Felicia rings the bell after completing proton therapy for breast cancer

Breast cancer patient says proton therapy allowed her to ‘go on with life’

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The way Felicia sees it, her cancer journey wasn’t a marathon. It wasn’t even just one race. Instead, it was a series of short courses, each with its own finish line.

And proton therapy was her final finish line. The one that meant the most.

“I took it in chunks. I looked at everything as a finish line,” she says. “Like going through chemo. Just get to that finish line. And proton therapy is my last finish line, so I’m excited!”

The road to that final finish line included mountains of research. She chose to be her own health advocate and made sure she knew each and every one of her treatment options. Ultimately, she took a path that led her to Provision CARES Proton Therapy.

“I still have a lot of life ahead of me. I’ve got things I want to do. Proton therapy makes me feel like my cancer is truly out of me and I’m done. Let’s go on with life. Let’s move forward!”

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Proton therapy can help reduce heart radiation exposure from cancer treatment

If you have one of these cancers, proton therapy can help keep your heart safe

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When it comes to treating cancer with radiation, many patients are concerned about the long-term effects the treatment will have on their heart. For cancers near this vital organ, traditional x-ray radiation can cause several cardiac health issues, including heart attacks, heart failure, and arrhythmias.1

Heart radiation from cancer treatment is especially worrisome for breast, lung, and esophageal cancer patients. If any part of the heart is exposed to radiation, the risk of heart disease is increased. Often, these cardiac side effects don’t appear until several years after the cancer treatment.

In this article, we’ll look at each of those cancers and identify the risk associated with radiation, as well as how proton therapy can help alleviate some of the concerns.

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Exercise for breast cancer patients improves survival rate and lower risk of recurrence

A little exercise goes a long way for breast cancer patients

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It’s no secret that exercise is beneficial for breast cancer patients. Years of research show a positive correlation between physical activity and cancer survival rates.  A new study is now shedding some light on just how much exercise you need to reap the rewards.

A study published in the Journal of the National Cancer Institute suggests that even a small amount of exercise helps high-risk breast cancer patients live longer and increases their likelihood of remaining cancer-free after treatment.

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Delaying cancer screening tests during COVID puts patients at risk

Delayed cancer screenings in COVID era put patients at risk

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When the COVID-19 pandemic began, life as we knew it came to an abrupt halt. That included routine healthcare visits, as many providers postponed appointments and cancer screening tests that were deemed “non-essential.”

In the United States alone, an estimated 22 million cancer screening tests were disrupted by COVID-19 from April to June 2020. As a result, about 80,000 patients could be at risk for delayed or missed diagnoses.

The IQVIA Institute for Human Data Science recently published these estimates as part of its report on shifts in healthcare demand, delivery and care during the COVID-19 era. In this article, we’ll look at how diagnostic procedures for some of the most common cancers are impacted. We’ll also share some tips to help you move forward with your cancer-related care in a timely and safe manner.

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Proton therapy cancer treatment significantly lowers the risk of second cancer compared to IMRT and 3DCRT

Proton Therapy significantly lowers risk of second cancer

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X-ray (also called photon) therapy has long been known to cause the development of potentially deadly new cancers in patients who undergo radiation therapy to treat their cancer. However, research shows that patients who choose proton therapy for cancer treatment have a significantly lower risk of developing a second cancer later in life.

In a  comprehensive study published last month in Cancer, the prestigious, peer-reviewed journal of the American Cancer Society, researchers at Stanford University found that patients who were treated with x-ray therapy developed more than three times as many new cancers as patients treated with proton therapy.1

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Breast Cancer Awareness Month

Breast Cancer Facts: 5 Common Myths Debunked

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One of the toughest parts about researching breast cancer online is trying to sort fact from fiction. The internet is full of half-truths, conflicting reports and flat-out myths about the disease. Provision CARES Proton Therapy is committed to our Culture of CARE, putting the patient experience first. So, for Breast Cancer Awareness Month, we’re debunking five of our most commonly heard myths. All of these breast cancer facts have been verified for quality and accuracy by our cancer care experts to help you make an informed decision about your healthcare.


