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What to consider when making a decision for your treatment?

“It’s strongly recommended that all women with breast cancer discuss their concerns about the effects of radiation therapy with their treating oncologist including the benefits and the possible side effects and the likely outcomes before making a final decision.” – Ramesh Pandey, Radiation Oncologist, Fellow of the Royal Australian and New Zealand College of Radiologists.

Breast cancer is the second most common cause of death from cancer in New Zealand women. Breast cancer is New Zealand’s third most common cancer and accounts for more than 600 deaths every year. However, breast cancer is mostly curable, if diagnosed early and treated early.

As a radiation oncologist, I have seen women who have made unfortunate decisions for their cancer treatment and missed opportunities to head towards health because of a wrong perception of radiation therapy.

It is of utmost importance that women make a well-informed decision based on their individual conditions. This means they will need to understand the benefits, possible side effects and associated risks of their treatment options. Here are three things women need to consider for making a decision on the optimal treatment:

  1. Among a range of treatment options, what is the role of radiation therapy? Is it safe?

The treatments available for breast cancer include surgery, radiation therapy, chemotherapy, and hormonal therapy.

The choice of treatment will depend on the type of breast cancer as well as the extent of disease and personal risk factors. A team of doctors including surgeons, radiation oncologists, medical oncologists and pathologists decide together as a team on the best treatment plan for each patient. This team is often referred to as the Multidisciplinary Team (MDT).

Please also note that breast cancer can unfortunately occur in pregnancy, but this may still be treated successfully and will need coordination between the breast cancer treatment team as well as the obstetrics team for both mother’s and baby’s health.

Radiation therapy is a safe and effective treatment for breast cancer and is required in most situations post breast conserving surgery and in some situations after a mastectomy.

  1. What are the benefits of radiation therapy? How effective is it?

Radiation therapy significantly reduces recurrence at the breast by up to two thirds and also improves breast cancer survival by up to 10%.

According to National and International Benchmark set following study of delivery of Radiotherapy Services in 2013, 1 in 2 cancer patients would benefit from radiation therapy at some time during their cancer experience but less than 1 in 3 patients in Australia and New Zealand will actually receive radiation therapy.

  1. What are the side effects and risks?

Some common short-term side effects include fatigue, skin reddening and irritation. However, loss of hair in the armpit maybe long-term.

There may be some mid-term and long-term side effects that may develop later. For example, loss of hair in the armpit maybe long-term. Read more about side effects.

When a woman has a left sided breast cancer, there is a very low chance of radiation therapy causing heart disease or damage to the heart. Radiation therapy techniques, such as deep inspiratory breath hold, are commonly used to keep the amount of radiation to the heart as low as possible.

The risk of ischaemic heart disease which can result in heart attacks is approximately 0.8% risk 10 years after radiation therapy.

The risk of cancer caused by radiation therapy is very low and may be 0.5% to 1% risk 10 years after radiation therapy.

Please note there may be possible cosmetic dissatisfaction with breast reconstructions, but radiation therapy still remains an important component in the treatment of breast cancer. It is best to discuss these with both the treating radiation oncologist and surgeon.

Recommendations

It is highly recommended that every woman with a breast lump visit their doctor for investigations and for all eligible women to attend breast cancer screening with mammograms and ultrasounds to improve their chance of cure through early detection and treatment. Evidence shows that women who have been through screening by Breast Cancer Aotearoa have their risk of dying from breast cancer reduced by a third compared to women who have never been screened by the program.

It’s strongly recommended that all women with breast cancer discuss their concerns about the effects of radiation therapy treatment with their treating oncologists including the benefits and the possible side effects with their likely outcome before making a final decision.

This article is contributed by Ramesh Pandey, Fellow of the Royal Australian and New Zealand College of Radiologists.