Tuesday, October 8, 2013
TECHNOLOGY IMPROVING BREAST CANCER DETECTION & TREATMENT
Breast-cancer technology is getting faster and more precise. Where mammograms were once cold and painful, they are now more comfortable and more accurate. Where treatment used to take 30 minutes a day for a period of six weeks, it now takes a 90 seconds and only one week. DETECTION When it comes to cutting-edge technology, it’s important to remember that it’s still imperfect. While new 3-D mammograms, called tomosynthesis, are available on the market, local doctors continue to use digital mammograms for two reasons. One, tomosynthesis is a new technology, and therefore expensive and not covered by most insurances. Two, 3-D mammograms deliver two times as much radiation as a standard mammogram.
Elizabeth Long, lead mammographer at Summerlin Hospital Breast Care Center in Las Vegas, said the medical community is not quite sold on the tech, but will continue to watch it. At the Breast Care Center, Long uses a Hologic digital mammography system. It uses stereotactic biopsy technology, which detects small masses and calcifications. The system has flexible paddles that don’t “crush” patients. The center also slips mammopads into the machine, so the procedure does not feel as cold or hard. “It’s digital and adds more comfort,” Long said of the digital system, which is also made by General Electric and Siemens. The center also uses a breast MRI to monitor breasts during treatment, and ultrasounds can be used to identify masses or lumps. The same technology is used by The Breast Center at Sunrise Hospital, the only breast center in Southern Nevada to be accredited by the National Accreditation Program for Breast Centers, a program administered by the American College of Surgeons.
Dr. Matthew Schwartz at the Comprehensive Cancer Centers of Nevada, is/was my Radiation Oncologist who treated me for Head and Neck Cancer. Just as in my treatment, Dr. Matthew Schwartz also uses IMRT or intensity-modulated radiation technology to treat his patients for breast cancer. IMRT is a high-energy X-ray beam that safely treats cancer cells in the breast with minimal damage to the lungs and heart. Though the technology has been available for years, Schwartz said, only recently has it been used for breast cancer. Previously, it was used to treat head, neck and prostate. “It allows us to kill the cancer cells and cure the cancer without hurting the patients,” said Schwartz, who sees an average of 25 to 30 patients per day. IMRT also minimizes side effects of radiation, which can include skin changes, swelling and fatigue. Comprehensive Cancer Centers is the largest multispecialty treatment center in the state, offering clinical trials, radiation and chemo therapy. It uses VMAT, or volume metric modulated arc therapy, the latest version of IMRT that allows radiation to be delivered in 90 seconds versus 20 or 30 minutes, as typical sessions can run. The center is the first in town to have VMAT, Schwartz said. “It costs millions of dollars,” he said. “Not everyone has it. We’re lucky to have it.” The center also has a comb beam CT, a form of image-guided radiation therapy. The treated area is imaged on a daily basis and lets doctors treat the correct spot with more precision. Overall, Schwartz said, technologies are more convenient and less toxic to patients. In breast cancer surgery, patients typically have two choices. A patient can have a lumpectomy, which removes only part of the breast, and undergo radiation after surgery. Or, if she wants to avoid radiation, can have a mastectomy and remove all breast tissue. “It changes year to year as far as popularity in lumpectomy versus mastectomy,” said Dr. Michael Anderson of Comprehensive Cancer Centers. Anderson, a radiation oncologist, is an expert in partial breast radiation, which allows a smaller amount of radiation to be delivered to a more closely targeted area. Instead of six weeks of radiation treatment, which is considered to be the standard of care, patients can undergo just one week of treatment — a convenience particularly appealing to who live in rural areas or are traveling from neighboring states. Anderson said roughly a quarter of his patients are not local. Ten treatments are administered during the course of a week, Anderson said, and the side effects are minimal.
Though partial breast radiation does have unique risks. Because radiation is delivered through a catheter that is placed in the lumpectomy cavity, there is chance of infection. Still, Anderson recommends it. “Some more time will have to go by before we can definitively say it’s as good a treatment,” Anderson said. “But right now it looks like it will be as good a treatment.” GOOD NEWS Breast cancer survival rates continue to improve, Anderson said. In the past, the five-year mark was considered a success. Today, survivors are looking at 10- or 15-year marks. “You’re never really out of the woods, but the idea is this is a chronic disease,” Anderson said, one that requires ongoing treatments — of which new ones are being developed rapidly. If cancer is detected during Stage 1, patients have a 90 to 95 percent chance of recovery. If Stage 2, 80 percent. Stage 3, 60 to 70 percent. Even in Stage 4, the most advanced stage, patients have a 50 percent chance of survival. Anderson recommends annual mammograms from age 40 and on, supplemented with self-exams and exams with a physician. “Technology is improving,” Anderson said. “Where we’re going, as far as radiation, is a less-is-more mentality.”