From an interview with
Dr. Virginia Clyburn-Ipock
MRMC Radiation Oncology
Radiation therapy is treatment with high-energy rays (or particles) that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments. In this Q & A, McLeod Radiation Oncologist Dr. Virginia Clyburn-Ipock explains why radiation is effective at decreasing the risk of breast cancer recurrence.
Q: When a woman is diagnosed with breast cancer, how likely is it that she will need to receive radiation treatment?
A: After a woman receives a breast cancer diagnosis, the first decision she will have to make is whether she will undergo a lumpectomy, which removes the cancer while the woman’s breast remains intact. Her other option is a mastectomy, which is the removal of the entirety of the breast. If she chooses a lumpectomy, she will likely join the majority of patients who receive adjuvant radiation. There are a few exceptions, such as a woman who’s greater than 70 years old and has stage one ER-positive breast cancer.
Q: How is radiation therapy effective in the treatment of breast cancer?
A: First, women undergo surgery, and then if they have certain risk factors, they might require radiation in the post-mastectomy setting. But the majority of women will need radiation in the post-lumpectomy setting due to potential microscopic disease that still remains in the breast. Radiation is effective in decreasing the risk of local recurrence of breast cancer in the post-lumpectomy setting by 50 to 60%.
Q: What sorts of advancements have been made in radiation oncology that will benefit patients with breast cancer?
A: One of the biggest advances over the past five to 10 years would be that traditionally, women were treated with what we call conventionally fractionated radiation, which was a low dose of radiation every day, spanning five to six weeks. Now we’ve cut that down to three to four weeks by giving slightly greater doses per day. And we can achieve that because now we have greater imaging and better treatment planning techniques that allow us to deliver what’s called a very homogeneous dose. This is an even dose throughout the breast. We can also track the dosage to underlying structures such as the lung and the heart, and avoid these with greater accuracy than we previously did.
Q: What sort of teamwork has been put in place at McLeod Health to make sure that a patient receives the best treatment for breast cancer?
A: When someone is seeking the best care after their breast cancer diagnosis, it is of utmost importance that they are in a medical institution that takes a robust multidisciplinary approach to fighting cancer. And what that means is there is a team of physicians that come together to treat breast cancer, and they all collaborate to determine the best treatment option for each individual patient.
For example, when a woman has an abnormality on her mammogram, she will get called back in to have what’s called a diagnostic mammogram, which usually includes a mammogram and an ultrasound. It’s extremely important that the radiologist who looks at those images or performs the ultrasound is very familiar with breast cancer. Beyond that, there is a biopsy of the breast, which the pathologist has to interpret to determine if it is, indeed, a malignancy. After that, the patient goes to a surgeon who will discuss surgical options, including a lumpectomy versus a mastectomy. Additionally, a medical oncologist will determine if the patient needs chemotherapy or immunotherapy before or after surgery. And then a radiation oncologist also gets involved to determine if the patient needs radiation. So a robust multidisciplinary approach is integral to the process of treating breast cancer.
At McLeod, we have a dedicated breast cancer tumor board, which meets weekly at 7:30 on Wednesday mornings to discuss our patient cases. The physicians discuss treatment options and what the best course of action is for each patient, depending on the specifics of her breast cancer.
To learn more, speak with a radiation oncologist near you.