On May 7^th, I wrote about a study that stated that whole breast radiation following breast conserving surgery may be a better choice than brachytherapy. The study was published in the May 2 issue of the Journal of the American Medical Association. Since the study appeared, a few groups within the medical community, have challenged certain aspects of the study.

What follows is a report on the outcomes of a multi-site study, with a median follow-up of four years, on the uses of Strut-based breast brachytherapy, a 5-day radiation therapy, a form of accelerated partial breast irradiation (APBI), which follows lumpectomy surgery.

The study was presented at the European Society for Radiotherapy & Oncology (ESTRO) World Congress of Brachytherapy in Barcelona, May 10-12. The study documented that breast brachytherapy with a strut-based applicator is a well-tolerated and effective treatment for early-stage breast cancer.

The data from UC San Diego Moores Cancer Center and two other institutions encompasses the longest-term study to date on breast brachytherapy with a strut-based applicator.

“This longer term follow-up gives more weight to the evidence that strut-based brachytherapy is a valid option for women with early-stage breast cancer,” said Catheryn Yashar, lead author of the study and a radiation oncologist at UC San Diego Moores Cancer Center.

“It’s an approach women should consider,” Dr. Yashar said.  “Women lead busy lives and they want a radiation option that will control their cancer, spare their healthy tissue and fit into their schedule more easily than six weeks of whole-breast radiation therapy.”

Other sites participating in the study were Arizona Breast Cancer Specialists (Phoenix,Az.) and 21st Century Oncology (Fort Myers, Fla.)

The research is based on 50 patients treated at those three different institutions with APBI using the Strut-Adjusted Volume Implant (SAVI). Successful completion of treatment was achieved in all 50 cases with favorably low recurrence rates and minimal acute and late toxicities.

“It is significant that these findings encompass patients over a median follow-up of four years since treatment – meaning we now have longer term data with outstanding results that show the efficacy of this therapy,” said Constantine Mantz, M.D., a study co-author and a radiation oncologist and Chief Medical Officer of 21st Century Oncology, the largest radiation oncology provider in the U.S.  “One likely reason for these favorable findings is that this technology spares healthy tissues and directs the radiation more precisely to the immediate area that needs to be treated.”

There were no symptomatic cases of seroma, fat necrosis, or breast asymmetry from radiation treatment. Rates of other side effects including fibrosis, breast pain and hyperpigmentation were also reported to be acceptably low.

The cancer recurrence rate in the study was comparable to the recurrence rate reported in the literature for whole-breast irradiation, which takes six weeks and is the traditional form of radiotherapy for early-state breast cancer.

A second study presented at the Barcelona conference, on the dosimetry of a small strut-based APBI device (SAVI 6-1 Mini), showed that the device is an excellent solution for patients with smaller breasts. The finding helps confirm the applicator’s ability to make breast brachytherapy an option for more women.

The 38-month study of 72 patients, by Serban Morcovescu, MS, and physician colleagues at Texas Oncology and North Texas Hospital (Denton, Texas) showed that the breast brachytherapy device, which is the smallest of its kind, allowed for precise targeting of radiation.

Content Sources: Dowling & Dennis Public Relations Liz@DowlingDennis.net

Cianna Medical , Inc manufacturers of SAVI^® (strut adjusted volume implant)

I wish all the mothers and grandmothers, who are in treatment, a time out from all thoughts and activities related to your breast cancer. I wish you a day of fun and love with family and friends.

For all of of you mothers and grandmothers who have moved past treatment and are getting on with life, I hope your day is all the sweeter, knowing what a gift it is to be well enough to be here enjoying the love of your children.

To all the mothers and grandmothers who are now, or were caregivers to those of us with breast cancer…thank you for your love and  selfless sharing. None of us, who’ve had breast cancer, want to think about what we would have done, how we would have done without you.

To the sisters, cousins, nieces, and aunts who also mothered us during treatment…thanks for making us feel less alone with our fears.

