SalemNews.com, Salem, MA

October 16, 2012

Doctors take a 'risk adapt' approach

Cheryl Lecesse
The Salem News

— Technological advancements have made breast cancer not only more detectable at an early stage of development, but have also lessened the impact the process of cancer treatment can have on a woman’s quality of life.

“We’ve already upped the ante with digital mammography,” said Dr. Andrea McKee, chair of radiation oncology at Lahey Clinic. “We see much more early stage breast cancer.”

Breast cancer is classified in stages, on a scale of 0 to 4, with stage 4 being the most serious. Early stage breast cancer in women refers to stage 0, also called a precancerous condition, or stage 1, which means a tumor has developed, but it is less than 2 centimeters in diameter.

For decades, radiation treatment for breast cancer at any stage meant treating the whole breast.

“We didn’t have the capacity of targeting the radiation to a more effective area,” McKee said.

According to McKee, most women present with a single focus of cancer in the breast. In severe cases, a mastectomy is necessary.

But for many early stage patients, a lumpectomy followed by radiation destroys the cancer. Today, there are radiation techniques available that are less onerous to earlier stage patients. For example, one procedure allows radiation to flow to where a tumor used to be through a catheter, targeting only the cells in direct contact with the tumor.

“We risk adapt,” she said. “Basically we don’t do the same thing for every patient with breast cancer.”

Risk adapting means that doctors take several factors into account, including the type of cancer, size of the tumor, location of the tumor within the breast, and whether the cancer has spread to the lymph nodes, when determining a recommended course of action. At Lahey, a team of healthcare professionals, including the breast surgeon, medical oncologist, radiation oncologist, a social worker and a breast health navigator meet with each patient to discuss treatment options.

“We’re counseling them regarding the options we think are appropriate for them,” McKee said.

But it’s also a time for women to have a say about what happens to their bodies.

“We really listen to the patient,” McKee said. “We’re really trying to kind of engage women by allowing them to participate in the decision-making. That puts them in the driver’s seat as much as they can be.”

McKee said a lot of women today say they don’t want to have radiation on certain parts of their body. For example, radiation on cancer in the left breast could also expose the heart to those rays. In these cases, there’s the possibility of treating the patient in the prone position — a woman would lie face down on a specially designed table that allows the breast to hang forward, so the radiation exposure on the chest wall is minimal.

In another technique, called gated radiation, a woman would take a deep breath just before the radiation hits.

“When you take a deep breath, your heart retracts a little bit into your chest,” McKee said. “You basically are controlling where the heart is.”

McKee said she loves when a patient comes to the first team meeting armed with knowledge about her cancer and treatment options, either from friends, family or from the Web.

“That’s a sign of someone who wants to be involved,” she said.