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A groundbreaking new Australian study paves the way for a major shift in the way early-stage breast cancer is treated, identifying women who can safely avoid radiotherapy and its often debilitating side effects.
By using magnetic resonance imaging (MRI) to screen women’s breasts for additional cancers or pre-cancers, researchers from Australia’s largest independent clinical trials group Breast Cancer Trials were able to pinpoint patients suitable for radiotherapy-free treatment.
Vicki Zugno feels lucky to have avoided radiation and all its side effects, and is now cancer-free. Credit: Chris Hopkins
This low-risk group – which had a cancerous tumour detected in one breast – was treated with surgery and hormone-blocking tablets.
Only one per cent of this cohort had a local recurrence of breast cancer within five years of their treatment, according to the study, which was published in prestigious medical journal The Lancet.
The study ran between 2011 and 2019 and screened 443 breast cancer patients at the Royal Melbourne Hospital, the Royal Women’s Hospital, the Austin Hospital and the Mater Hospital in Sydney.
Additional cancers or pre-cancerous areas were detected in 11 per cent of patients following an MRI scan, which meant they required radiotherapy. A further 110 patients required radiotherapy after surgery and revealed that their cancer was too large, or had spread to their lymph nodes. This left 201 patients in the cohort who avoided radiotherapy.
“It’s remarkable,” said the Royal Melbourne Hospital’s Professor Bruce Mann, who chaired the PROSPECT study and is director of research at Breast Cancer Trials.
“It is challenging the idea that these additional cancers don’t matter and that you don’t need to look for them. We’re saying well, they do matter because if you exclude them, you can avoid radiation.”
There has also previously been a reluctance to use MRI in patients with lower risk breast cancer due to concerns that the sensitive technology could lead to false-positives and unnecessary mastectomies. It is also much more expensive than a mammogram.
But the researcher determined that the forgone radiation more than paid for the additional costs of the medical imaging.
Vicki Zugno was able to return to work two weeks after treatment to remove her breast cancer.Credit: Chris Hopkins
“Every woman who was on the study saved the health system $2900,” Mann said.
The patients who avoided radiotherapy reported a reduced fear of cancer recurrence and improved quality of life compared with those who received radiotherapy.
Vicki Zugno, 67, was diagnosed with breast cancer in 2014 after undergoing a routine mammogram. She had noticed a flatness to the side of her breast in the months before the screening.
The Moonee Ponds resident signed up to the study because she wanted to avoid the side effects of radiotherapy.
“Radiation is quite intense,” she said. “It didn’t sound like much fun.”
The former nurse met the criteria for avoiding radiotherapy. She was able to return to work two weeks after a small cancerous tumour was surgically removed from her breast and she started taking hormone-blocking tablets.
“I don’t think I even took a Panadol,” Zugno said. “It was very straightforward.” She has remained cancer-free ever since and does not live with the fear of it returning.
Mann said MRI scans were very thorough and reassured women that all cancer had been detected. They are spared the side effects of radiotherapy which can include short-term pain and fatigue and some ongoing discomfort in the breast.
Mann said while radiotherapy was an excellent treatment for cancer when needed, it was linked to a small risk of developing additional cancers and heart damage.
“Identifying those who can safely avoid it is a high priority,” he said.
There was another unintended finding from the study: cancer did not recur around the body in any of the 443 patients within five years of treatment.
“It raises the possibility that the small number of distant recurrences in these patients with lower risk cancer is not due to the cancer that has been known about, but due to the [other cancers in breast] that we have found and therefore treated in the trial,” Mann said.
A larger, follow-up trial will be conducted to confirm the findings.
Victorian Comprehensive Cancer Centre Alliance executive director Grant McArthur said there was an increasing focus on de-intensifying cancer treatment.
“Radiation treatment is quite a long course,” he said. “There is travel time, time off work and side effects…all those things get reduced when we can de-intensify treatment. It improves patients’ quality of life.”
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