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An interview with
Attending Radiation Oncologist at Saint Barnabas
Q.
A. A risk factor is anything that increases your chances of
developing a disease. Even with one or more risk factors
it doesn’t mean that you will develop the disease.
The majority of women who develop breast cancer have no apparent
risk factors. Some of the following have been associated
with an increased risk of developing breast cancer.
1. Women have more breast cells, than men
and are continuously exposed to female hormones which are
growth-factors. Breast cancer is approximately 100 times more
common in women than in men.
2. Ones risk of breast cancer increases with aging. 18
percent of breast cancers occur in women in their 40’s
while 77 percent are diagnosed in persons older than age 50.
3. It has been reported that 5-10 percent of breast
cancers are hereditary. The most common gene changes are BRCA1
and BRCA2.
4.
two or more relatives with ovarian cancer (The risk is
higher if your mother or sister has a history of breast cancer)
Breast cancer in a relative before age 50 on either side
of the family.
Male relative with breast cancer
5. of breast cancer.
6. breast biopsy.
7. of exposure to unopposed estrogens.
Early age onset of menstruation
Late onset of menopause
No pregnancies or first child after age 30
Hormone replacement therapy
Obesity (Fat cells produce estrogen)
8. is
associated with an increased risk of breast cancer.
Q.
A. Mammograms don’t prevent breast cancer, but they
can lower your chance of dying from breast cancer by 35 percent
for women over age 50 and by 25-35 percent for women between
the ages of 40-50.
 For women at average risk of developing breast cancer, The
American Cancer Society recommends screening mammograms beginning
yearly at age 40. For women with an increased risk, screening
should begin at a younger age and one might strongly consider
an MRI in addition to screening mammography. Patients should
discuss their risk of developing breast cancer with their
physician.
A woman’s risk of breast cancer rises as she ages,
but in elderly women with a short life expectancy the benefits
of screening diminish.
Q.
A. Most commonly breast cancer is discovered on a screening
mammogram. Occasionally breast cancer may appear as a painless
lump in the breast or under the arm. Some women have nipple
discharge, but the majority of nipple discharge is related
to benign disease. Breast cancers do not typically cause
pain.
Q.
A. Most women with breast cancer can choose to have either
a mastectomy or a lumpectomy followed by radiation therapy.
Whether or not a woman chooses to have a mastectomy or a
lumpectomy, the physician needs to know if the cancer has
spread to the lymph nodes. Sentinel lymph node mapping is
a common procedure performed by experienced breast surgeons
to identify the lymph node which is most likely to contain
cancer cells. If this sentinel lymph node is not involved,
it spares most patients from having to undergo a complete
auxiliary lymph node dissection.
A lumpectomy removes only the breast lump and a small margin
of normal breast tissue. If cancer cells are present at the
margin (the edge of the excision specimen), then a second
excision can usually be done. In almost all cases, radiation
therapy is given after a lumpectomy. The combination of a
lumpectomy and radiation is known as breast conservation.
Women who are not candidates for breast conservation include:
Women with two areas of cancer in the same breast too far
apart to remove in one incision.
Women with tumors too large to be removed and still leave
a patient with a reasonable cosmetic outcome.
Pregnant women who require radiation during their pregnancy.
Most women with tumors larger than 5 cm.
Women with a history of radiation therapy to the affected
breast.
Certain women with a history of collagen vascular disease.
Some women require radiation therapy after a mastectomy,
usually women with breast cancers greater than 5 cm or with
four or more lymph nodes involved with cancer regardless of
the size of the primary cancer.
Q.
A. Acute side effects of treatment that occur during or shortly
after radiation may include:
Fatigue
Breast redness or chest wall redness
Breast swelling
Breast tenderness
Minimal lowering of the blood counts
Long-term side effects, which can occur six weeks or longer
after the completion of radiation, may include:
Minimal change in the texture or color of the breast
Small risk of rib fracture
Small risk of pneumonitis
Small risk of lymphedema
Small risk of secondary cancer like skin cancer
Each woman’s outlook with breast cancer differs depending
on the cancer stage, hormone receptor status, and the patient’s
general health and treatment.
Q.
A. At Saint Barnabas Health Care System, we offer some novel
approaches to the management of women with breast cancer.
These techniques include 3D conformal radiation therapy.
We are one of the few centers in New Jersey to offer prone
breast radiation for larger breasted women, which minimizes
both short-term toxicity and improves long-term cosmetic
outcome for this group of women. IMRT (intensity modulated
radiation therapy) is used to deliver a more homogeneous
breast dose, minimizing hot spots and cold spots within either
breast that needs treatment, as well as potentially minimizing
the dose to the underlying heart and lung for left-sided
breast cancers. We also utilize Mammosite brachythearapy,
a form of partial breast irradiation. We individualize our
treatment recommendations as all women with breast cancer
are not the same and the goals of radiation are to both maximize
cure and minimize both shortand long-term treatment toxicity.
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