MYTH: I found a lump in my breast, so I have cancer.

TRUTH: Lumps don’t always indicate cancer. Likewise, the absence of lumps doesn’t always mean you don’t have breast cancer.

While the most common symptom of breast cancer is a lump, most breast lumps are caused by conditions other than cancer. According to the Centers for Disease Control and Prevention (CDC), the two most common causes are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, while cysts are small fluid-filled sacs that develop in the breast.

The American Cancer Society (ACS) says lumps are more likely to be cancerous if they are painless, hard and have irregular edges. However, some breast cancers can be painful, soft or round. That’s why you should always check with your doctor if you notice any changes in your breasts.

There are many other symptoms of breast cancer, even if a lump is not detected. These can include swelling of the breast, skin dimpling, breast or nipple pain, nipples turning inward, red or flaking breast skin, nipples discharging fluids other than breast milk, and swollen lymph nodes under your arm or around your collar bone. The ACS recommends contacting your doctor if you experience any of these symptoms.


MYTH: Breast cancer only happens to older women.

TRUTH: Breast cancer can develop in younger women, too, as well as men.

While your risk does increase with age, the NCI reports women in their 30s have a 1 in 208 chance of developing breast cancer. By the time a woman reaches her 40s, that risk has increased to 1 in 65. Overall, it’s estimated that 1 out of every 8 women in the United States will develop breast cancer at some point in her life.7

Breast cancer in men accounts for less than 1% of cases in the United States. However, the ACS says male breast cancer is on the rise.1 Unfortunately, a higher percentage of men are diagnosed with advanced-stage breast cancer, likely a result of less awareness and fewer early-detection screenings.

If you’ve been diagnosed with breast cancer and would like to learn more about proton therapy as a possible treatment, please visit our Proton Benefits page or contact a Care Coordinator.


MYTH: My family has no history of breast cancer, so I am not at risk.

TRUTH: While a family history of breast cancer does put you at greater risk, most women who develop breast cancer do not have a family history of the disease.1

According to the CDC, a family history of breast cancer may put you at higher risk for the disease, but is not indicative of whether you’ll actually develop cancer.2 In fact, the ACS says most women with one or more affected first-degree relatives (parents, siblings, children) will still never be diagnosed.

The CDC provides a table with examples of average, moderate and strong family health histories, along with suggestions for preventative measures each group can take. Regardless of your family history, the CDC recommends you get mammograms and other breast exams as recommended by your doctor, maintain a healthy weight and exercise regularly. As family history of breast cancer increases, genetic counseling becomes an option to test for hereditary breast cancer. Be sure to talk to your doctor about what screenings are best for you and when you should get them.


MYTH: A double mastectomy will eliminate my risk of breast cancer.

TRUTH: If the cancer is detected early enough, other treatment options can eliminate the cancer without removing the entire breast.

A mastectomy involves removing the entire breast and is typically performed when breast-conserving surgery (lumpectomy) is not an option. However, women with early-stage cancers can typically choose between the two types of surgeries. The ACS notes that while it’s normal for your gut reaction to be to “take out all the cancer as quickly as possible” with a mastectomy, the fact is that, most of the time, a lumpectomy combined with radiation therapy results in the same outcome.

Many patients at Provision CARES Proton Therapy choose to combine a lumpectomy with proton radiation therapy. Proton therapy for breast cancer treatment is non-invasive and painless, causing less cosmetic damage than conventional x-ray radiation. It is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. Because proton radiation has little to no impact on a patient’s energy level, quality of life during treatment is improved.

For women who do opt for a mastectomy, it’s important to remember that post-surgery treatment is still necessary. Even after removing the breast, there’s a small chance the cancer could recur on residual breast tissue or the chest wall. You should continue to perform self-breast exams and see your doctor on a regular basis.


