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How Many Radiation Treatments For Stage 1 Breast Cancer

Risk Of Heart Disease From Breast Cancer Radiation

Understanding Breast Cancer – Radiation Therapy

Although radiation exposure from breast cancer treatment is associated with a small risk of subsequent heart disease, the risk is lower than it was 20 years ago, according to the results of a study published in JAMA Internal Medicine.9

Radiation is used after surgery to kill any remaining cancer cells and this decreases the risk of local recurrence and improves survival. Like any treatment however, radiation carries risksâincluding an increased risk of heart disease when radiation is used on the left breast, which is closer to the heart.

Because long-term breast cancer survival rates have improved dramatically in recent decades, researchers continue to look for ways to minimize long-term treatment-related complications. Researchers conducted an analysis to evaluate the risk of developing heart disease as a result of radiation treatment to the left breastâand found that the risk varies depending on the underlying risk of heart disease.

They report that the average risk of developing heart disease as a result of radiation exposure for breast cancer treatment is less than one percent. The risk increases for woman who already have a high underlying risk of developing heart diseaseâin these cases, the risk may be as high as 1 in 30. In contrast, women who already have a very low underlying risk of heart disease may face odds as low as 1 in 3000, which is a tiny risk.

What Is Stage 0 Dcis

Stage 0 breast cancer, ductal carcinoma in situ is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if its left untreated or undetected, it can spread into the surrounding breast tissue.

What Should I Expect After Radiation Therapy For Breast Cancer

You may notice fatigue as well as skin changes while undergoing radiation therapy. Your skin may become irritated, tender and swollen . People with fair skin may develop a red sunburn appearance. People with dark skin may notice darkening of the skin. This condition can also cause dry, itchy, flaky skin. Your skin may peel as you get close to finishing treatments . This skin irritation is temporary. Your provider can prescribe creams or medications to ease discomfort, if needed.

Skin discoloration can persist after treatment ends. Some people with fair skin have a slight pink or tan appearance for several years. You may also see tiny blood vessels in the radiated area. These vessels look like thin red lines or threads. These are not cause for concern.

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Stage 0 Breast Cancer

What is Stage 0 breast cancer?

Stage 0 breast cancer is when the cells that line the milk ducts have become cancerous. This type of cancer is called ductal carcinoma in situ , or non-invasive or pre-invasive breast cancer.

At this stage, the cancer has not spread to surrounding tissues. And while its considered non-invasive, its important to remember that it can still become invasive and spread beyond the milk ducts if it isnt treated.

What are the treatment options for Stage 0 breast cancer?

  • Surgery Breast surgery is often the first step at Stage 0. Depending on the size of the tumor, how fast the cancer appears to be growing and your personal preferences, there are two types of surgical options:
  • Lumpectomy A lumpectomy is a targeted surgery that removes the lump or tumor in question, and a small amount of normal tissue around it. This is commonly referred to as breast conservation surgery . In the United States, most women with Stage 0 breast cancer undergo a lumpectomy followed by radiation therapy.
  • Mastectomy If the cancer has spread throughout the ducts and affects a large part of the breast, doctors may recommend a mastectomy. With this surgery, the entire breast is removed and possibly some lymph nodes as well.
  • Radiation If BCS is done, radiation is almost always recommended after surgery. The goal of radiation is to get rid of any cancer cells lingering in your breast and prevent them from coming back.
  • Complementary And Alternative Treatments

    Breast Cancer Stages

    Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.

    These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.

    Examples of alternative therapy include:

    • using massage to relax
    • using peppermint tea to reduce nausea
    • using cannabis to relieve pain

    While some alternative medicine treatments might help you feel more comfortable, its important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments youre interested in pursuing.

    Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.

    Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs , such as ibuprofen.

    For severe pain in a later stage, your doctor may recommend an opioid such as morphine, oxycodone, hydromorphone, or fentanyl. These opioids have the potential for addiction, so they are only recommended in certain cases.

    While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.

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    Is Radiation Necessary For All Patients With Node Negative Disease

    Researchers are evaluating whether eliminating radiation in several groups of women is ongoing but inconclusive at this time. For example doctors are trying to determine if women over 70 years who have hormone receptor-positive, HER2-positive disease or those with luminal A breast cancer can avoid radiation altogether.

