Alta Bates Summit Medical Center Breast Cancer Mini Website Expert's Corner #1 Transcript Accelerated Partial Breast Irradiation (APBI): External Radiation The most exciting development in Breast Cancer is what I call "less is more" radiation treatments. Clinical studies over the last 15 years have demonstrated that early stage breast cancer can be treated safely and efficaciously with faster radiation treatment than in the past. Thus giving more women the option of keeping their breast after the diagnosis of breast cancer. This form of treatment is called APBI. This stands for Accelerated Partial Breast Irradiation. Only the part of the breast where the cancer was is treated. This spares the lung and heart from unnecessary radiation. The treatments are noninvasive and can be given over 5 days instead of the usual multi-week course of radiation. This exciting form radiation to the breast is very safe and well tolerated. Thus, less treatment to the breast results in more women opting for breast conservation with high cure rates. Here at Alta Bates Summit Medical Center we have extensive experience using APBI for breast cancer treatment. (73 seconds) #2 Transcript Accelerated Partial Breast Irradiation (APBI): Internal Radiation (Brachytherapy) Brachytherapy is a method of delivering a high dose of radiation to a small area. And to do that, we, in the case of the breast cancer, after the surgeon has removed the tumor, there is a small cavity left in the breast. And we'll put in a special treatment device - there are several vendors now that make these treatment devices - what they have in common, a balloon catheter that can be inflated to conform to the lumpectomy cavity. And it has a catheter that extends external to the breast and, within, the balloon. The idea is to give the radiation from the inside out. To give high dose to the high risk area and minimize the dose to the rest of the breast. The further advantage is, that it should translate to a better cosmetic result eventually. The other advantage is that the treatment is completed in just ten treatments. Every day for five straight days, morning and afternoon, and then the catheter is removed. (85 seconds) #3 Transcript Breast Conservation I am a surgeon at Alta Bates Summit Medical Center specializing in breast cancer surgery. There have been numerous studies over the last fifteen years showing no difference in survival between women who opt for mastectomies versus women who opt to conserve their breast in the surgical therapy for breast cancer. Mastectomy rates across the United States are increasing due to the inclusion of breast MRI in the newly diagnosed breast cancer population. MRI and MRI guided biopsies are finding additional cancers in the same breast or the opposite breast in this population. At Alta Bates Summit Medical Center we have some of the best mammographers in the country with expertise in performing breast MRIs, biopsies and MRI guided localization for women who opt to conserve their breasts. Surgeons have extensive skills performing these surgeries along with sentinel node biopsies and I am proud to be part of this team. (50 seconds) #4 Transcript Chemotherapy/Hormonal Therapy Except for some women with very small tumors of less than 5 mm, or with lymph nodes that do not have cancer, additional therapy is almost always recommended for patients with early stage invasive breast cancer. The type of therapy, which may be either hormonal or chemotherapy, depends on many things such as the patients age, the estrogen receptor status, the number of positive nodes, if there are any, and her general state of health. Chemotherapy uses drugs to kill cancer cells. Treatment usually begins 4-6 weeks after the final surgery and most often uses a combination of drugs. Occasionally the chemotherapy may be given prior to surgery. Chemotherapy drugs can be taken in pill form or injected intravenously. Sometimes a combination of the two is used. Depending on the drugs used, a patient receives chemotherapy once or twice a month for three to six months. Chemotherapy drugs are often used in combinations for better effect rather than being used singly. Almost all of our combinations we use have been developed by clinical research conducted in the U.S. and worldwide. These combinations are continually being modified and tested in ongoing research protocol, always seeking to improve effectiveness and to reduce toxicity of the drug. It is important to remember that no one type or combination of chemotherapy drugs is best for all patients. Your doctor will recommend what is best for you, and will also discuss with you your eligibility for any research protocol which might be helpful in your care. (93 seconds) #5 Transcript Digital Mammography Digital mammography really represents the final element in a fully integrated digital department. In such an environment, the radiologist can bring to bear on any given case, multiple sources of information, such as a patients history, her risk profiles and any other test that she may have had, for example, breast ultrasound, or breast MRI. Digital mammography, just like your digital camera, is of great value in that the images can be processed in such a manner that certain areas that deserve more attention can be magnified and better evaluated than the old system of