Radiation on Left Breast vs. Mastectomy for IDC?

I had a lumpectomy and left side radiation in the summer of 2007. I had no problems related to the radiation then or later. The technology today really minimizes the chance of problems.

Having a mastectomy is not a guarantee that you won't need radiation, so don't have one if avoiding radiation that is your sole purpose. Also, a mastectomy is a major surgery with huge potential negative SEs of its own, as is the reconstruction process. Some people have no choice but to have a mastectomy, others feel in their heart that it is the right choice for them. But if you have doubts, then I would definitely go with the lumpectomy.

This article is on the home page of BCO right now:

Modern Radiation Therapy Less Risky for Heart

Published on December 9, 2013 at 4:18 am

For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy has been shown to be as effective as mastectomy without radiation for removing the cancer AND minimizing the risk of the cancer coming back (recurrence). Radiation therapy after lumpectomy can destroy any cancer cells that may have been left behind after surgery, making recurrence less likely. Some women who have mastectomy may also have radiation after surgery. Experts agree that radiation therapy improves the overall prognosis for many women diagnosed with early-stage breast cancer.

Still, studies have found a link between radiation therapy for breast cancer and a higher risk of heart and lung problems, especially if the cancer is in the left breast, the same side as the heart.

In encouraging news, a research letter estimates that modern radiation therapy techniques are less likely to cause heart problems than radiation therapy techniques used 20 or more years ago.

The research letter was published online on Oct. 28, 2013 by JAMA Internal Medicine. Read the abstract of “Risk and Risk Reduction of Major Coronary Events Association With Contemporary Breast Radiotherapy.”

The research letter looked at the radiation therapy treatment plans of 48 women diagnosed with stage 0 to stage IIA breast cancer who were treated after 2005 at the New York University Department of Radiation Oncology.

Taking into account factors such as:

• radiation dose
• side of the body being treated
• position of the woman during radiation treatment (lying face up or face down)
• a woman’s baseline risk for heart problems before radiation treatment

the researchers estimated the future risk of heart problems for the women.

Overall, the average radiation dose for the 48 women in this study was 1.37 gray compared to 4.9 gray reported in a study looking at women treated with radiation therapy from 1958 to 2001.

The researchers found that women treated for cancer in the left breast who had a high baseline risk of heart problems before radiation therapy started had the highest risk of future heart problems. Women treated for cancer in the right breast with a low baseline risk of heart problems had the lowest risk of future heart problems.

The estimated risk of future heart problems for specific groups of women were:

• 0.22% for women with a low baseline risk of heart problems treated for cancer in the left breast lying face up
• 0.42% for women with a medium baseline risk of heart problems treated for cancer in the left breast lying face up
• 3.5% for women with a high baseline risk of heart problems treated for cancer in the left breast lying face up
• 0.09% for women with a low baseline risk of heart problems treated for cancer in the left breast lying face down
• 0.17% for women with a medium baseline risk of heart problems treated for cancer in the left breast lying face down
• 1.3% for women with a high baseline risk of heart problems treated for cancer in the left breast lying face down
• 0.05% for women with a low baseline risk of heart problems treated for cancer in the right breast lying face up
• 0.10% for women with a medium baseline risk of heart problems treated for cancer in the right breast lying face up
• 0.79% for women with a high baseline risk of heart problems treated for cancer in the right breast lying face up
• 0.06% for women with a low baseline risk of heart problems treated for cancer in the right breast lying face down
• 0.11% for women with a medium baseline risk of heart problems treated for cancer in the right breast lying face down
• 0.84% for women with a high baseline risk of heart problems treated for cancer in the right breast lying face down

So while there is still some risk to the heart from radiation therapy to treat breast cancer, it’s encouraging to know that advances in radiation therapy have greatly reduced the amount of radiation exposure to the heart, lungs, and other healthy tissue. This is because:

• Doctors now use computers to plan radiation therapy that is extremely precise in dose and delivery.
• A type of radiation therapy equipment used today (called respiratory gating) tracks heartbeats and lung movement and effectively blocks those tissues from radiation exposure.
• Other tools, such as intensity modulated radiation therapy, allow the radiation oncologist to change the intensity of the radiation during treatment to ensure the tissue at risk receives an even dose and to avoid healthy tissue.
• Doctors may have some women lie face down to receive radiation therapy to reduce the amount of radiation that unintentionally reaches the heart and lungs.
• Some radiation treatment fields, such as the internal mammary lymph node treatment field, which is right in front of the heart, are more likely to expose the heart to radiation. It’s a good idea to ask your doctor which treatment fields will be included as part of your radiation therapy. If the internal mammary lymph node treatment field is included, you may want to ask if that treatment field is necessary.

If you’ve been diagnosed with breast cancer, you and your doctor will consider the characteristics of the cancer, your unique situation, your surgical options, and your treatment options after surgery when creating your treatment plan. If you choose lumpectomy, it’s very likely that radiation will be recommended after surgery. If you choose mastectomy, radiation after surgery may or may not be recommended for you. Talk to your radiation therapy treatment team about how they’ll make sure that you get only the radiation therapy required to effectively treat the cancer. Together, you can plan your treatment to minimize any risks.

I asked about the prone position, lying face down. My RO (head of dept) explained that the she wants perfection and techs here could not be as precise without breast in view. She said if i wanted that done precisely only few places are that skilled and said I think it may have been Sloan. I am in ohio so not feasible for me and I have total respect for her opinion.