To our dear friends who are mothers, and those who are not…thanks for mothering us during an incredibly difficult time of our lives. You made our time in treatment bearable with your calls, your visits, the hours of listening, the dinners, your company in treatment rooms, and at medical appointments, childcare and child comfort when we were to sick to do so, the errand running and most of all…your upbeat, positive attitudes.

To those women, on our treatment team, that treated us as individuals with feelings and fears that needed attention, not just women with breast cancers that required medical interventions…thank you!

As women, as caregivers, as survivors, as mothers, we all have so much to celebrate about ourselves today!

While the incidence of breast cancer is low in men, a recent national study shows their survival rates lags behind women.

Jon Greif, D.O. of Alta Bates Summit Medical Center in Oakland, Calif., reported on the new study at a press briefing in conjunction with the American Society of Breast Surgeons meeting in Phoenix. He and his colleagues found that while the five-year overall survival rates among women is 83%, it is 74% for men.

Briefing moderator, Deanna J. Attai, MD, of the Center for Breast Care in Burbank, Calif. said, “Even though we think of male breast cancer as a rare disease, we all see at least one or two cases a year in our practice.”

The study used the world’s largest breast cancer data bank, focusing on the 13,457 cases of male breast cancer diagnosed from 1998 through 2007. Findings showed that men with breast cancer were more likely to have disease characteristics associated with poorer outcomes, including:

• Older age at diagnosis (mean 63 versus 59 in women)

• Larger tumors

• Higher grade tumors

• Higher lymph node metastasis rates

•  Men were more likely than women to have hormone receptor-positive tumors (88% versus 78% estrogen receptor positive and 77% versus 67% progesterone receptor positive).

While men accounted for just 0.9% of breast cancer cases in the analysis of the National Cancer Data Base, Greif suggested more needs to be done for them.”If the example of female breast cancer is any indication, simply raising public awareness should boost early detection and thus drive down mortality from the disease in men,” he told reporters.

“Treating men according to standard guidelines for women and screening those with known breast cancer risk mutations or a history of breast cancer might also help,” he added.

For higher risk men, he recommended not only mammography and yearly clinical breast exam but also monthly breast self-exams after age 40. “He should periodically take a look at his breast, make sure he doesn’t see anything out of the ordinary — a lump, a distortion, a discharge, a crustiness, an ulceration, that sort of thing — and then he should just feel the area for lumps,” Greif said at the briefing. “There’s very little to the exam. It shouldn’t take more than a minute.”

Greif cautioned that large databases can unearth statistically significant findings that aren’t necessarily clinically significant and noted possible under reporting of treatment for male breast cancer.

Another limitation, according to Greif, was the older age of the men at diagnosis. Greif told reporters,”In the absence of disease-specific mortality data, we do not know whether the deaths were due to breast cancer or other conditions.”

Source reference: Greif J, et al “Gender differences in breast cancer: Analysis of 13,000 male breast cancers from the National Cancer Data Base” ASBrS 2012; Abstract 104.

Thirteen years ago, following a lumpectomy (surgical removal of that part of the breast containing a malignant tumor) brachytherapy was not an option for me. I received 36 treatments of external beam radiation.

Since then, brachytherapy has become an increasingly popular treatment choice  for women with early-stage breast cancer following  a lumpectomy. The treatment involves inserting a radioactive pellet near the lumpectomy site. The treatment can take as little as one or two weeks, a far cry from  my treatment with external beam radiation, which took six+ weeks.

In a current study published in the May 2 issue of the Journal of the American Medical Association, researchers looked at the rates of mastectomy (surgical removal of the  breast), survival and complications following brachytherapy and whole-breast radiation from national Medicare records of women aged 67 and older between 2003 and 2007.

The  study included nearly 93,000 women aged 67 and older. About 7,000 women received brachytherapy, while almost 86,000 had whole-breast radiation.

Researchers found that women receiving brachytherapy may go on to have higher rates of breast cancer recurrence and side effects such as breast pain and infection than women receiving whole-breast radiation.

Four percent of the women who received brachytherapy had a mastectomy within five years of their radiation treatment, compared with about 2 percent of the women in the whole-breast radiation group.

