Henry M. Kuerer, MD, PhD, professor and director breast surgical oncology training program, The University of Texas M.D. Anderson Cancer Center, Houston.
Many women with breast cancer want to do anything and everything to fight the disease as aggressively as possible — in fact, as I reported last year (Daily Health News, “Cutting Away Breast Cancer Concerns,” October 19, 2009), more and more are choosing preventive mastectomies even when their cancer is the noninvasive kind that hasn’t spread. But sometimes less treatment may be the healthiest decision — for instance, new research pinpoints a group of women who will do just fine and, in fact, far betterwithout adding radiation to their breast cancer treatment program.
The latest research, from The University of Texas M.D. Anderson Cancer Center, shows that most early-stage breast cancer patients do notneed radiation after their mastectomies because there is such a low risk for recurrence. But because what one woman sees as “low risk” can seem “too risky” to another, I contacted Henry Kuerer, MD, PhD, professor and training program director in M.D. Anderson’s department of surgical oncology and senior author of the study, to get some perspective.
Researchers reviewed the records of more than 1,000 women (average age 54) whose stage I or II breast cancer had spread to three or fewer lymph nodes. Each woman had had a mastectomy, 77% had also received postoperative chemotherapy and/or hormone therapy, and none had received postoperative radiation. After an average follow-up time of seven-and-a-half years, this group’s rate of recurrence was quite low — just 2.3%.
“Radiation therapy has so many risks — we have to decide if it’s really a benefit when we consider that the risk for recurrence is so low,” Dr. Kuerer told me. The risks of radiation therapy include injury to the cardiopulmonary vessels, the neurological system, the skin and the musculoskeletal system, plus a higher risk for lung cancer, esophageal cancer and leukemia. Meanwhile, he said, surgery and chemotherapy for early-stage breast cancer are better and more effective than they used to be, so there’s less need to add radiation to the mix.
Of course, some women really do need radiation treatment for their breast cancer. According to Dr. Kuerer, radiation is advised — and very effective in decreasing the risk for recurrence — for many breast cancer patients with advanced disease (stage III and IV), because their risk is far higher, between 10% and 15%. Radiation should also be strongly considered for women with tumors of more than 5 centimeters… more than four positive lymph nodes… positive margins (indicating that cancer cells have spread to the edge of the biopsied tissue) … and/or extra-capsular extension (a tumor growing from the lymph node into the underarm). Also, it should be considered for breast cancer patients under age 40 (who typically have an aggressive form of the disease), for patients with metastatic breast cancer and for those whose cancers are at borderline stages, such as between stage II and stage III.
Dr. Kuerer advises asking your doctor to assess your risk of recurrence, adding that it’s important to make sure he/she is using currentdata. Also, he suggests seeking another doctor’s opinion if you feel uncertain. “You need to feel comfortable with your team of doctors and confident that they understand the true risks and benefits of radiation therapy for you.” In the end, there’s no single “right” answer — just what’s right for you.