider. Obtaining a sample, a saliva test, is easy to secure; however, the genetic evaluation of the sample can be costly. Most insurance companies will cover the cost for patients that meet the NCCN high-risk categories. “Once the BRCA gene is identified in a family, they know specifically which mutation to look for, and tests for the relatives of that first person are much less expensive,” said Kreider.Kreider notes that it is critical to remind people that only 10 percent of breast cancer is related to the breast cancer gene. Indeed, most breast cancer patients have no family history of breast cancer.“The number one risk factor for getting breast cancer is being a woman. But, for those patients with the breast cancer gene, the risk is very high. In addition, for those patients diagnosed with BRCA1 or 2, all of that patient’s siblings and children would have a 50 percent chance of having inherited the gene and need the genetic test, including the males.Testing the children of these patients can wait until around age 20,” he said. Kreider said many patients who do find out they have the breast cancer gene decide to have both breasts removed. Some women also choose to have their ovaries surgically removed once they’ve had children. The second option to surgery is having annual mammograms, breast MRIs, pelvic ultrasounds, and blood tests to aggressively seek out any hints of early cancer. “The main options are very close surveillance or surgery,” said ... Read more

MIT researchers have recently developed a ‘stealth’ drug delivery system designed to attack a kind of breast cancer that is highly resistant to existing therapies and treatments. Paula T. Hammond and peers at the Koch Institute of Integrative Cancer Research at MIT illustrate a way to slip small particles into tumor cells, lower their defenses and then proceed to attack them with drugs. Their work centers on triple-negative breast cancer (TNBC), an aggressive disease that is very hard to effectively treat with conventional therapy. Their "one-two punch" approach utilizes the "stealth" nanoparticles transporting the cancer drug doxorubicin, as well as short strands of RNA that can seal off one of the genes that cancer cells use to elude the drug. An outer layer shields the particle from deterioration in the bloodstream, which had been a key concern when developing such a strategy on previous attempts. The researchers note that the system was proven effective in mice and could be modified to treat other forms of cancer. It's the latest development in the strive toward personalized medicine, particularly in the treatment of cancer. Breast cancer, for example, is now believed to consist of at least 10 totally separate diseases, each with its own life expectancy and calling for its own specific treatment, BBC News explained in announcing a massive cancer database being established in England. In related news, researchers in Scotland have invented computer technology that classifies "smarter drugs" to treat diseases. The program decodes protein structures in cells and can rapidly tell how the proteins could be "shapeshifted" by ... Read more

Based on a study published online in the October issue of Radiology, analyzing breast density at CT of the chest could provide additional information on a patient's risk evaluation for breast cancer. Mary Salvatore, MD, of the Mount Sinai School of Medicine in New York City, and her peers conducted a pilot study comparing radiologists’ reading of breast density at chest CT with breast density readings from mammography done for the very same patient(s). A subgroup of these readings were then compared with computer-derived measurements of breast density at CT. The researchers chose two radiologists with impressive experience in analyzing, reading, and interpreting mammographic and CT findings to independently perform a retrospective review of mammograms and chest CT scans from 206 women aged 29 to 91. The radiologists were also asked to categorize each case into one of the four breast density types, as defined by the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology.   Computer-derived measurements were then used to identify the estimated breast region of interest (ROI). The computer-based breast density was based on the percentage of glandular tissue in the breast ROI and typified into one of the four CT density grades. Statistical analysis was completed to find an agreement between the breast density type on the basis of the mammogram and chest CT scan for each radiologist. Intrareader agreement was determined, as well as the percentage agreement between the computer-derived measurements and the consensus-read CT scans. Results eventually revealed that interreader agreement was higher for the CT density grades (0.79) than for the mammographic density types (0.62), which illustrates that the CT agreement was considerably more effective than the mammographic agreement. The intrareader consistency of breast density grades on CT images was 0.88. The computer-derived breast density measurements were in agreement with those of the radiologists in 90 percent of the cases. When the four cases were manually adjusted for complex anatomy, agreement was discovered and recorded for all cases. “CT breast density readings represent an opportunity to provide additional information about the risk of breast cancer that is readily available and currently not being used in a standardized manner,” wrote Salvatore and ... Read more