The rates of infection and other complications were about 28 percent among women who received brachytherapy, compared with 17 percent of women who received whole-breast radiation.

Researchers were quick to point out that although brachytherapy patients experienced more complications and had more mastectomies, indicating their breast cancer came back, there was no difference in survival rates between the two groups five years after treatment.

“There is nothing in our study saying that a woman should not choose brachytherapy if they want the convenience, but I think it is helpful for women to think about the trade-offs, such as higher rates of mastectomy, postoperative complications and infections,” said study author Dr. Benjamin Smith, a radiologist at University of Texas M.D. Anderson Cancer Center, in Houston.

Brachytherapy is appropriate for women aged 60 and older with small tumors that have not spread outside of the breast, along with other indicators of less-advanced breast cancer, according to a 2009 American Society for Radiation Oncology statement written by a group of doctors that included Smith.

“In younger women, breast cancer is generally thought to be more aggressive and data is lacking about the effectiveness of brachytherapy in this group,” Smith said. Dr Smith went on to say that his practice only offers brachytherapy to younger women as part of clinical trials.

While the current study looked at Medicare records of women who had already been treated, “The definitive trials, that follow women, comparing brachytherapy to whole-breast irradiation are still ongoing, but they are years away from giving definitive results,” Smith said.

SOURCE: Benjamin Smith, M.D., assistant professor, radiation oncology, University of Texas M.D. Anderson Cancer Center, Houston;  May 2, 2012, Journal of the American Medical Association

This month’s post in the”New Beginnings” series is from Linda Fisher, a breast cancer survivor who founded a business, Wings of Angels, inspired by her experiences during recovery.

When I was forty, I was told that I had breast cancer. That day – that moment – changed my life forever.

My thoughts were suddenly focused on so many questions.  How long do I have?  What about this, and what about that?  It was a long while before I was able to think about something other than cancer.

During that time, I crossed paths with a beautiful lady named Lisa.  She gave me the strength I needed to help me put my life back together. I remember asking her if my life would ever get back to a point where I can smile again…even laugh. Lisa had already gone through this ordeal herself, and she was happy to tell me that I would indeed enjoy life again, smile, laugh, and so much more! I remember how those words sounded and thinking “I HOPE she is right.”  Well, it is my pleasure to share with you that she was right.

If you or someone you know has been diagnosed with cancer, it does not mean life is over. It took me a while to figure it out, but eventually I realized that this was actually a strengthening experience for me.

Lisa gave me support and encouragement when I needed it most. Now I want to help others who face the challenges of breast cancer, other illnesses, recovery, even loss. That’s why I founded Wings of Angels – to provide support and comfort to individuals dealing with life’s most challenging times.

During my recovery time, I received many beautiful gifts and was very thankful for them. However  there were more items I needed to make me feel better. This is when the seed started that someday I would start a business that would help women get through their recovery time.  My purpose in starting the business..spare women  recovering from breast cancer surgery some of the discomforts that I went through.

In 2008, I took a business course, joined our local Lancaster Chamber of Commerce, and got a business coach. After my website was competed in 2009 I opened my business…my dream.

My business, Wings of Angels, is all about gift baskets filled with items carefully selected by me, items to soothe and comfort the healing body, mind and soul. My mission is to spare women some of the discomfort I went through when I came home from the hospital after my surgery.

I’ve been given the gift of life. When I send out a gift basket, I like to think I am passing a gift of comfort and hope along to a woman recovering from breast cancer surgery.

You can visit Wings of Angels at  www.recoverwithangels.com 

With a breast cancer diagnosis comes a whole range of feelings.

Some of these feelings are brand new.  Others are just old feelings, about self image and self worth, that tend to simmer on the back burner of our minds and now are front and center in our thoughts.

Whatever our feelings, we are not to judge ourselves harshly for having them. Feelings are feelings.

