Breast cancer arises from the abnormal growth of cells that once formed healthy breast tissue, especially those lining the milk ducts. Ductal Carcinoma In-Situ (DCIS) occurs when these cells remain within the duct. If they breach the duct wall, it becomes an Invasive Ductal Carcinoma. Similarly, when cells from the milk-producing lobules turn malignant and invade surrounding tissue, it’s known as Invasive Lobular Carcinoma.

Several factors heighten the risk of developing breast cancer, from aging and family history to certain genetic mutations (BRCA1 and BRCA2). Other contributors include early menstruation, late or no childbirth, race, and lifestyle factors like alcohol consumption, smoking, being overweight, and previous radiation exposure.

Breast cancer can present in various ways. Anomalies detected during mammography are often the first sign, but lumps may also be discovered through self-exams or clinical breast exams. Other indicators include changes in breast shape, persistent redness, nipple retraction, discharge, or skin thickening. In men, symptoms typically manifest as a palpable mass or nipple changes.

Upon noticing these symptoms, further diagnostic imaging like advanced mammograms, ultrasound, or MRI, followed by a biopsy, is essential to determine the nature of the cells. Detected cancers lead to a referral to a breast surgeon for further action.

Post-diagnosis, a series of tests determine the cancer stage, involving advanced imaging and molecular testing to understand the cancer’s characteristics. This data, including tumor size, grade, and hormone receptor status, informs the treatment strategy devised by your medical team. Referral to a breast surgeon, medical oncologist and radiation oncologist usually follows, and together with the patient, a medical consensus for treatment plan is confirmed and implemented.

The treatment of breast cancer depends on the specific presentation of a patient’s individual situation. Typically, surgery is the mainstay of therapy, with either a lumpectomy (to remove the mass without removing the breast) or a mastectomy (which removes the breast with the mass).  Some form of lymph node sampling might be performed to aid in assessing any local movement of cells and to finalize a pathologic staging. Following surgical excision, a patient is usually referred to a medical oncologist and a radiation oncologist for consideration of adjuvant therapies to follow surgical.  Rarely, surgery is not performed first, but follows a course of chemotherapy or chemotherapy and radiation therapy, to first shrink disease and sterilize the local area allowing for a more successful surgical excision.

A medical oncologist uses the clinical and pathologic assessment and often molecular testing to assess a patient’s systemic risk after surgery – i.e. the risk of any stray cells being outside of the breast/chest area for which systemic therapies like hormone therapy, chemotherapy or immunotherapy might be useful to lower that particular risk.

A radiation oncologist uses the clinical and pathologic assessment to assess a patient’s local risk – i.e. the risk of stray cells being in the local area for which a local therapy like radiation that could be useful to lower that particular risk.

ARC’s team excels in breast cancer treatment, employing state-of-the-art 3D-conformal radiation therapy and IMRT and a number of other technologies and techniques, some of which are noted below. Radiation therapy plays a crucial role in eliminating residual cancer cells post-lumpectomy, post-mastectomy, or in certain cases when local or distant recurrences have occurred.

Advanced Radiation Centers (ARC) employs a range of breast radiation modalities and techniques, ensuring each patient receives the most effective, personalized treatment. Our commitment to cutting-edge technology and patient-centered care includes:

• 3D-Conformal Radiation Therapy: This technique uses imaging to create a three-dimensional model of the tumor, allowing for precise targeting while sparing surrounding healthy tissue.
• Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT): These techniques allow for the modulation of radiation doses, concentrating the treatment on the tumor while sparing surrounding healthy tissue. Treatments are often spread out, or fractionated, over a number of weeks, to allow a more optimal separation of dose between tumor and normal tissues.
• Intensity-Modulated Radiation Therapy (IMRT): IMRT delivers radiation in variable intensities across the treatment area. This modulation enables us to target the cancer more accurately and reduce the dose to adjacent normal tissues, minimizing side effects.
• (Accelerated) Partial Breast Irradiation (APBI/PBI): PBI focuses the radiation on just the portion of the breast where the tumor was located, rather than the whole breast. This approach can significantly reduce treatment time and limit radiation exposure to non-affected breast tissue.
• Deep Inspiratory Breath Hold (DIBH): DIBH is a technique used to minimize radiation exposure to the heart in left-sided breast cancers. Patients take a deep breath and hold it during treatment, expanding the chest and moving the heart away from the radiation field.
• Surface Tracking: Advanced surface tracking technologies ensure the utmost precision during treatment, monitoring the patient’s movement to adjust the radiation beam in real time and allowing for the ability to adjust the delivery of radiation based on minute movements.
• Prone Breast Irradiation:   Often, positioning a patient prone (on their stomach) and using gravity to allow the breast to fall away from the chest, an improvement can be achieved in reducing radiation exposure to the heart, lungs, and opposite breast.  So called “prone breast irradiation” requires particular equipment to ensure daily reproducibility, and is  particularly valuable for treating left-sided breast cancer where the heart is at greater risk. This method is also beneficial for patients with larger or more pendulous breasts, as it can help to distribute the breast tissue more evenly, allowing for more precise targeting of the tumor area, and has been shown to decrease the amount of skin reactions.

