Editor’s note: Every Sunday during the month of October, a column by a St. Joseph’s/Candler administrator, doctor or researcher will be published on the opinion page as part of the Paint the Town Pink breast cancer awareness campaign.
Each October, as part of our Paint the Town Pink efforts, we remind the community that the best way to treat cancer – any cancer---is through early detection. That means being receptive to changes in your body, responding to symptoms and warning signs by seeking appropriate medical consultation when something just doesn’t seem right.
The earlier the diagnosis, the more promising the odds are for successful intervention and ultimate survival.
There are many tools in our arsenals to fight breast cancer. Modern science has made great strides over the last several decades in the diagnosis and treatment of the disease. Yet, there remains one solid constant: the earlier the disease is detected, the more effective the tools.
Radiation is one of those treatment tools. It is commonly part of a standard combination of regimens routinely implemented as part of many breast cancer patients’ treatments. Often times, radiation is used in combination with surgery and other therapies such as chemotherapy. These combinations of treatments can afford patients positive outcomes with the least amount of invasive surgery, often with more conservation of the breast tissue and improved cosmetic results.
Historically, in the case of left-sided breast cancers, there was a significantly increased risk of coronary artery disease following radiation, as the heart sits behind the left breast. The risk of long-term heart disease rose with increased dose of radiation to the heart. Much of this risk has been mitigated in the modern era with the use of three- dimensional (3D) treatment planning, which allows us to design and shape the radiation to avoid the heart. In an effort to further reduce that risk to the heart, we use a newer technology called Deep Inspiration Breath Hold (DIPH) treatment at the Lewis Cancer and Research Pavilion and all of our satellite facilities throughout the region.
Using this technique, the treatment machine monitors the patient's breathing and only delivers radiation when the patient inhales deeply and holds their breath within a specified threshold. When one breathes in deeply, the lungs inflate and lift the breast and chest wall away from the heart. This creates a better avenue to radiate the breast and essentially miss the underlying heart muscle. As a result, the odds of long-term cardiac disease from the treatment are minimized.
Another option for heart sparing is prone radiation treatment, wherein the patient is treated on their stomach with the breast hanging through a gap in a specially designed cushion. This allows us to use different beam angles to treat the breast and similarly reduce the dose to the heart.
It’s important to note that regardless of the technology used for treatment, the risks of long-term toxicity with breast radiotherapy remain relatively low. However, in the fight against breast cancer, it’s important to chase and capture any marginal gains possible.
The biggest and most important gains still come from the conscientious patients who are aware of their health, are responsive to changes in their bodies, and actively seek annual health screenings such as mammograms.
John Mikell, MD, is a radiation oncologist at the Nancy N. and J.C. Lewis Cancer & Research Pavilion.