It is perfectly normal to have all kinds of feelings in the midst of active treatment for a potentially life-threatening illness. Here are some feelings common to many of us after a diagnosis of breast cancer:

• Fear-ongoing from time of diagnosis, through treatment and into survivorship including fear of: unknown, pain, disfigurement, loss of femininity, loss of hair, loss of attention from spouse or significant other and of being unable to take care of one’s, children, work and family responsibilities. All of us live with the fear of recurrence. Many fear the economic fallout of treatment costs and loss of time from work.
• Anger – At having breast cancer, changes in self image, changes in body image, self-confidence, time lost from work, personal and family activities missed due to treatment and side effects, having to learn to manage fears of recurrence, and the disappointment of some family and friends being emotionally unavailable.
• Mourning – The loss of a breast(s) hair, self image, body image, confidence, peace of mind.
• Confusion  – How to handle treatment, telling family and friends, especially children, as well as employers.
• Guilt – Is our  cancer because we smoked, drank, had a poor diet? If we have a genetic mutation, are we passing it on to our children? Is cancer is a punishment for something we did or didn’t do? Are we letting our spouse or family down, causing economic hardship. Are we a burden?
• Jealousy -Being jealous of the good health of others, their ability to enjoy life, their freedom from fear and pain and changes to their self-image.
• Impatience – having little tolerance for the concerns and worries of others that seem small and insignificant compared to what we are going through.

These feelings can be white-hot after initial diagnosis and during treatment. A loving network of support from family and friends goes a long way to ease the pain and discomfort of these feelings during that time.  Talk to a trusted friend, spouse or family member; a person who is not judgmental, a good listener.

With time, most of the feelings will subside. If feelings continue that interfere with moving on with life as a survivor, it is time to get help. Being a survivor is a whole new place, full of promise. We want to be free to enjoy it.

When you are going through treatment you need to take as many time outs from all things cancer as your schedule permits and you can physically handle. You will feel the better for it emotionally.

Even the smallest escapes help; sitting in a movie theater viewing an upbeat movie, or watching  a TV show without interruptions, or curling up with  a good book for a few hours.

On days that you feel up to it, get out and do something that you enjoy, something you did regularly before cancer treatment. If you feel your best when you get up in the morning, meet a friend for breakfast who is  fun to be with and positive, or grab your favorite beverage and just take a walk.

If you are getting daily radiation, do something pleasant either on your way to or back from treatment just to make it less of a cancer happening.  Stop  for a snack or sit in a park for several minutes and force yourself to empty your thoughts of cancer.

Each day of radiation, following my first breast cancer, I made it a habit to stop at a diner for breakfast before heading to work. The normalizing experience of eating out helped to interrupt the cancer-related feelings and fears, which were my daily fallout from treatment. It helped to get my head on straight for the work day.

Preparing for surgery for my second breast cancer and while in recovery, I came to rely on the time outs that car rides gave me. When friends and family asked what they could do, I’d answer with, “Let’s take a drive.” The destinations didn’t much matter and two hours was enough for me to get away from the cancer thoughts and refresh myself .

Walking through a park, by the water, or in a mall on a rainy day, with a caring person to talk to,  was what I needed to get things in perspective.

When treatment is over, a closure time out is what is needed.  It will mark the end of treatment and the beginning of life as a survivor. A closure time out will help cancer recede from the position of prominence it has held in your life from the time of diagnosis through the long months of treatment.

The best closure time out is a physical get-a-way. It doesn’t have to be expensive or far, or long; it just needs to be away. It needs to be free of all things cancer. It needs to be refreshing and distracting. It needs to be a place where it will sink in for you that treatment is over and when you go home it is a brand new, cancer-free time.

If you have children, ask friends or family to mind the kids for a few days while you and your husband  get away. If you can’t afford to go away, take a few day trips and come home each evening, just the two of you.

There is nothing easy about cancer treatments. Getting through them is about giving yourself, no matter how you feel, a time out from cancer.

Mammography screening, like all screening tests, carries the possibility of a false positive.