MYTH: Antiperspirants and wire bras can cause breast cancer.

TRUTH: There has been no conclusive evidence linking antiperspirants or bras to breast cancer.

Rumors have swirled across the internet claiming underarm antiperspirants cause breast cancer. The National Cancer Institute (NCI) says the basis of these claims is the aluminum-based active ingredient in antiperspirants. Some scientists have suggested that absorbing these aluminum compounds into your skin could increase your risk factor for breast cancer.4 Still, no clear link has ever been established between antiperspirants and breast cancer. In fact, the NCI even cites a study from 2002 that concluded there is no increase in risk for breast cancer among women who reported using an underarm antiperspirant.3

Another rumor making its rounds across cyberspace is that wearing a wire bra can increase your risk of breast cancer. This myth was debunked by a 2014 study published by the American Association for Cancer Research. According to the authors, it had been suggested in the media that bras impede lymph circulation and drainage, interfering with the process of waste and toxin removal.6 However, the study concluded that wearing a bra had no effect on your risk of breast cancer.


Sources:

  1. Breast Cancer Facts & Figures 2017-2018. American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf
  2. Breast and Ovarian Cancer and Family History Risk Categories. Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/breast_ovarian_cancer/risk_categories.htm
  3. National Cancer Institute. Antiperspirants/Deodorants and Breast Cancer. https://www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html
  4. Darbre PD. Aluminium, antiperspirants and breast cancer.Journal of Inorganic Biochemistry 2005; 99(9):1912–1919. [PubMed Abstract]
  5. Mirick DK, Davis S, Thomas DB. Antiperspirant use and the risk of breast cancer.Journal of the National Cancer Institute 2002; 94(20):1578–1580. [PubMed Abstract]
  6. RayCC. Q and A – Bras and Cancer [Internet]. NY times; 2010 [cited 2013 Dec. 16]. Available from: http://www.nytimes.com/2010/02/16/science/16qna.html?ref=science.
  7. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD,https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

 

proton therapy for breast cancer treatment

Proton Therapy for breast cancer treatment ‘safe and effective’ concludes new study

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Proton therapy for breast cancer treatment is “safe and effective.” That’s the conclusion of a new study released in the Journal of Clinical Oncology, which highlighted proton therapy’s ability to control cancer cells with much less toxicity in the heart and lungs as compared to conventional (x-ray) radiation therapy.

“In our prospective trial of women with locally advanced breast cancer who required treatment of the internal mammary nodes, proton beam radiation therapy was safe and effective,” says Shannon M. MacDonald, MD, of Massachusetts General Hospital in Boston, and colleagues.

Breast cancer tumors usually occur in the lobules and ducts of the breast, which are used in the production and delivery of breast milk. Breast cancer is the most common cancer among women aside from skin cancer. Men are also susceptible to breast cancer, although the disease is rare among males.

As with other cancers, the best possible outcomes for breast cancer treatment come through early breast cancer care. Proton therapy has unique attributes that reduce radiation exposure to normal, healthy organs3,4. This is especially important in left-sided, node positive breast cancer patients (those who need the internal mammary nodes irradiated), as the cancer is close to critical organs such as the heart and the lungs.

How Massachusetts General Hospital conducted the study

Researchers enrolled 70 prospective patients with nonmetastatic breast cancer who required radiation therapy to the chest wall and regional lymph nodes. The average age of enrollees was 45, with patients ranging from 24 to 70 years old. The vast majority (91%) of evaluable patients had left-side breast cancer, and all but four patients had stage II-III disease. Only one patient did not receive chemotherapy in conjunction with proton radiation therapy.

The study, which lasted from 2011 to 2016, specifically chose patients whose treatment would include irradiation of the internal mammary nodes (IMNs). This made them suboptimal candidates for conventional radiation therapy, since exposure to the IMNs would also increase radiation to the heart and lungs. According to the study’s authors, that has been associated with an increased risk of cardiac events.

