Study suggests some breast cancer patients facing radiation after a mastectomy may be over-treated

September 22, 2008

BOSTON -- A new study suggests standard radiation therapy for some breast cancer patients may not be medically required and may, therefore, be causing unnecessary serious side effects such as lymphedema and pulmonary problems. The research conducted at Fox Chase Cancer Center involved women who got a mastectomy, but whose lymph nodes were negative.

"When a woman has a tumor greater than 5 centimeters and negative lymph nodes, a mastectomy followed by radiation is recommended," said Penny Anderson, M.D., attending physician in the radiation oncology department at Fox Chase. "We typically irradiate the chest wall because it's been shown to improve survival. Out of an abundance of caution, many radiation oncologists also treat the surrounding lymph nodes, but there is little evidence that this improves outcome."

Irradiation of axillary (under arm) and supraclavicular (above the collarbone) lymph nodes can lead to lymphedema, a swelling of the extremities caused by fluid build up because the nodes which allow the fluids to drain have been damaged by radiation. There are also pulmonary radiation risks including pneumonitis, inflammation, scarring and fibrosis.

For the study, Anderson and her colleagues evaluated the need for irradiating these lymph nodes in women whose axillary nodal status following surgery was negative.

The study included 64 patients with node-negative breast cancer treated by mastectomy and radiation from 1985-2006. Fifty-three patients received radiation therapy to the chest wall only and 11 patients received radiation to the regional lymph nodes in addition to the chest wall. The median follow-up was 78 months. The results were presented at the 50th annual meeting of the American Society for Therapeutic and Radiology Oncology in Boston.

"We found an extremely low rate of recurrences in the lymph nodes among those who didn't have them irradiated," said Anderson.

In fact, Anderson added, of the 53 patients that received chest wall radiation but no radiation to the lymph nodes, only one developed a recurrence in an axillary lymph node. None of the patients who received chest wall and node radiation had a recurrence.

The 5-year overall survival rates for the two groups were 91 percent for group who received radiation to the chest wall and 100 percent for those who also received radiation to their lymph nodes. There was no statistically significant difference noted between the local, regional or distant recurrence rates between the two groups.

"Given these findings and the risks of lymphedema and pulmonary toxicity, avoiding irradiating the lymph nodes may be an acceptable approach in select patients," Anderson concludes.