Mammography results may appear to be abnormal even though no cancer is present. Getting a false-positive result causes a great deal of anxiety. It is usually followed by more testing such as a biopsy, which can have risks. Follow up tests may be painful and prolong the anxiety during the weeks between the original false-positive diagnosis and the pathology report following a biopsy.

Most women are initially relieved to hear that a biopsy shows no cancer, than angry at having been put through the expense, pain and anxiety of additional tests. Some decide not to have future mammograms while others dismiss the false-positive as a fluke.

However, anyone with a previous false-positive might want to read an article in the May 2 issue of the Journal of the National Cancer Institute, which paints a different picture of the possible significance of false-positives.

The article states that a recent population study suggests that a false-positive finding on mammography points to a greater chance of breast cancer long-term, possibly because of underlying pathology or initial misclassification.

The study noted that the risk of breast cancer remained significantly elevated from 6 to more than 12 years after a false-positive test result.

The study examined outcomes for 58,003 women, ages 50 to 69, who participated in Copenhagen’s population-based mammography screening program from 1991 to 2005. At that time, false-positive test rates ranged from 5.6% to 1.4%.

My von Euler-Chelpin, PhD, of the University of Copenhagen, and colleagues reported that women with any type of false-positive test faced an adjusted 67% higher risk of breast cancer after a false-positive test than women who had only negative screens  They recommended encouraging women with false-positive tests to continue to receive regular screenings even though it could cause extra anxiety.

“Women with false-positive tests manifest suspicious mammographic patterns in their breast tissue, including tumor-like masses, suspicious microcalcifications, skin thickening or retraction, recently retracted nipples, distortions, asymmetric densities, or suspicious axillary lymph nodes,” von Euler-Chelpin and colleagues noted.

“Despite a thorough assessment to exclude malignancies at baseline, these suspicious patterns in breast tissue may eventually develop into detectable cancer.

Even with newer screening methods, women with false-positive tests should be encouraged to use regular mammographic screening because a false-positive test may indicate underlying pathology that could result in breast cancer.”

Sources: Journal of the National Cancer Institute, Von Euler-Chelpin M, et al “Risk of breast cancer after false-positive test results in screening mammography” J Natl Cancer Inst 2012; 104; DOI: 10.1093/jnci/djs176.

A new study of women having completed breast cancer treatment found that a significant number of the women experienced at least one treatment-related complication.

Such complications included, but were not limited to, skin reactions from radiation, weight gain, fatigue, surgery-related issues, upper body symptoms and physical limitations, and lymphedema, an incurable condition most often resulting in swelling of the arms and hands.

The study, conducted by researchers at the University of Pennsylvania, was published online April 6 in a special issue of the journal Cancer that focuses on the physical late effects of breast cancer treatment and ways to prevent, monitor and treat these conditions.

The study entailed researchers looking at the post-treatment situations of 287 Australians who received treatment for breast cancer. They found that more than 60 percent of this group had at least one treatment-related complication up to six years after their diagnosis, and 30 percent had at least two complications.

“Our work provides the first accounting of the true magnitude of the post-treatment problems suffered by breast cancer patients, and serves as a call to action for proper monitoring and rehabilitation services to care for them,” study leader Kathryn Schmitz, associate professor of biostatistics and epidemiology at the University of Pennsylvania, said in a university news release.

“We can no longer pretend that the side effects of breast cancer treatment end after patients finish active treatment. The scope of these complications is shocking and upsetting, but a ready solution for many of them already exists in rehabilitative exercise,” said Schmitz, who is a member of the university’s Abramson Cancer Center and serves as a senior scientist on a committee overseeing creation of a surveillance model for breast cancer survivors.

Dr, Schmitz and her colleagues shared that many factors can prevent proper monitoring of breast cancer survivors for the types of complications identified in the study. Patients may have fragmented care and receive different types of treatment at different hospitals; both patients and doctors may believe that certain complications are “expected” and “normal” and don’t warrant treatment; and many breast cancer patients aren’t aware of or referred to physical therapy professionals.

(SOURCE: University of Pennsylvania, news release, April 10, 2012)