More breast cancer patients should get radiation, new guidelines say

September 21, 2016 by Kathleen Doheny, Healthday Reporter

(HealthDay)—New guidelines issued by three leading cancer organizations suggest that more breast cancer patients should get radiation therapy after a mastectomy.

Overall, the guidelines say there's enough evidence to show after a mastectomy decreases the risk of recurrence, and that even women with smaller tumors and three or fewer involved can benefit from the therapy.

"The new guidelines say there is clear evidence that the benefit of [post-mastectomy radiation therapy] extends to women with limited lymph node involvement," said Dr. Stephen Edge. He is vice president for health care outcomes and policy at Roswell Park Cancer Institute in Buffalo, N.Y. Edge was co-chair of the panel that developed the new guidelines.

One radiation treatment expert welcomed the updated recommendations.

"The guideline is timely," said Dr. Janna Andrews, an attending physician in radiation medicine at Norwell Health Cancer Institute, in Lake Success, N.Y. "The field of post-mastectomy radiation is changing. It's always up for discussion now as to who needs [post-mastectomy radiation therapy]."

The new guidelines help clarify what used to be a gray area, Andrews explained. "In the past, if a woman had a small tumor, less than 5 centimeters, and not more than three or four positive lymph nodes, many doctors would say she does not need [post-mastectomy radiation therapy]," she said.

The guidelines don't offer a single formula for which patients need radiation therapy, Edge noted. But they do focus on the group of women for whom there is the most debate about the value of radiation.

"There is a great deal of controversy about whether women with one, two or three lymph nodes [with cancer] have sufficient risk to warrant radiation," he said. "For women with four or more lymph nodes involved, everyone would recommend radiation."

The guidelines also strongly support input from all specialists who treat breast cancer in making the decision about radiation treatment. That typically includes the surgeon, radiation physician and an oncologist.

Doctors need to weigh the risks and benefits, Edge added. Side effects can include redness of the skin, swelling and skin breakdown severe enough to compromise future breast reconstruction, he explained.

Edge said that doctors need to consider patients individually. For instance, he explained, ''a woman 65 who has microscopic involvement in a single lymph node and an estrogen-receptor positive cancer would be very different from a 38-year-old who has three lymph nodes involved and so-called triple-negative breast cancer." The younger woman, he said, would typically be advised to get radiation.

The older woman, because her risk is lower, should have a discussion with her doctor to decide if the benefit outweighs the risk, Edge noted.

Andrews said that one take-home message for patients is to expect the surgeon to have consulted with the radiation oncologist and others on her team. If a woman's doctor tells her she does not need radiation after a mastectomy, the woman should be told why and she should ask if the weighed in on the decision.

Edge was a panel representative from the American Society of Clinical Oncology, which created the guidelines along with the American Society for Radiation Oncology and the Society of Surgical Oncology.

All three groups published the guidelines online this week in their respective journals: the Journal of Clinical Oncology, Practical Radiation Oncology and the Annals of Surgical Oncology.

Explore further: Additional radiation reduces breast-cancer recurrence for some patients

More information: To learn more about radiation in breast cancer treatment, visit BreastCancer.org.

Related Stories

Additional radiation reduces breast-cancer recurrence for some patients

July 22, 2015
A study has found no increase in overall survival but a reduction in breast cancer recurrence when additional radiation is given to the lymph nodes as well as the standard treatment of whole-breast irradiation after breast-conserving ...

More guidelines, uniformity in RT needed following chemotherapy, surgery in breast cancer

April 7, 2016
Wide variability exists in radiation treatment decisions following neoadjuvant chemotherapy (NAC) and surgery for breast cancer, according to a review of the American College of Surgeons Oncology Group (ACOSOG) Z1071, a prospective ...

Radiation after lumpectomy helps prevent need for mastectomy in early stage breast cancer

August 13, 2012
Contrary to clinical recommendations, older women with early stage breast cancer may want to undergo radiation after lumpectomy to help ensure that they will not need a mastectomy in the future. That is the conclusion of ...

Cancer surgeons advise against removal of healthy breast

July 30, 2016
(HealthDay)—Only certain women with cancer in one breast should have their healthy breast removed in an attempt to prevent cancer, a leading group of breast surgeons maintains.

Recommended for you

'Liquid biopsy' predicts lymphoma therapy success within days, study finds

August 20, 2018
A blood test can predict which patients with a type of cancer called diffuse large B cell lymphoma are likely to respond positively to initial therapy and which are likely to need more aggressive treatment, according to a ...

Study shows how to make (and destroy) a metastatic cancer cell

August 20, 2018
Many cancers become especially dangerous only when they metastasize from their site of origin to faraway tissues such as lung, brain or bone. Now, a University of Colorado Cancer Center study published today in the Proceedings ...

Research team develops predictor for immunotherapy response in melanoma

August 20, 2018
In a new study, researchers developed a gene expression predictor that can indicate whether melanoma in a specific patient is likely to respond to treatment with immune checkpoint inhibitors, a novel type of immunotherapy. ...

Study details effect of radiation exposure on hormone deficiencies

August 20, 2018
In a new study, University of Cincinnati (UC) researchers, in collaboration with Massachusetts General Hospital, have detailed the effect of radiation exposure on the development of hormone deficiency in pediatric and young ...

Scientists discover new method of diagnosing cancer with malaria protein

August 17, 2018
In a spectacular new study, researchers from the University of Copenhagen have discovered a method of diagnosing a broad range of cancers at their early stages by utilising a particular malaria protein that sticks to cancer ...

Researchers find pathways that uncover insight into development of lung cancer

August 17, 2018
Lung cancer is the leading cause of preventable cancer death. A disease of complex origin, lung cancer is usually considered to result from effects of smoking and from multiple genetic variants. One of these genetic components, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.