    Internal Beam Radiation Or Brachytherapy

    Brachytherapy is a type of radiation therapy that generates radiation from within the body. In comparison with external beam radiation, which projects particles of radiation from outside the body, brachytherapy can deliver higher doses of radiation in a precise fashion, resulting in fewer side effects and shorter treatment times.

    The type of brachytherapy that doctors use depends on the location of the tumor, how much the cancer has spread, and the persons overall health.

    Intracavity brachytherapy

    The doctor will use a tube or cylinder to deliver a radioactive substance into the body and place it in the tumor.

    Interstitial brachytherapy

    The doctor will use a needle or catheter to place radioactive material within a cavity either a natural one or one that surgery has created. For breast cancer, they will place it in the breast.

    Brachytherapy can also involve either high-dose-rate or low-dose-rate treatments.

    High dose rate

    This type consists of multiple treatment sessions in which doctors place radioactive material in the body for about 1020 minutes before removing it.

    Low dose rate

    This type uses substances that release a constant, low dose of radiation over 17 days, during which time a person will likely stay in the hospital. Doctors will remove the radiation source after a designated amount of time.

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    How Radiation Is Used With Other Cancer Treatments

    For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

    When radiation is combined with surgery, it can be given:

    • Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
    • During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
    • After surgery to kill any cancer cells that remain.

    How Often Does Stage 1 Breast Cancer Come Back After Treatment

    Radiation Therapy for Breast Cancer

    If stage 1 cancer is treated comprehensively, it rarely comes back. A new, unrelated breast cancer is more likely to emerge after stage 1 breast cancer is treated than a recurrence. Your healthcare provider will recommend a surveillance schedule for you so that new breast cancer or a recurrence can be identified and treated as quickly as possible.

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    What Are The Different Kinds Of Radiation Therapy

    Most radiation therapy is administered by a radiation oncologist at a radiation center and usually begins three to four weeks after surgery. The radiation is used to destroy undetectable cancer cells and reduce the risk of cancer recurring in the affected breast.

    There are two main kinds of radiation therapy that may be considered, and some people have both.

    • External Beam Breast Cancer Radiation
    • Internal Breast Cancer Radiation

    Keep in mind that the course of treatment you decide is something you should discuss with your radiation oncologist in order to ensure that it is as effective as possible.

    The Stages Of Breast Cancer And Your Treatment Options

    Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.

    At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.

    Below we dive into the treatment options your care team might recommend at various breast cancer stages.

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    Enhancing Healthcare Team Outcomes

    Breast cancer still remains a common malignancy in females, and although there are reports that the incidence is declining in certain countries, prompt diagnosis and treatment are necessary to prevent morbidity and mortality. The management of breast cancer is by an interprofessional team that includes an oncologist, surgeon, radiation oncologist, a pathologist, and an oncologic nurse. With a higher emphasis on breast-conserving surgery followed by radiation, many studies report favorable results. Further, many techniques have been developed to deliver radiation to the breast and studies have shown that the risk of recurrence outside the excised lesion is similar whether the whole or partial breast is treated. The treatment of breast cancer continues to evolve, and there are now studies trying to determine the feasibility of delivering radiation intraoperatively. Because breast cancer is a heterogeneous disorder, the key is proper patient selection to achieve the highest cure rates with the least morbidity.

    Biologic And Targeted Therapies

    Radiation Therapy Breast Cancer Stage 1

    Patients with HER2 positive breast cancer are given HER2 targeted therapy in combination with a chemotherapy backbone. The availability of HER2 targeted agents has dramatically changed the prognosis of patients with HER2 positive breast cancers. Initial trials randomizing patients to chemotherapy alone or chemotherapy plus trastuzumab, a monoclonal antibody directed against the HER2 receptor, demonstrated nearly 50% reduction in rate of recurrence.â At present, patients with stage I HER2 positive breast cancer often receive a regimen of paclitaxel with trastuzumab . Until United States Food and Drug Administration approval of pertuzumab in 2013, patients with stage II-III HER2 positive breast cancer received regimens with trastuzumab added to AC-T or to docetaxel and carboplatin . Recent data have shown an improvement in pathologic complete response rate when pertuzumab, an HER2 dimerization inhibitor, is added to trastuzumab in the neoadjuvant setting. Administration of dual-HER2 agents in the neoadjuvant setting is now standard for patients with stage II-III HER2 positive breast cancer., The National Comprehensive Cancer Network has also endorsed the addition of HP to chemotherapy for patients with the same burden of disease in the adjuvant setting if these therapies were not received neoadjuvantly. Recently the APHINITY trial demonstrated a small but statistically significant benefit of adjuvant HP-based over H-based therapy for one year.