film screen mammography. Of paramount importance, however, is the individual who is reading the examination, because it is that experience and expertise that converts any type of technology into a proper diagnosis. When you combine advanced technology with the kind of expertise and experience that can be found at the Alta Bates Summit Medical Center, you offer a woman the best opportunity for early detection, diagnosis, and treatment of breast cancer, as well as the reassurance for normal women that they will be followed on a periodic basis carefully and deliberately without necessarily resorting to unnecessary biopsies. (80 seconds) #6 Transcript IMRT/Respiratory Gating Hello, I am a radiation oncologist. When a woman is diagnosed with breast cancer, the treatment options include surgery, chemotherapy, radiation, or some combination of these. Breast radiation is standardly given with two fields, one from the front and one from the back. Some women's breasts, however, can be better treated with a technique called IMRT, or Intensity Modulated Radiation Therapy. IMRT allows us to deliver just the right amount of dose to the breast. It also allows us to decrease the radiation dose to other organs, and to decrease unwanted side effects. In fact, IMRT is so precise that we may ask you to hold your breath during radiation planning and treatment. This is called Respiratory Gating. We do this to ensure that the dose is delivered accurately. Breast IMRT and Respiratory Gating are available at the Alta Bates Summit Medical Center. (73 seconds) #7 Transcript Magnetic Resonance Imaging (MRI) Hello... I am a physician at Alta Bates Summit Medical Center and I'd like to talk to you about breast MRI. Although screening for breast cancer starts with mammography and ultrasound, breast MRI is a very helpful tool. We find it especially helpful in the following situations. If you have known breast cancer, a breast MRI can help evaluate the extent of disease and help plan the proper surgery. Additionally it can help us determine if there are other areas of involvement in the other breast or lymph nodes. We use it as a screening tool in high risk patients including patients who have had a personal history of breast cancer or have dense breasts with a family history of breast cancer, also patients who have the breast cancer gene positivity, as well as history of chest wall radiation benefit from breast MRI. It is not considered a screening tool for the general population. Finally we use it for patients who are on chemotherapy to determine whether or not they are responding appropriately to their regimen. There are disadvantages to breast MRI. Most importantly it is an expensive examination and your insurance company is going to want to make sure you meet the proper indications before approving the examination. Additionally, you will be expected to lay motionless on your stomach in a tube for 30 minutes and receive an injection. One other criticism of breast MRI is that because it is a sensitive examination, it can lead to additional biopsies. However, there are a lot of advantages including the sensitivity which allows us to help tailor the surgery for the patient. Additionally, there is no radiation. This is a very important examination and it helps us to detect breast cancer every day, and is available at the Alta Bates Summit Medical Center. (107 seconds) #8 Transcript Oncoplastic Surgery When a woman is diagnosed with breast cancer there are a lot of things that she is concerned about. The first, of course is, that her breast cancer would be treated in the best possible way for her to live her life. Women are also concerned with how the breast will look after breast surgery. At Alta Bates Summit Medical Center we are able to offer excellent breast cancer surgery but also a process called oncoplastic breast surgery. Oncoplastic means a good cancer surgery outcome, which refers to the word onco, and also a good plastic surgery outcome, providing good breast symmetry and excellent breast shape after the surgery; no divots, as some women call them, and symmetry with the other breast. So that in the end, the woman's had the best cancer surgery that she can have, but also the best cosmetic result possible. (59 seconds) #9 Transcript Tomotherapy (TM) Radiation therapy is a vital component of breast cancer management, either instead of, or following mastectomy. Alta Bates Summit Medical Center has been a leading innovator of techniques designed to enhance targeting accuracy and reduce normal tissue toxicity. The Helical Tomotherapy is another such innovation. It combines the features of a linear accelerator with a spiral CT scanner and allows us to image the tumor before treatment each day and to make adjustments for internal organ movement that previously could not be seen. As the patient travels through the scanner, computers adjust intensity, and the shape of the therapy X-Ray machine as it rotates around the tumor. It allows us to pinpoint, highly, the tumor itself and spare normal tissues. For breast cancer patients there is an added benefit. If necessary, we can treat the lymph nodes of both breasts and we can treat the boost simultaneously, thus reducing the overall treatment time, the number of treatments and the toxicity associated with treatment. (69 seconds) Reviewed 02/2010