Women and physicians alike understand that standard mammogram screenings are the key to detecting and preventing breast cancer. Indeed, mammograms remain the staple for detecting early breast cancer. It is only when a patient or their doctor ... Read more

The month of October is known as Breast Cancer Awareness month. And while various people are sporting pink ribbons, it is important to note that 1 in 8 women will develop invasive breast cancer during her lifetime; of which 85 percent have no known family history of the disease. Therefore, retired special education teacher in Susquehanna Township, Kathie Thomas claims: if your breasts have dense tissue, you should know it. Thomas had been consistently getting annual mammograms with the results indicating no sign of cancer. However, it was not until she received results from a biopsy on scar tissue on her kidney did she learn that she had some form of female cancer. An MRI of her breast showed the source, lobular carcinoma and what was most surprising to her and her doctors was that the cancer was Stage IV and had metastasized to her bones.  “I had just had my mammogram four months before and nothing showed up. Apparently, I had breast cancer for several years,” said Thomas, whose mammogram results over the last three years told her otherwise. It wasn't until Thomas had an MRI and learned that dense breast tissue can disguise a growing cancer during a mammogram screening. This is due to dense breast tissue comprising of considerably more fibrous and glandular tissue than fat. On a mammogram the fibrous, glandular tissue appears white, as do cancer cells. Thus, tumors can remain concealed by the dense tissue. It also delineates why Thomas and thousands of other women with dense breasts are at a higher risk of contracting breast cancer and finally being diagnosed at later stages of the cancer. According to Dr. Thomas Kolb, who has been featured in the Wall Street Journal and is a New York radiologist who discovered in his research on breast cancer detection, “mammograms missed 60 percent of cancers in women with the densest breast tissue that were found on ultrasound.”  In response to the growing concern as to the accuracy of mammography for women with dense breast tissue, advocacy groups throughout the nation are campaigning for legislation that requires mammogram reports to inform women whether they have dense breast tissue (there are four levels). Four states have passed, “dense breast notification” laws (New York, Connecticut, Texas and Virginia) and at least twelve other states and Congress are considering similar legislation. Yet some physicians and radiologists are against the legislation believing that it will trigger an unnecessary anxiety in women and cause them to ask for further testing leading to more false-positives. Not to mention, insurance companies are wary of the cost of supplemental testing. For instance, according to the American College of Radiology, the national Medicare average recompensation for a film mammogram is $81, a breast ultrasound is $99 and MRI of both breasts is $716. However, Mayo Clinic preventive medicine specialist Dr. Deborah J. Rhodes argues otherwise, “Dense breasts is a greater risk factor [for breast cancer] than having a mother or sister with the disease. The vast majority of women are capable of hearing this information and not freaking out.”  While Thomas enthusiastically concurs, "When you get your blood work back, no one hides from you a high cholesterol level because they think you’ll panic into believing you’ll have a stroke or heart attack," she said. "It’s a finding that allows you to have an informed discussion with your doctor. So why shouldn’t I know my mammogram’s finding that I have dense breasts? Let me talk with my doctor about the risks and decide if I need an ultrasound." The state of Pennsylvania is now considering dense breast legislation. Senate Bill 358 requires reporting by radiologists of breast tissue density on mammograms. The bill has passed the Senate and is now awaiting approval by the House of Representatives. The Pennsylvania Breast Cancer Coalition is leading the campaign for the legislation in an attempt to give women like Thomas a choice they never had. “If only I had known that my dense breast tissue would prevent my mammograms from detecting breast cancer, I would have at least had a conversation with my doctor, and would have asked for an ultrasound to establish a baseline to compare to over the years,” she said. Instead, Thomas now looks to undergo various forms of treatment including radiation, medications, PET scans and the nerve-wracking news of blood work results to cope with what her doctors tell her is terminal. Yet Thomas remains focused on what is within her grasp of control. "No one thought people with an HIV/AIDS diagnosis would live long, but with advances in medicine they can now live a full life and that’s how I view my cancer. So far, I’m responding well to treatment.” And if her resolute spirit and faith remains in control, there's always a possibility her voice will still be around. However, it is best to listen to that voice ... Read more

