Building a Better Breast Cancer Treatment

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When Arlene Horwitz, 63, was diagnosed with breast cancer, she was determined to do whatever it took to defeat the disease. She endured a mastectomy, eight hours of surgery for breast reconstruction and months of chemotherapy. After all that, doctors felt one more treatment was required: radiation therapy. And that's when Horwitz almost lost her resolve. Not because it hurt. (It didn't.) And not because it was inconvenient. (It was; she had to show up at the radiation center every morning for six weeks.) The problem was emotional. "I could deal with everything else, but as crazy as it sounds, I was terrified of those invisible radioactive rays," she said. "They told me it was safe, but day after day, I just didn't know what was being done to me."

She's not alone in fearing radiation, and now some doctors are rethinking the whole business. An array of new approaches, from tiny implanted balloons to radioactive coils placed in the breast while a woman is still in surgery, may forever change the way women are treated for breast cancer. A small group of physicians think that for some patients it may be possible to confine radiation to a small area surrounding the tumor, eliminating the practice of blasting the entire breast. The new "mini" treatments may enable women to receive a full course of radiation — which currently takes six weeks or more — in just a few days or even one sitting. And they may enable more women to avoid a mastectomy.

At the moment, most breast cancer patients are given a choice of mastectomy — removal of the entire breast — often followed by chemotherapy, or lumpectomy — removal of the tumor and a small amount of surrounding tissue — usually followed by radiation treatments. The prospect of undergoing weeks of radiation, however, is so frightening that fully half of early stage breast cancer patients who could keep their breasts choose not to, largely because they fear getting zapped.

And radiation is not without side effects: it's exhausting and it can make the skin less pliant, rendering breast implants a near impossibility. Sometimes radiation causes the skin to take on a sunburn-like sheen. In rare instances, it can damage the lungs or heart. Physicians hope that carefully restricting radiation to a small area will eliminate many of these problems — including the fear factor.

One experimental technique, which takes place while the woman is still on the operating table, involves a tiny coil that's inserted into the cavity created by the removal of the tumor. In 25 minutes, the device emits all the radiation that's needed; then it's removed. So far, the coil has been tested on only 15 patients, who were treated about a year and a half ago. None of the 15 has seen their breast cancer return.

Another method, called MammoSite, does the job in five days. MammoSite delivers radioactive seeds to the tumor site through tiny balloons temporarily implanted after lumpectomy surgery. So far, a few dozen women have tried MammoSite, which may get FDA approval as early as this year. Trials on hundreds of women for several years are still needed to be certain that the new methods are as effective as conventional radiation.

Indeed, it will be years before these treatments are widely available. But even more important than the techniques themselves is the change in thinking they represent. Restricting radiation to a small part of the breast would have been unthinkable a decade ago. But now studies show that if the breast cancer recurs, nine out of 10 times it appears only at the site of the previous tumor. Moreover, the risk of cancer appearing elsewhere in the breast is about the same as the risk of occurrence in the other, healthy breast. "When you realize this, you realize that many women probably don't need drastic treatment." says Dr. Jayant Vaidya, a breast surgeon at the University College London in England who helped develop the radiation coil.

Truth is, a kinder, gentler approach to cancer is nothing new. Just ask the guys: prostate cancer patients have been treated with radioactive seeds and other local approaches for years. At last, it looks like equal treatment for women is making its way into the doctor's office.