Breast Cancer

When you hear the words, "You have cancer", you are undoubtedly shell-shocked and the whole world spins out of control. We understand and that is why our compassionate doctors and staff, do everything they can to turn your treatment into an effective yet comfortable and nurturing experience.

 

At ICI, there is no "one-treatment-fits-all" approach to patient care. Dr. Beatriz Amendola and our radiation oncology staff will partner with you throughout your entire course of treatment.

 

We provide the best individualized cancer therapy using the latest treatment techniques. We work directly with your referring doctors and jointly guide you throughout your treatment course.

Prone Breast Radiation Therapy

Prone breast radiation therapy is a concept that has been recently perfected to treat breast cancer. Several new studies have shown that receiving radiation to the breast while lying in the prone, or face down position has many benefits for women.

 

This approach, while obtaining the same quality results as treatments in the traditional supine position, where women lay flat on their back for the radiation treatment, avoids radiation exposure to internal organs like the heart and lungs.

 

 

The heart is especially vulnerable to damage when the left breast is treated because of the location of the heart on the left side of the chest just beneath the breast. Consequently, the prone breast position is most often used when radiating left breast cancer, although it can be used for treatment in both left and right breast cancer patients.

 

Prone breast radiation is administered using a specially-designed table (for example the Qfix™ Prone Breast Access 360 system available at ICI) to help women lie more comfortably in the prone position. The other healthy breast is kept close to the body, isolating the area for treatment.

 

Prone-breast radiation therapy is effective in delivering a consistent and precise dose of radiation throughout the course of treatment. Before the development of the prone breast technique, women with larger breasts were placed on their backs in the traditional position to receive radiation. Gravity pulls the breasts close to the body, causing exposure to internal organs and also making treatment less consistent because larger breasts may lay flat differently with each radiation session. With the prone position, we can ensure radiation is distributed evenly, consistently and accurately during each treatment.

 

At ICI we are thrilled to be able to offer this advanced technique to our breast cancer patients.

 

Advantages of Prone Breast Radiation Therapy:

  • - Radiation dose is evenly distributed in the breast

  • - Protecting the heart and lungs from unwanted radiation

  • - Minimized skin irritation

- Optimal cosmetic results

Should you get prone breast radiation therapy?

Generally speaking, any woman regardless of age without a contraindication to lie prone can benefit from prone breast radiation therapy. All patients are fully evaluated and provided with all the options that give them the best chance of successfully fighting their cancer with minimal side effects. However, there are certain women who may prefer the supine, or conventional, treatment position. We are pleased to offer prone breast radiation therapy as another effective and innovative alternative option for breast cancer treatment.

Brachytherapy

An Alternative to Conventional Irradiation for Early Breast Cancer Accelerated Partial Breast Irradiation (APBI): 5-7 Days Treatment Course

Accelerated Partial Breast Irradiation (APBI) means that only part of the breast is treated and that a shorter course (usually 5 to 7 days) is used as opposed to conventional external radiation treatment which usually requires 5 to 6 weeks of daily radiation treatments. APBI is delivered using a variety of balloon catheters and / or other devices to deliver radiation to the area where it is needed most with minimal radiation exposure to the adjacent normal tissues reducing the potential for side effects.

 

Advantages of APBI Brachytherapy

Radiotherapy may also be delivered internally, inside the breast, with a technique known as brachytherapy, by which high-dose remotely controlled radiation is delivered over a short treatment course of 5 to 7 days in comparison with external beam radiation therapy usually administered over a period of 5 to 6 weeks.

Advantages of APBI Brachytherapy

Radiotherapy may also be delivered internally, inside the breast, with a technique known as brachytherapy, by which high-dose remotely controlled radiation is delivered over a short treatment course of 5 to 7 days in comparison with external beam radiation therapy usually administered over a period of 5 to 6 weeks.

 

The specific parameters of your disease will be the basis on which Dr. Amendola and her team will create your personalized therapy plan.

 

 

Brachytherapy treatment performed by Dr. Amendola and her team offers several advantages compared to external-beam radiation therapy:

 

  • - Radiation only targets the area surrounding the tumor bed (after removal of the tumor- by surgical lumpectomy) rather than the whole breast.

  • - Radiation is delivered in fewer treatments at larger doses, so the total number of treatments is usually completed in only 5-7 days.

  • - The fewer number of days required for treatment is especially helpful for patients who live far away from the radiation center or have a busy schedule.

  • - Elderly women are excellent candidates, because all patients are treated with a shorter course of radiation on an outpatient basis.

  • - The cosmetic results are excellent.

  • - Most women feel little or no discomfort during the treatment.

External-Beam Radiation Therapy

Conventional Irradiation for Early Breast Cancer 5-6 Weeks Treatment Course

 

When whole-breast external-beam radiation therapy (EBRT) is used following a lumpectomy, the radiation is usually delivered using a Linear Accelerator (LINAC) in a treatment period of 5-6 weeks.