The first day and even weeks of radiation are unlikely to produce any noticeable side effects; however, the cumulative effect of radiotherapy over weeks can lead to temporary irritative symptoms of the local tissues such as skin redness or discoloration or local swelling. Fatigue may also be noticeable, but it is unlikely to warrant any change in daily schedule and patients could work or exercise without restriction. These “acute” irritative symptoms typically resolve 4-6 weeks after treatment completion. Long term risks of therapy will be discussed with you during your consultation, and certain advanced techniques like IMRT, prone breast irradiation and partial breast irradiation (see above) may aid in to minimize these risks. During the course of radiation, weekly visits with the radiation oncologist are set to assess your response to therapy and discuss any possible side effects.

Radiation treatment demands meticulous preparation by a dedicated team, ensuring precision and patient safety throughout the process.  Each step of the radiation treatment process is designed with precision, safety, and your well-being in mind, ensuring that you receive the most effective and personalized care possible.

Consultation

The initial step involves you and your family meeting with an ARC radiation oncologist to discuss your diagnosis, review your medical history, and consider the most effective radiation treatment options tailored to your specific case.  Expectations of therapy, side effects and treatment alternatives will be discussed.

Simulation

Once a course of radiation is agreed upon a simulation, or treatment planning session is performed over a 45-60 minute period.  During the simulation, the positioning of the body is set, often with a mold or cradle being customized to ensure reproducibility of positioning on a day-to-day basis. Small “freckle-like” tattoo marks are often used for alignment and an imaging scan is performed to pinpoint the exact location of the cancer or areas at risk relative to the geometric position of the body and treatment room. This step is crucial for designing a treatment plan that maximizes the radiation dose to the cancer while sparing surrounding healthy tissue.

The Planning Process (Behind the Scenes)

For a week or two following the simulation, a multi-disciplinary team composed of the radiation oncologist, medical physicists, and dosimetrists, collaborate behind the scenes using advanced software to 3-dimenionally reconstruct the anatomic areas of consideration and map out the precise treatment plan, calculating the optimal radiation dose distribution.  This dosimetry plan is a “blueprint” that will be used to ensure accuracy in the treatment delivery.

Daily Radiation Treatments

Radiation therapy typically involves daily treatments over several weeks using a machine that generates high energy photons called a linear accelerator. The treatment room is large and is not claustrophobic.  Each session typically takes place in a 10-15 minute appointment slot, with most of this time used in positioning and alignment, with the actual beams of radiation are on for only a few minutes. The radiation is invisible and not felt. Patients can typically drive themselves to and from the appointments, continue to work or exercise and maintain their normal daily activities.  Specific restrictions, if any, can be discussed with your radiation oncologist at consultation and during the weekly on-treatment visits.

Weekly On-Treatment Physician Review

Regular meetings with patients undergoing radiation are conducted with the radiation oncologist throughout your treatment course. These check-ins allow the doctor to monitor your progress, briefly exam the area under treatment for any possible side effects, provide any medications or treatment adjustments, and discuss any questions or concerns that may arise during therapy.

Completion of Therapy and Follow-Ups

Upon finishing the radiation treatment course, a final conversation with your radiation oncologist will discuss the next steps, expectations for resolution of side effects, and any further treatment or monitoring needed. Regular follow-up appointments are crucial after completing radiation therapy, and allow the radiation team to monitor your recovery, manage any late side effects, and check for signs of cancer recurrence.