Results of a randomized trial revealed that patients with early breast cancer had considerably less lymphedema if they were administered axillary radiotherapy in place of surgical lymph node dissection. The occurrence of clinically significant lymphedema ranged from 21% to 25% over a span of 5 years in patients who received surgical dissection of axillary lymph nodes as opposed to 10% to 15% among patients who underwent radiotherapy. Patients who had both lymph node dissection and radiotherapy had the highest occurences of lymphedema. A preliminary analysis of the data revealed that surgery and radiation therapy reached similar 5-year disease control, according to Mila Donker, MD, of Netherlands Cancer Institute in Amsterdam, and reported the findings at the European Cancer Congress. "Axillary lymph node dissection (ALND), compared to axillary radiotherapy (ART), is associated with a 2.5 times higher baseline surgical complication rate and a two times higher rate of lymphedema at 5 years. Axillary lymph node dissection plus axillary radiotherapy is associated with a lymphedema rate that is five times higher than axillary radiotherapy at 5 years. The type of axillary treatment is the strongest risk factor for both lymphedema and shoulder function,” said Donker “Sentinel lymph node biopsy has supplanted ALND as the preferred approach to management of patients who have early breast cancer and clinically negative axillary lymph nodes. For patients with positive sentinel lymph nodes, ALND and ART provide similar axillary disease control. ALND carries a well-recognized risk of side effects, including potentially severe lymphedema. In contrast, few studies have examined side effects associated with ART for patients with positive sentinel lymph nodes,” she added. The randomized AMAROS trial drew comparisons from ALND and sentinel lymph node biopsy (SNB) in patients with early breast cancer. Moreover, patients with positive sentinel nodes were randomized to surgical axillary dissection or radiotherapy. The trial involved 4,800 patients, 1,400 of whom had positive sentinel nodes. The trial displayed identical low rates of axillary reappearance with the two treatment methods. The 5-year disease-free and overall survival did not vastly differ between the two groups. The AMAROS results verified those from the ACOSOG Z0011 trial, which also revealed no major difference in recurrence rates with surgical dissection or radiation therapy to the axilla. Updated AMAROS results with follow-up passed 10 years showed 5-year axillary recurrence rates of 0.43% with surgical dissection and 1.19% with radiation therapy, Donker noted. She also assessed complication rates for patients who underwent upfront ALND as opposed to SNB.ALND was linked to notably higher rates of hemorrhage (3.1% versus 1.7%, ... Read more

BYU and Utah research teams are working in a joint to develop a new breast cancer screening technique that could lead to a significant reduction in false positives and potentially minimize or completely eliminate the need for invasive biopsies. Led by BYU electrical engineer Neal Bangerter and University of Utah collaborators Rock Hadley and Joshua Kaggie, the team has produced an MRI device that could improve both the process and accuracy of breast cancer screening by scanning for sodium levels in the breast. "The images we're obtaining show a substantial improvement over anything that we've seen using this particular MRI technique for breast cancer imaging," said Bangerter, who als serves as senior author on the study detailing the method in academic journal Magnetic Resonance in Medicine. In particular, the device is generating as much as five times more precise and accurate images than prior efforts with an up and coming approach called sodium MRI. As of today, there are two clinical imaging procedures mostly used for screening breast cancer: mammograms and proton MRI scans. X-ray mammography is the most widespread screening tool, but the procedure involves x-ray exposure and is normally disagreeable. Mammograms are relatively inexpensive, but they still lead to biopsies when a suspicious lump or lesion is detected. And due to their increased sensitivity, proton MRI scans are normally used to further examine suspicious areas found by mammograms. However, they can produce false positives leading to unnecessary invasive biopsies. Sodium MRI has the potential to improve evaluation of breast lesions because sodium concentrations are thought to increase in malignant tumors. Bangerter and his collegues believe that the addition of sodium MRI to a breast cancer screening exam could offer vital additional diagnostic information that will significantly reduce any false positives. The team has developed a new device used for sodium imaging that is acquiring up a level of detail and structure never seen before, or thought possibly to attain. "This development by Dr. Bangerter and his group represents a major advance in the field of multinuclear MRI of the breast," said Stanford Professor of Radiology Bruce Daniel. "He and his group have invented a way to dramatically boost the sodium signal from the breast, enabling much better, higher resolution sodium MR images to be obtained. This should open the door to new avenues of research into breast cancer." As of yet, this breakthrough advancement delivers high-quality images in only 20 minutes, greatly improving the odds that sodium MRI breast scans could be incorporated in regular clinical practice. The MRI’s team objective remains to produce and develop a device that possesses the ability of attaining both exceptional sodium and solid proton images without having to resort to the patient being screened to be repositioned for numerous scans. "This method is giving us new physiological information we can't see from other types of images. We believe this can aid in early breast cancer detection and characterization while also improving cancer treatment and monitoring,” Bangerter ... Read more