The benefits of proton therapy, however, significantly reduce exposure to the heart and lungs. It’s an advanced form of radiation therapy that precisely targets a tumor using a single beam of high-energy protons to kill cancer cells. Unlike conventional photons, which have almost no mass and extend beyond a tumor through the body, protons are relatively heavy and will hit their target – then stop. This spares nearby healthy tissues and organs from receiving unnecessary radiation.

Summary of the study’s results

Proton therapy for breast cancer treatment received high marks from this study. Of the 69 evaluable patients, the 5-year cancer recurrence rate was just 1.5% and the 5-year overall survival rate was 91%. Those positive results go hand-in-hand with low rates of severe side effects. Study authors reported no patient developed grade 3 pneumonitis (inflammation of the lungs) or grade 4 or higher toxicity in the lungs. They also reported no significant changes in cardiac function or key cardiac biomarkers.

Dr. MacDonald and colleagues concluded that “Proton beam radiation therapy (RT) for breast cancer has low toxicity rates and similar rates of disease control compared with historical data of conventional RT.”

Dr. Ben Wilkinson, MD, FACRO, Radiation Oncologist and Medical Director at Provision CARES Proton Therapy Knoxville says the findings of this study support the success he’s seen at Provision.

“Among mostly young women with left-sided breast cancer receiving regional nodal irradiation, proton therapy produces excellent target coverage with miniscule cardiac doses and low rates of lung toxicity,” Dr. Wilkinson says about the study’s conclusion. “When we treat breast cancer, those lymph nodes run very close to the heart. Proton therapy allows us to deliver the dose to the tumor site and spare the surrounding area – the heart, lung, chest wall, and even the esophagus.”

What’s next for proton therapy research?

The authors of the study from Massachusetts General Hospital say their findings open the door for more extensive studies in the future. “No early cardiac changes were observed,” they note, “Which paves the way for randomized studies to compare proton beam radiation therapy with standard radiation therapy.”

In fact, the results of the study bode well for a more comprehensive trial already underway to compare proton therapy with conventional x-ray therapy. The Radiotherapy Comparative Effectiveness (RADCOMP) Consortium Trial, which began in 2016 and will continue until at least 2022, is being conducted by the University of Pennsylvania, in conjunction with the Patient-Centered Outcomes Research Institute.

According to the U.S. National Library of Medicine, it is a pragmatic randomized clinical trial of patients with locally advanced breast cancer. More than 1,000 patients will be randomly assigned to receive either proton therapy or x-ray therapy. Each patient will have a 50-50 chance of getting into either treatment group. Both groups will be followed for at least 10 years after completing radiation therapy. The trial’s ultimate goal to is to study the patients’ quality of life outcome to help decide which is the best treatment option for future patients with breast cancer – proton therapy or x-ray therapy.

The Benefits of Proton Therapy for Breast Cancer Treatment

Proton therapy shows remarkable promise and advantages over conventional therapy in the treatment of breast cancer. It is a type of radiation that stops at a very specific point in the targeted tissue; conventional radiation continues beyond the tumor. In breast cancer, this means on average no radiation to the heart and on average 50% less radiation to the lung5 as compared with conventional radiation.

Proton therapy is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. It is not a substitute for a lumpectomy. Rather, it is used as an alternative to conventional radiation therapy. After surgery a breast cancer patient may receive 2-6 weeks of proton therapy.

Sources:

  1. Phase II Study of Proton Beam Radiation Therapy for Patients with Breast Cancer Requiring Nodal Irradiation. Journal of Medical Oncology
  2. Pragmatic Randomized Trial of Proton vs. Photon Therapy for Patients with Non-Metastatic Breast Cancer: A Radiotherapy Comparative Effectiveness (RADCOMP) Consortium Trial. ClinicalTrials.gov
  3. MacDonald S, Specht M, Isakoff S, et al. Prospective pilot study of proton radiation therapy for invasive carcinoma of the breast following mastectomy in patients with unfavorable anatomy – first reported clinical experience. Int J Radiat Oncol. 2012;84(Suppl 3):S113-S114. Abstract 281
  4. Moon SH, Shin KH, Kim TH, et al. Dosimetric comparison of four different external beam partial breast irradiation techniques: three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, helical tomotherapy, and proton beam therapy. Radiother Oncol. 2009;90:66-73.
  5. Early Toxicity in Patients Treated with Postoperative Proton Therapy for Locally Advanced Breast Cancer. U.S. National Library of Medicine, National Institutes of Health

