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Breast Cancer Awareness Month Series with Augusta Health - Week 2: Treatment

Published: Oct. 13, 2021 at 10:17 AM EDT
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HARRISONBURG, Va. (WHSV) - One of the most common treatments for breast cancer is radiation. I spoke with Dr. Robert Kyler and Sarah Scarboro from Augusta Health about their innovative efforts to take an individualized approach to treat each patient.

“There is something called the therapeutic ratio where you look at the benefit versus the risks. You always want to have a therapeutic ratio that delivers more benefits than risks,” Dr. Kyler said.

Dr. Kyler says for early-stage breast cancer, radiation is most often used to treat the breast after a lumpectomy. This can be done as an alternative to a mastectomy, depending on the stage of cancer.

Radiation treatment can be done in several ways, depending on what is best for the patient.

“You can’t deliver any kind of treatment, including radiation without some risks. Our goal is to minimize the long-term risks while maximizing the benefits,” Dr. Kyler explained.

Prone positioning, breath-holding during radiation and shorter courses of treatment are some of the techniques used in eligible patients at Augusta Health.

For larger breasted women, prone positioning allows for a more even dose of radiation to be delivered. This technique can help further down the line in treatment.

“Allows us to use gravity to our advantage. Instead of lying on her back, the woman lies prone or face down. There is an opening in the device she is lying on that allows the breast to go through it and hang down toward the base of the table. Then the radiation machine or the linear accelerator treats the portion of the breast that hangs through the table,” Dr. Kyler explained.

“Our goal is to position women in a position that they are comfortable with,” Sarah Scarboro with Augusta Health said. “If they are comfortable and their position can be reproduced for treatment every day, that is going to make our treatment more effective.”

This technique can also keep radiation away from other organs while still treating the breast. A different technique with a similar outcome is DIBH.

“Deep Inspiration Breath Hold or DIBH, with respiratory gating. In women with left-sided breast cancers, when the heart is too close to the breast such that treating the breast would deliver more radiation than wanted to the heart, we will gate the woman’s treatments to breathing,” Dr. Kyler said.

The treatment area includes part of the heart, but when the woman takes a deep breath, it allows for the radiation to focus more on the breast.

“The major advantage, we are delivering a much lower dose of radiation to the heart. The risks of long-term heart damage are significantly lower with this approach,” Dr. Kyler explained.

Aside from how radiation is administered, how long radiation is given can make a big difference.

“For the last 10 years, we have been offering women shorter courses of radiation. Instead of five days a week for six weeks, for most women, it is five days a week for three to four weeks. We have a lot of experience with that regimen and it is just as safe and effective,” Dr. Kyler explained. “A more recent twist in that is treating them with a total of five treatments but giving them once a week.”

Dr. Kyler says that all of these techniques work best in the earliest stages of breast cancer.

“You pick it up with a mammogram as opposed to waiting for that lump to show up, your odds of being cured go up dramatically. Your odds of having multiple options for treatment is the highest when you are in the earliest stages,” Dr. Kyler explained.

“We have many different options to suit both the woman’s breast cancer, preferences, positioning, as well as her family constraints, transportation constraints. We try and offer the full spectrum,” Scarboro said.

To learn more about breast cancer treatments at Augusta Health, click here.

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