For the first time, researchers have approximated the daily dose of radiotherapy that could be expended in compensating for cancer cell growth that happens overnight and during weekends in patients with early breast cancer. In research presented to the 2013 European Cancer Congress (ECC2013), Professor John Yarnold said that, “until now, there has been contradictory evidence as to whether gaps between radiotherapy treatments, for instance overnight or at weekends, makes any difference to the overall effectiveness of radiotherapy on breast cancer, and, if it does make a difference, why that could be.” "Traditionally, breast cancer has not been regarded as a fast growing cancer, unlike some other cancer types, but our research now suggests that a significant part of the daily radiotherapy curative dose is 'used up' in compensating for tumor growth overnight and over weekends. We have estimated that the amount of radiotherapy dose that is used up in this way corresponds to approximately 0.60 Gray (Gy) [2] per day," added Yarnold who is also a Professor of Clinical Oncology at The Institute of Cancer Research, London, and Honorary Consultant at the Royal Marsden NHS Foundation Trust (London, UK). "This is the first numerical estimate to suggest that the duration of a course of radiotherapy has an effect on local cancer cure for patients with early breast cancer. The results of our analysis are hypothesis-generating; they offer an explanation as to why prolonged radiotherapy schedules may allow cancer cells to fight back, and suggest that breast cancer cell growth rates after surgery are higher than historically assumed. If confirmed, it means that current trends to deliver shorter radiotherapy schedules are likely to bear fruit in the future. However, I should emphasise that current schedules delivered over five weeks or more remain highly effective, and patients should follow recommendations from their specialists." Radiotherapy is typically administered as a succession of treatments over a number of weeks in order to eradicate any remaining cancer cells in the breast, chest wall or underarm area after surgery, and to lessen the risk of the cancer recurrence in the same breast, while, simultaneously reducing any collateral damage to healthy tissues. Yarnold and Ms Jo Haviland, who is a senior statistician at The Institute of Cancer Research (ICR) Clinical Trials and Statistics Unit (CTSU) predicated their research on the Standardization of Breast Radiotherapy (START) trials (START Pilot, START A and START B), which have been assessing the outcomes of administering shorter radiotherapy sessions following surgery for early breast cancer patients in the UK since 1986. The researchers collected and utilized data from 5,861 UK patients who were registered between 1986 and 2002 into the three START randomized clinical trials that compared different sessions for administering radiotherapy. The START Pilot and START A trials compared the international standard of giving a total of 50 Gy in 25 daily doses of 2.0 Gy over a five week period versus two other sessions of somewhat higher daily doses of 3.0-.3 Gy over the same time period. The START B trial compared the international standard (50 Gy in 25 daily doses of 2.0 Gy over five weeks) with a shorter schedule administering a total of 40 Gy in 15 daily doses of 2.67 Gy over three weeks. After a follow-up period of ten years, the three-week schedule was shown to be as effective as the five-week schedule at preventing the cancer from recurring in the same breast and has since been incorporated and used as the standard in the UK. In terms of safety, the three-week schedule was more advantageous on normal tissues, with fewer late side-effects. Utilizing the data gathered from these trials, the researchers then estimated the effect of overall radiotherapy treatment time on the risk of the cancer recurring, comparing the three-week schedule with the five-week schedules. They employed a statistical tool that took the total dose into consideration, the size of the daily dose, the length of time over which the radiotherapy was given, and factors known to be connected to the risk of the cancer recurring in the same breast. They discovered that around 0.60 Gy of the daily radiotherapy dose was being squandered during the five-week treatment schedules to compensate for cancer cells growing. "This suggests that a shorter one-week radiotherapy schedule, replacing the five to seven-week schedules that were more usual in the past, may be more effective against breast cancer recurrence and reduce the chances of side-effects on the surrounding normal tissues. In addition, shorter treatment schedules would be more convenient for patients, with benefits including fewer trips to the hospital, and also highly cost-effective for health services," said Yarnold. More work on the study in the near future will determine whether reducing the overall treatment time further is as safe and as effective as the current three-week schedule which has been standard practice in the UK since 2009, following publication of the five-year results from the START A and START B trials. "The UK FAST Forward phase III trial is an example of this research, comparing the current UK standard three-week schedule with two radiotherapy dose levels of a one-week schedule in women with early breast cancer. This trial is well on the way to recruiting 4000 women," Yarnold ... Read more