 

Most breast cancers are treated surgically, with removal of all or a portion of the breast containing the cancerous lesion. For early-stage breast cancer, a lumpectomy followed by radiation is the current standard of treatment. A surgeon removes just the tumor and a small portion of normal tissue around the cancer, leaving the rest of the breast untouched. This is an accepted and appropriate local treatment option for selected patients with early-stage breast cancer instead of surgically removing the entire breast (mastectomy).

 

How We Treat Breast Cancer with Radiation: we don't forget the rest of your body - it is what sets ICI apart:

 

    - At ICI we use the latest version of the most advanced commercially available Linear Accelerator: The Varian EDGE™.

  • - We are the only center in South Florida using the Qfix™ Prone Breast Access 360 system, to treat breast cancer patients in the prone position. This is very advantageous to treat breast cancer, especially in the left breast to protect the heart from unnecessary radiation

  • - We also offer accelerated partial breast irradiation (APBI) as a shorter course of treatment using brachytherapy for selected patients with early breast cancer who do not want to have the usual 5 to 6 weeks of treatment with standard external beam radiation therapy (EBRT).

 

External Beam Radiation Therapy (EBRT)

If you have been diagnosed with breast cancer, choosing the right treatment option for you may be overwhelming. It is important to work with your doctor to discuss your treatment options, potential side effects, and the expected results of your treatment plan.

 

Conventional conservative treatment of breast cancer after lumpectomy is usually done with a Linear Accelerator (LINAC). This is called External Beam Radiation Therapy (EBRT). With this technique radiation is given from outside the body covering the affected breast while sparing the adjacent normal structures. These conventional treatments are given Monday through Friday over 5 to 6 weeks with each treatment session lasting between 10 to 20 minutes.

 

Image Guided Radiation Therapy (IGRT)

IGRT is a system that uses frequent imaging of the area being irradiated to make sure that the radiation is being precisely targeted to the treatment area. This is important because minimizes harm to healthy tissues.

 

What is breast cancer?

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is a complex disease, differing by individual, age group, stage and even the kinds of cells within the tumors themselves.

 

Does a family history of breast cancer put someone at a higher risk?

If you have a grandmother, mother or sister who has been diagnosed with breast cancer, this does put you in a higher risk group. This risk increases if the relative has been diagnosed before 50 years of age. Have a baseline mammogram at least five years before the age of breast cancer onset in any close relatives, or starting at age 35. See your physician at any sign of unusual symptoms.

 

Are there other risk factors for breast cancer?

There is a multitude of risk factors for breast cancer, including some which are potential modifiable such as:

  • - Obesity

  • - Physical inactivity

  • - Alcohol consumption

 

 

Other risk factors include: increased exposure to endogenous and exogenous hormones related to reproduction, such as from long menstrual history (early menarche and late menopause), nulliparity, having a first child after age 30 years, use of oral or injected contraceptives, or use of combined estrogen-progestin therapy during menopause; high breast density on mammography; personal history of ovarian cancer; and previous high-dose radiation of the chest for cancer treatment. Inherited mutations in the BRCA1 and BRCA2 breast cancer susceptibility genes, although affecting less than 1% of the population, account for 5%-10% of breast cancers in women, 5%-20% of breast cancers in men, and 15%-20% of familial breast cancers. In patients with BRCA1 and BRCA2 mutations, most breast cancer cases are diagnosed before 50 years of age. Other extremely rare hereditary syndromes associated with increased breast cancer risk include Li-Fraumeni syndrome, Cowden disease and Peutz-Jeghers syndrome.

 

How do I decide which treatment option is best for me?

Speak with your physician about treatment options. Although there are four standard scientifically proven ways to treat breast cancer (surgery, radiation therapy, hormonal therapy and chemotherapy), several treatments may be combined. Your physician can recommend specific treatments depending on the type and location of the cancer, the stage at which it was detected, and your age and general health.

 

What are the current screening recommendations?

Screening mammography is the only imaging modality that has been shown to reduce breast cancer mortality. Screening mammography is 77%-95% sensitive and 94%-97% specific in breast cancer detection. Although plain film and digital mammography have similar diagnostic accuracy overall, digital mammography is more sensitive in women younger than 50 years as well as premenopausal and postmenopausal women with increased breast density.

 

 

Most major medical and cancer organizations in the United States recommend starting screening mammography at 40 years of age for women with average breast cancer risk. However, the United States Preventive Services Task Force (USPSTF) recommends starting screening mammography at 50 years of age, and some major medical organizations, including the American Academy of Family Physicians, follow the USPSTF's recommendations. Mortality reduction from screening mammography in women aged 40-49 years has been demonstrated by mature follow-up of the randomized trials.

 

Are there any radiation side effects to the breast?

Radiation therapy to the breast/chest wall may cause:

  • - Dry Skin

  • - Skin redness, similar to sunburn

  • - Skin inflammation, sensitivity and/or warmth of the breast tissue

  • - Skin discoloration after treatment

 

Side effects of breast cancer may not be the same for each woman, or even for women having the same treatments. During the course of treatment our doctors and the therapy staff will monitor you during treatment. Patients receiving radiation to the breast/chest wall are encouraged to evaluate their skin regularly and limit exposure to the sun and chlorine to the area of treatment as these things can create a drying effect and intensify the skins reaction to radiation.