Breast cancer treatment improving

Sure, doctors would love to come up with the magical breakthrough that cures all women of breast cancer. But progress is always made in small steps — aided by the willingness of women "to have the coin tossed," says Dr. Vilija Avizonis.

"The only way medicine moves forward is these randomized, national trials," says Avizonis, a radiation oncologist at LDS Hospital who participates today in the Deseret News/IHC Health Hotline about breast cancer. Also answering calls, from 10 a.m. to noon, will be Dr. Brett Parkinson, director of breast imaging services for Intermountain Health Care.

In the olden days of breast cancer treatment — which is to say as recently as 20 years ago — a woman might go in for a biopsy and be told "if it's positive, you'll wake up without a breast," recalls Avizonis. Today we know that a less invasive treatment that combines lumpectomy and radiation is often just as useful as a mastectomy — thanks to women who were willing to take part in randomized studies testing the two different modalities. "All of us owe a lot to these older ladies."

At any given time there are eight or 10 breast cancer trials in progress at LDS Hospital, and more studies at other hospitals and cancer centers, as doctors try to come up with the best, safest treatments. There are studies of new drugs, and new combinations of old drugs, and new ways of providing radiation therapy, plus the usefulness of MRIs, ultrasound and computer-aided detection in diagnosing breast cancer.

One new randomized trial, which begins this fall, will explore whether "partial breast radiation" will be as risk-free as it is convenient. The study, sponsored by the National Cancer Institute, will provide half the women with standard treatment — six weeks of daily radiation — and the other half (with their consent) with a more concentrated regimen of 10 treatments in just one week. The two treatments have never gone head-to-head in a study, Avizonis says.

The advantage of the shorter treatment is convenience. But the higher dosage might mean increased scarring of the breast tissue. The first goal of any breast cancer treatment is medical, but the secondary purpose is cosmetic, Avizonis notes. "You want a breast that is as close to normal as possible."

Thousands of women across the country will be studied and will be followed for life to determine if the new treatment will be as effective as current radiation therapy and whether it causes more scarring. Scarring can occur as late as five or 10 years after the initial radiation, Avizonis says.