According to radiologist at SNMH Diagnostic Imaging Center, Dr. Michael Hallenbeck, annual screening mammograms are still the best early detection method for women in their 40s and beyond. “Annual mammograms can detect cancer early, when it is most treatable. In fact, mammograms show changes in the breast up to two years before a patient or physician can feel them,” said Hallenbeck who also noted that October is National Breast Cancer Awareness Month. While nurse navigator at the Sierra Nevada Women’s Imaging Center, Linda Aeschliman said “special funding is available through the Barbara Schmidt Millar Fund and the Susan G. Komen Fund for women who aren’t insured or can’t afford the screening.” Aeschliman also pointed out that health insurance coverage attained under the Affordable Care Act must, as of January 1, include well-women checkups and screening mammograms. “All new health insurance plans must cover preventive care and medical screenings, like mammograms and colonoscopies, as well as women’s services such as breast-feeding support, contraception and domestic violence screening. Health insurance companies cannot charge copayments, coinsurance or deductibles for such services,” explained Covered California, the nonprofit organization established to help guide individuals and businesses through the selection and enrollment process. The SNMH Women’s Imaging Center has also put together a series of Moonlight Mammogram events to encourage women to get their annual screenings. “Some women are anxious about getting a mammogram. We are happy to answer questions and provide information, which can go a long way to relieve that anxiety,” said Aeschliman. Aeschliman also mentioned the Moonlight Mammogram program is adding a little bit of fun to the process. “We stay open in the evening and have music, food, beverages, and offer chair massages to women getting their mammograms. Bring a friend or family member,” she said. Some women allude to a number of fears as excuses not to undergo a mammogram screening. “Our mammogram unit uses flexible compression to achieve the best and sharpest images, while applying the least amount of compression,” said Aeschliman. Hallenbeck recommended that women with sensitive breasts should schedule their appointment for when their breasts are least tender, so as to avoid any potential discomfort. “Some express fear of radiation exposure, but X-rays usually have no side effects in the typical diagnostic range for this exam. In fact, the benefit of an accurate diagnosis far outweighs this risk,” said Hallenbeck. Hallenbeck highly recommends women to begin conducting annual screening at the age of 40, or earlier if they find a lump in their breast. This same recommendation has also been made by the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging. Screenings are also vital to women whose family histories have included breast cancer. Breast cancer may also be caused by inherited gene mutations, which account for five to ten percent of all breast cancers,” said Hallenbeck. “While family history is an important factor the Imaging Center employs the broader risk assessment tool developed by the National Cancer Institute: age, age at start of menstruation, age at first live birth, number of first degree relatives with breast cancer (mother, sisters, daughters), number of previous breast biopsies, and at least one breast biopsy with atypical hyperplasia (accumulation of abnormal cells). Other risk factors include age at menopause, dense breast tissue on a mammogram, use of birth control pills or hormone replacement therapy, a high-fat diet, drinking alcohol, low physical activity, obesity and environmental exposures,” he added. Hallenbeck considers mammography to be the best available screening tool, but new technology continues to be developed that will further enhance the process of detecting breast cancer. “In the near future, SNMH will add Breast Tomosynthesis or 3D mammography, which will significantly increase the cancer detection rate in women with dense breast tissue.” In addition, the hospital will be adding Automated Whole Breast Ultrasound. “This is an extremely useful adjunct to screening mammography in patients with dense breasts and in women looking for a screening alternative to mammography,” he ... Read more