Fox Chase Cancer Center

---

---

	Now What?: A Patient's Guide to Recovery after Mastectomy by Amy Curran Baker (Author), Linda Curran (Author), MaryBeth Curran Brown (Author) In 2008, Amy Curran Baker was diagnosed with invasive ductal carcinoma and opted for bilateral mastectomy with Direct to Implant Reconstruction. Within three weeks of being diagnosed she had a mastectomy and was on the road to recovery. But after the surgery she had a lot of questions, the same that most women will have. As an Occupational Therapist, she knew some of the answers from her own clinical training and experience. But many more came from speaking with other women who had undergone mastectomies, from researching message boards, and a little bit of luck. Now she and her co-authors have brought together the answers to the questions that women face in chapters that cover everything from how to prepare for going to the hospital to when you come home Amy and her co-authors...
	From Zero to Mastectomy: What I Learned and You Need to Know About Stage 0 Breast Cancer by Jackie Fox (Author) FROM ZERO TO MASTECTOMY: WHAT I LEARNED AND YOU NEED TO KNOW ABOUT STAGE 0 BREAST CANCER, chronicles Jackie Fox's journey through the unique challenges of stage 0 DCIS breast cancer. Although not life-threatening, DCIS can require the same treatment and cause the same stress as advanced cancers. When Fox's oncologist tried to reassure her by saying her DCIS was not "real cancer," she responded, "It's close enough! Someone sign me up for the fake mastectomy!" Fox describes her journey with humor, candor and compassion for women in this situation. A Q&A chapter with Fox's medical team addresses common questions. Library Journal named it one of the Best Consumer Health Books of 2010.
	Mama Said There'd Be Days Like This: A Twelve Step Guide to Surviving a Mastectomy by Karen Klein (Author) This book, written by a woman who has undergone breast cancer surgery, presents a series of guiding principles and excercises that can help those who are working to overcome the psychological effects of a mastectomy, as well as those who are just interested in understanding the types of issues and emotions involved.
	Why I Wore Lipstick: To My Mastectomy by Geralyn Lucas (Author) NOW A LIFETIME ORIGINAL MOVIE PREMIERING IN OCTOBER!Having recently graduated from Columbia Journalism School and landed her dream job at 20/20, the last thing 27-year-old Geralyn expects to hear is a breast cancer diagnosis. And there is one part of the diagnosis that no one will discuss with her: what it means to be a young girl with cancer in a beauty-obsessed culture. Trying to find herself, while losing her vibrancy and her looks, Geralyn embarks on a road to self-acceptance that will inspire all women. Although her book is explicitly about a period of time where she was driven by fear and uncertainty about the future, Geralyn managed a transformation that will encourage all women under siege to discover their own courage and beauty. The important and outrageous lessons of Why I...
	When Mommy Had A Mastectomy by Nancy Reuben Greenfield (Author), Ralph Butler (Illustrator) How does a mother tell a daughter she has breast cancer? How can a child understand what a mastectomy and reconstruction are all about? When Mommy Had a Mastectomy is a children's book that explains, in a simple and clear manner, why Mommy is sick and what she does after she feels better to return to normalcy. It tells the story of a mother and daughter discovering new ways to show they care despite the painful illness of breast cancer and subsequent breast reconstruction surgery. Pairing enchanting illustrations and an engaging story, When Mommy Had a Mastectomy is sure to be a treasured book that will help children and their parents through a difficult time and will provide a fond memory for families to reflect on and share after tragedy.
	After A Mastectomy - Choosing Which Clothes to Wear by Technical Writing and Technical Design Services A booklet to help mastectomy (breast removal) survivors figure out how to make daily clothing choices, based on illustrations of neckline and armhole styles. Also included are instructions to show how to make a bra pad to wear instead of a prosthesis, and how to add a bra liner pocket to a garment with a built in bra.
	After Mastectomy: Healing Physically and Emotionally by Rosalind Benedet NP (Author), Bob Hogenmiller (Illustrator) Who Is the Main Person on Your Medical Team Now?   It is you. Prior to leaving the hospital, you were at the center of a flurry of activity, surrounded by a busy health care team – physicians, surgeons, and nurses. The surgery is over now, and you’re home. It is quiet. Now, you become the most important member on your health care team.   Author Rosalind Benedet understands the concerns and questions you now have as you begin this phase of your recovery. An oncology nurse, she has worked with hundreds of women who have undergone mastectomies. In After Mastectomy, she gently guides you through recovery, both physically and emotionally. Among the many topics she covers:         •  Adjusting emotionally and overcoming depression       •  Choosing a...
	Mammograms, Mastectomies, and Mom's Apple Pie: My Recipe for Handling Breast Cancer and Returning to a Healthy Life by Vickie Jenkins An engaging and educational how-to book for breast cancer survival through first-hand stories, humorous observations, and hands-on health care tips and tools. Author Vickie Jenkins blends her talent as a writer and journalist, improv comedy performer, and cancer survivor to serve up her personal recipe for surviving a health crisis. ‘Mammograms, Mastectomies, and Mom’s Apple Pie’ fills you with inspiration and helpful information that’s easy to digest. About the Author Farm girl. Radio news reporter. Media coach. Improv comedy performer. Screenwriter. Murder-mystery novelist. Corporate communications executive. Poet. Vickie Jenkins has worn many career hats and now celebrates a totally different achievement—overcoming breast cancer to continue...
	Prophylactic Mastectomy: Insights from Women Who Chose to Reduce Their Risk by Andrea Patenaude (Author) Author Andrea Farkas Patenaude, a clinical psychologist at the Dana-Farber Cancer Institute, has spent much time talking with women who decided to have risk-reducing or prophylactic mastectomy rather than undergo a lifetime of repeated screenings—a strategy that can help to detect cancers early, but cannot prevent breast cancer. In Prophylactic Mastectomy: Insights from Women Who Chose to Reduce Their Risk, Patenaude shares many candid stories from these women and documents the risks and benefits of this decision. The potential emotional trauma and lifelong effects on self-concept, body image, and sexual function for those who choose the surgery are profound. While the risks involved are great, these interviews also demonstrate the relief many women find in making this powerful...
	The Breast Reconstruction Guidebook, Second Edition by Kathy Steligo (Author) The best-selling guide to mastectomy and reconstruction has been rewritten and updated. The 2nd edition of The Breast Reconstruction Guidebook retains all the comprehensive information, descriptions ad explanation of the original issue, along with new information about the lattest implant and flap reconstruction procedures, how to find a surgeon who specializes in these newer techniques and much more. No woman wants to lose her breasts. But having a mastectomy doesn't have to mean living without them. How do you find answers about mastectomy and reconstruction when you're still overwhelmed by your diagnosis and treatment? How real will your new breasts look and feel? What if you don't want implants? How painful is the process? Will your insurance cover all the costs? What is recovery...