FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

"ELECTRON BEAM" THERAPY USEFUL PART OF BREAST CANCER TREATMENT

Question: I recently had a lumpectomy for removal of a cancerous breast tumor. I'm now undergoing radiation therapy and the radiation oncologist says he'd like me to have about six "electron" treatments after the radiation therapy is over with. He said this electron therapy would be more focused on the area from which the tumor was removed and on the scar tissue. I had never heard of this type of therapy before. What exactly is it? What risks are involved? Is it worth the risks?

Answer: Breast cancer, like most cancers, continues to be an area of concern, frustration and challenge for individuals with the disease, for physicians and for researchers. In most types of cancer, we don't have a single medication or treatment that will "cure" the illness. What we have instead is a variety of therapies that each offers some benefit for those with cancer.

Surgery is the cornerstone of treatment for breast cancer. Most operations are done to remove as much of the cancer as possible. The "lumpectomy" you had was done to remove the obviously cancerous growth. In years past the surgery for breast cancer involved removing the obvious cancer lump, just like the lumpectomy, and also the surrounding tissue a procedure called a radical mastectomy. Fortunately, this more disfiguring and extensive surgery has shown no significant benefit when compared to the lumpectomy. So, the lumpectomy you had is the "standard of care" for today.

The surgeon will also remove some of the lymph nodes from the breast and underarm areas. This is done because breast cancer typically spreads by one of two ways: it grows larger and extends into adjacent areas, and it spreads to distant areas through the lymphatic system. The local extension of the cancer is responsible for the size of lump that is removed at the time of the lumpectomy. The lymph nodes are removed so that they can be studied under a microscope for signs of cancer.

Surgery is the most common treatment for breast cancer, but it alone can't offer as great a chance for cure as surgery combined with other cancer treatments. Since cancer is a rapidly growing tissue, it is more easily damaged than is other slower growing tissue. Both chemotherapy and radiation attempt to permanently damage the fast growing cancer while doing only repairable injury to normal tissue.

In radiation therapy, beams of high energy radiation are directed at the area where the cancer lump was and also at areas into which the cancer may spread. Radiation with high energy levels, like the treatments you have already had, penetrate deeply. This type of treatment is used when the suspected areas are deep within the breast, underarm or chest. Several treatments are required to have the desired effect on the deep tissues while minimizing the damage to the skin and other superficial structures.

The electron beam therapy your doctor suggests is radiation therapy that uses electron beams at relatively low-energy levels instead of other subatomic particles or electromagnetic radiation at higher energy levels. These electrons have most of their effect on the skin and tissues one to two inches below it. This is used when the cancer is particularly close to the skin and, therefore, easily attacked by the electron beam. Your doctor is obviously concerned that you have a risk of cancer spreading close to the skin as well as to deeper tissues. That is why he has suggested both types of radiation treatments.

You asked if there are risks associated with electron beam radiation and if the benefits are worth the risks. Certainly there are risks. Radiation damages living cells, including normal cells. It should be avoided, except when medically necessary. Legitimate medical uses include the low doses needed to take X-rays and the much higher levels required to treat life-threatening situations like your cancer. You and your radiation oncologist should discuss the specific benefits and risks of the treatment he has suggested for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.