A new study shows that administering radiation therapy to the lymph nodes situated behind the breast bone and above the collar bone to patients with early breast cancer improves overall survival without the risk of increasing side effects. This new discovery puts an end to the uncertainty regarding whether the advantageous effect of radiation therapy in such patients was merely the result of irradiation of the breast area, or whether it treated in the lymph nodes as well. The study’s findings were presented at the 2013 European Cancer Congress (ECC2013). Radiation oncologist from the Institute Verbeeten, Tilburg, The Netherlands, and a member of the EORTC Radiation Oncology and Breast Cancer Groups, Dr Philip Poortmans, stated that the results from an international randomized trail, which included 4004 patients from 43 centers, were credible. "Our results make it clear that irradiating these lymph nodes give a better patient outcome than giving radiation therapy to the breast/thoracic wall alone. Not only have we shown that such treatment has a beneficial effect on locoregional disease control, but it also improves distant metastasis-free survival and overall survival," he said. Lymphatic drainage from breast cancer means that the cancer has a greater chance of spreading to other areas of the body, usually diverging into two paths; the first and most known is to the axilla (armpit), and these lymph nodes are typically treated by surgery and/or radiation therapy. The second pathway drains to the internal mammary (IM) lymph nodes behind the breast bone, and also to those just above the collar bone, the medial supraclavicular (MS) nodes. Therefore, due to the uncertainty surrounding the effects of treatment in this region, and growing concerns over the increased toxicity that might be caused by the irradiation of a larger area, many centers do not currently treat the IM-MS lymph nodes. Moreover, after a median follow-up of 10.9 years, the researchers discovered that patients in the IM-MS treatment group had better overall survival independent of the number of lymph nodes involved. A total of 382 patients in the IM-MS group died during that period, in comparison with 429 in the non IM-MS group, and there was no increase in non-breast cancer related mortality in the first group. As of today, there have been no serious complications related to the treatment. The researchers also trust that the beneficial effect of IM-MS radiation can be elucidated by the ability of the treatment to abolish microscopic tumor deposits in the lymph nodes. "With this treatment, we can stop the development of metastases at their source. Interestingly, this effect is irrespective of the stage of the tumour. We believe that this is likely to be related to the positive interaction of the IM-MS treatment with systemic treatment chemotherapy, hormonal therapy and targeted treatment,” said Poortmans. Patients who are already at a low risk of their cancer spreading anywhere beyond the breast receive less intensive systemic therapy in order to avoid any unnecessary side effects. In such circumstances, utilizing IM-MS radiation therapy can improve their outcome by abolishing any remaining tumor cells in the breast/thoracic wall. Patients with a higher risk of metastases, who receive systemic therapy, the outlook of a cure is also linked to the chance of leaving remaining tumor cells behind throughout the body. Therefore in such circumstances, the definitive outcome can be improved by using effective locoregional treatment to abolish disease at the site where it is most likely to be present. "The results of our trial, in which the patients received appropriate systemic treatments, contradict the existence of a 'competition' between locoregional and systemic treatments," said Poortmans. "Because there is an interaction between these treatments, in many patients their combination will result in an enhancement of the combined benefits; in other words, one plus one can equal more than two." As of now the researchers plan on following up on these patients in the long term, roughly over an average follow-up of 20 years, with the next analysis set at 15 years. "It is of the utmost importance that we record all possible events, including recurrence and toxicity, and such follow-up will also give us the opportunity to continue evaluating our patients in other areas, for example quality of life and wellbeing. But we believe that our trial has already given solid evidence of the benefits of radiation treatment of the IM-MS lymph nodes, and we hope that such treatment will become standard clinical practice for patients with early breast cancer,” said Poortmans. "In past studies, radiotherapy as an adjunct to surgery has shown important improvements in locoregional control as well as survival, and these further survival benefits without an increase in short and long-term toxicities are a valuable development. The results of this study will help us on the road to the development of yet more personalised treatments, in which we have to find the delicate balance between under-treatment resulting in an increased risk of disease recurrence, and over-treatment accompanied by unnecessary toxicity, in order to provide optimal care for breast cancer patients,” said President of ECCO, Professor Cornelis van de ... Read more