 

Surviving Breast Cancer (Part 3)

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Casey’s Story: Starting Treatment

Casey is a two time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading part one and part two of her blog series. As a Care Coordinator for Provision CARES Proton Therapy Knoxville and going through radiation therapy for the first time for recurring breast cancer, I can absolutely say that radiation therapists are gems…each and every one of them.

After initial office visits, CT Simulation, and treatment planning are finished it is time to start radiation therapy and these folks, the radiation therapists, are right there in the trenches with you. For the next 7 weeks I will see these wonderful people day in and day out to “finish off” this breast cancer.

Working at Provision gave me a sense of calm about the end result but to be candid, I was still nervous about the process.  Would I know what to do and say?  Is it weird to just lay on the table and be alone while radiation is being delivered?  What does it feel like?  Will I be self-conscious being exposed from the waist up?

Trust me when I tell you these therapists are experts at what they do. Zane, who manages the radiation therapists, was present for my first day.  He explained everything to me as it was happening which was particularly helpful to me. A quick example:  Zane explained body positioning, and how important it was to relax while being still. Proton therapy is very individualized which means no two plans are alike.  Your plan is specific to your tumor size and site, your physical body size and contours and believe it or not, your breathing!  These radiation oncologists and physicists think of everything.  

After putting on a gown you are escorted to the treatment room and use a step stool to get on to a slightly raised table.  In my case, radiation was going to be delivered with my arms above my head while I was lying flat with my knees slightly bent and supported.  There is a mold for my arms to rest in that was made specifically for me.  I remained covered up with a sheet until it was time for the actual treatment which was important to me.  The next and maybe most appreciated step for me:  MUSIC! It was calming and an immediate source of comfort for me.  The therapists will ask you each day what you feel like listening to that day.  This was a godsend to me as the music eased my nerves and passed the time.  

I was unprepared for, but very impressed by, the perfection in positioning the therapists strive for.  This is of utmost importance as the precise delivery (within a millimeter) of the proton beam depends on it.  Before your actual treatment, one of our Radiation Oncologists will check the position of the patient and give the okay for proton delivery.  The therapists leave the room and you are alone for about 90 seconds during treatment.  You are never truly alone as you are being watched remotely, and after a few treatments you become very accustomed to the whole process.  

Truthfully, it is a very quiet and calm time in the treatment room.  There were no smells or sounds to really get used to and I did not “feel” the radiation delivery.  For me, it was a time of reflection…a time to really think and appreciate what these fine folks do day in and day out.  I never got the feeling that it wasjust a job for them.  I always felt like I was the only patient there that day when in reality, there were up to 80 patients being treated in three treatment rooms.

Weekly visits with the clinical team are also part of your radiation therapy treatment.  This is an important step in monitoring your skin and any other changes you may be going through such as fatigue.   As I proceeded through treatment my only symptom was a significant “sunburn” to the areas treated.  I was prepared for this and used creams and lotions that were suggested by my doctor.  It was an easily forgotten side effect for me, though uncomfortable for a short period of time.  

Every Friday I was given a treatment schedule for the next week.  Wait, no weekends?.. a whole two days without radiation treatment?  I wondered “What will I do without the conversations and encouragement from Amos, Chris, Jamie and Jennifer?  They were my people.  My lifesavers. My friends.  I can do this, and I will do this with the help of these compassionate, kind and relatable therapists.

To follow Casey’s story, please follow us on Facebook.