New research shows ways to reduce future risks of treatment for breast cancer patients

Dr. Jean-Philippe Pignol says it's a testament to the effectiveness of cancer therapy today that his most recent research is even possible.

The professor of radiation oncology and head of the radiotherapy department at Dalhousie University is a co-author of a recently completed four-year study looking at ways to reduce the long-term risk of secondary cancer for patients receiving radiation treatment for breast cancer.

Pignol believes the paper, which becomes widely available in September, could have major positive outcomes for patients and the way they are treated.

'Empowering patients'

"I think the patient deserves to receive the better treatment and I think that it's also about empowering patients," he said.

"If they know what the consequences are of the treatment, they can ask the right questions."

Traditionally when breast cancer has been detected, the whole breast was treated with radiotherapy. But, as technology has advanced, doctors could instead use partial-treatment techniques for early-stage patients with a good prognosis.

The partial-treatment techniques focus on a specific area of the breast. The treatment has been shown to beequally effective.

Reducing the risk to the lungs

Aside from providing a more accelerated treatment, the partial approach also reduces the scatter radiation that might ultimately affect other parts of the body.

Pignol's study, co-authored with researchers from the Netherlands and Chile, shows partial radiotherapy treatment reduces the patient's long-term risk of developing cancer in areas such as the esophagus, colon, ovaries, uterus, thyroid and especially in the lungs, where the risk of developing secondary cancer is greatest.

The most "exciting" part of the findings relates to the lungs, said Pignol, where the use of partial radiotherapy showed a "four-fold" reduction in the risk to patients. It's the most important area to consider, he said, because the mortality rate for someone who develops lung cancer is about 80 per cent.

Consideration for these secondary risks is now a necessity, said Pignol, because people whose breast cancer is detected and treated early are living so much longer. It's quite common for someone diagnosed and treated early at age 50, for example,to live into their 80s, but during that time there also becomes a "significant risk" the person will develop lung cancer by the time they're 80.

Considering long-term consequences

There will always be cases where radiotherapy for the whole breast is necessary, such as with high-risk patients and people presenting with a more aggressive disease, Pignol said. That's when the priority becomes the immediate situation and higher doses of radiation are required, he said.

"In medicine it's always about, 'I give you a treatment, there are some side effects, but I have to balance that against the benefits.'"

The findings will be presented as part of a conference in San Antonio, Texas, in September. Pignol is hoping they lead patients to press their doctors for different approaches to treatment and doctors to consider the long-term consequences of treatment choices for patients who are living much longer than they once did.

"In my view, the future is for every patient we should compare all of those possibilities, look at how much dose is delivered to the lung and put a constraint on the lung," he said.

"With a very simple technique, we may reduce some very dire consequences of the radiation treatment."

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