According to research presented at the American Society for Radiation Oncology's (ASTRO's) 55th Annual Meeting, early-stage breast cancer patients who undergo external beam therapy (XRT) are not at a greater risk for serious long-term side effects in the chest region, consisting of an increase in deaths via cardiac disease and secondary malignancies. The study made significant use of patient information from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. It examined women recognized as having primary Stage T1aN0 breast cancer (tumor of 5mm or less that has not yet spread to the lymph nodes), who underwent surgery, with or without post-operative radiation therapy, between 1990 and 1997. The analysis was performed in order to determine if XRT was connected with a rise in mortality due to breast cancer, secondary cancer in the chest region, or cardiac conditions for these patients; only patients with breast cancer (BC) identified as the first malignancy were included. The women had an average age of 55-59 and were split into two groups: 2,397 who were administered XRT following surgery, and 2,988 who were not administered XRT following surgery. Cause of death (COD) codes were employed to classify cardiac mortality, breast cancer mortality, and deaths from secondary chest cancers in order to evaluate overall survival (OS), breast cancer survival (BCS), second-tumor specific survival and cardiac-cause specific survival (CCS), and then draw a comparison between the XRT and non-XRT groups. The occurrence of mortality was compared between the XRT and non-XRT groups using the Chi-Square test; and, the relative risk (RR) and allied 95 percent confidence interval (CI) were determined. Kaplan-Meier survival analysis and log-rank test were performed to evaluate OS, BCS, second-tumor specific survival and CCS. At 10 years following treatment, OS rates were 91.6 percent for the XRT patients and 87 percent for the non-XRT group; BCS rates were 97 percent for the XRT patients and 95.7 percent for the non-XRT group; and CCS was 96.7 percent for the XRT patients and 92.7 percent for the non-XRT group. Analysis of the results further illustrates that, with an average follow-up of 14 years there was no statistically significant difference in deaths from succeeding non-breast cancers in the chest area, the greater part of which were lung cancers. The number of deaths from cardiac causes was not that much higher for those patients treated with XRT for left-sided breast cancer, as opposed to those with right-sided breast cancer among the patient sample and time period reviewed. In fact, more women from the non-XRT group died from all causes, including cardiac causes, pointing out that those patients had worse general health conditions than the women who received radiation therapy. "Breast conserving therapy, consisting of lumpectomy and XRT, has been an excellent approach to early breast cancer treatment, offering equivalent disease control and better cosmetic results compared to mastectomy as demonstrated by multiple randomized controlled trials in the past. Our study's results suggest that serious long-term side effects of radiation therapy, such as increase in deaths from cardiac disease and secondary malignancies, are rare. Radiation therapy is an integral part of early stage breast cancer treatment for those who choose to have a lumpectomy instead of a mastectomy, with its benefits likely far outweighing the potential risks in majority of the cases. The field of radiation oncology is rapidly changing, with new technology constantly being introduced that may reduce these risks further. Continued long term follow up and additional studies are needed to monitor for potential long term side effects,” said the study's presenting author and a second-year resident in radiation oncology at Weill Cornell Medical College in New York City, Jason Ye, ... Read more

As evidenced in the results of EORTC trial 10853 featured in the Journal of Clinical Oncology, breast conserving treatment merged with radiotherapy diminishes the risk of local recurrence in women with ductal carcinoma in situ (DCIS). The frequency of DCIS has been on a gradual rise over the past decades, and has been credited to increased detection through breast cancer screening using mammograms.In the EORTC study, adjuvant radiotherapy following local removal decreased the rate of both in site and invasive local recurrences by a factor of two and led to an overall lower risk of mastectomy. After the inclusion of radiotherapy alongside breast-conserving surgery for operable invasive breast cancer in the 1980's, numerous trials were conducted in order to examine and explore the addition of radiotherapy to local excision of DCIS. These trials revealed that radiotherapy diminished both the risk of DCIS and invasive local recurrences. As of now the long-term results of local recurrences and survival in women who undergo radiotherapy in accordance with breast conserving surgery for DCIS have been reviewed at an average follow-up of 15.8 years. "Survival after treatment for DCIS is excellent. Therefore, the question rises whether the current treatment for DCIS (local excision and adjuvant radiotherapy of the breast) is overtreatment. To answer this question, not only long-term data about local disease recurrences and prognosis are important, but also information about the prognosis and treatment in case of recurrence,” said Dr. Mila Donker of The Netherlands Cancer Institute, Amsterdam, and lead author of this paper. The EORTC trial 10853 was set-up and made possbile by the EORTC Breast Cancer Group and launched in 46 sites in 13 countries: The Netherlands, France, Italy, Belgium, United Kingdom, Portugal, Greece, Switzerland, Germany, South Africa, Austria, Israel, and Spain. It was a fully academic trial supported by EORTC Charitable Trust, Kankerbestrijding/KWF from The Netherlands. From 1986 and 1996, the phase III EORTC trial 10853 observed 1010 women with total local excision of DCIS to no further treatment (503 patients) or radiotherapy (507 patients). The risk of any local recurrence was discovered to be decreased by 48% (HR: 0.52, 95%CI 0.40-0.68, ... Read more