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    Patients Refusal Of Surgery Strongly Impairs Breast Cancer Survival

    This was a Swiss study by Verkooijen et al, published in 2005 in the Annals of Surgery that looked at 5339 patients under the age of 80 with non-metastatic breast cancer. It didnt examine CAM, just the decision to refuse breast cancer surgery. It compared patients who refused breast cancer with those that those that accepted surgery. Only 1.3% of women refused surgery. Of that group, 37 had no treatment, 25 had hormone-therapy only, and 8 had other types of treatments. So only a small percentage refused all treatment. In this study, the five-year survival of women that refused surgery was 72% versus 87% of women who had surgery. Adjusting for prognostic factors, the authors estimated that women that refused surgery had a 2.1-fold increased risk of death from breast cancer compared to conventional treatment. The survival curves make this clear:

    The bottom line in this paper was that a decision to forgo surgery for breast cancer is associated with dramatically worse outcomes and survival.

    What Are The Cosmetic Results Of Breast Conservation Therapy

    Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.

    Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.

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    Why And When People Start Radiation Therapy

    Radiation therapy is a flexible and safe treatment. Doctors may use it after surgery to remove cancerous tumors, as it can reduce the chances of a recurrence by destroying any remaining cancer cells.

    If an individual has metastatic breast cancer, which is when cancer has spread to other parts of the body, doctors may also opt to treat them with radiation therapy to ease their symptoms.

    What Is External Beam Radiation Therapy

    Radiation Therapy For Breast Cancer

    During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given five days a week, Monday through Friday, for a number of weeks. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.

    The radiation beam is usually generated by a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.

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    Late Effects Of Radiotherapy For Breast Cancer

    Radiotherapy to the breast may cause side effects that happen months or years after radiotherapy. They are called late effects.

    Newer ways of giving radiotherapy are helping reduce the risk of these late effects happening. If you are worried about late effects, talk to your cancer doctor or specialist nurse.

    The most common late effect is a change in how the breast looks and feels.

    Radiotherapy can damage small blood vessels in the skin. This can cause red, spidery marks to show.

    After radiotherapy, your breast may feel firmer and shrink slightly in size. If your breast is noticeably smaller, you can have surgery to reduce the size of your other breast.

    If you had breast reconstruction, using an implant before radiotherapy, you may need to have the implant replaced.

    It is rare for radiotherapy to cause heart or lung problems, or problems with the ribs in the treated area. This usually only happens if you had treatment to your left side.

    Tell your cancer doctor if you notice any problems with your breathing, or have any pain in the chest area.

    What Type Of Drug Treatment Might I Get

    Most women with breast cancer in stages I to III will get some kind of drug therapy as part of their treatment. This may include:

    • Chemotherapy
    • Hormone therapy
    • HER2 targeted drugs, such as trastuzumab and pertuzumab
    • Some combination of these

    The types of drugs that might work best depend on the tumors hormone receptor status, HER2 status, and other factors.

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    Determining The True Stage Of Breast Cancer

    All the diagnostic tests and scans up to this point have been critical for helping your doctors understand your disease. But the exact stage of cancer cant be determined until surgery happens which is sometimes referred to surgical staging or pathological staging.

    Breast surgery is usually the first step in Stages 0-2, and sometimes Stage 3 breast cancer. Surgery allows your surgeon to see whats happening inside your body. It also allows them to remove cancerous tissues which is an important step in preventing the cancer from spreading and determining next steps for your treatment.

    If surgery cant be done right away or at all, a clinical stage is given instead based on diagnostic imaging test results, biopsy pathology results, and a physical exam.

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