Around 25 years ago, virtually every woman diagnosed with breast cancer would have a mastectomy, even if the cancer was still very small. However, with advances in medical technology, it is now known that small cancers respond just as well, if not better, to breast cancer lumpectomy in Los Angeles and elsewhere, so long as it is followed by radiation treatment. In fact, the rates of the cancer returning are just as low as what they are with a mastectomy.
Traditionally, radiation means an external beam of radiation is sent to the whole breast for a six to seven week period, five days a week. If the cancer is larger, the radiation may also be sent to the axilla (armpit) and/or the chest wall, although only on the side where the cancer is situated. Sometimes, the nodes just above the collarbone, which are the supraclavicular lymph nodes, as well as on the nodes founder near the center of the chest under the breast bone, which are the internal mammary lymph nodes.
A new form of treatment is APBI, or Accelerated Partial Breast Irradiation. Through APBI, radiation is only delivered to the area where the lumpectomy was performed. This is due to the fact that, if a cancer comes back, it generally comes back at or near to the original cancer’s site. At present, APBI involves having five radiation treatment days. The lumpectomy site is fitted with a balloon under local anesthetic, and is pulled back out on the last day of radiation. Mammosite is the most popular form of APBI, which has currently been used in over 35,000 women in this country alone. To date, their four year follow-up results have been very good.
APBI is very convenient, but it isn’t right for everyone. As of 2010, guidelines have been developed to determine whether someone is a good candidate or not. The technique itself is also still being studied, which means that these guidelines could change again. At present, however, they state that:
- The patient should be at leas 50 years old.
- A single, unifocal cancer should be present.
- The size of the invasive cancer has to be below 2cm.
- The pure DCIS (dual carcinoma in situ) should be no larger than 3cm.
- The invasive cancer and DCIS should not be more than 3cm placed together.
- The tumor should not have affected the margins.
- Microscopic examination should not have shown an invasion of the lymphatic system.
- The cancer should not have spread to the lymph nodes.
- The woman should not be a BRCA 1/2 carrier, or have hereditary breast cancer.
These are just guidelines, however. It must be stressed that APBI is still very new, and its effectiveness requires further study. Furthermore, every patient is unique, and what works for one woman may not work for another. This is why you must be under constant consultation with medical experts who can make recommendations for you. While the choice is always yours, you do have to make an informed decision.