Pick any 19 women at random in Malaysia and chances are that one of them will develop breast cancer at some point if not already diagnosed. In Singapore, breast cancer is the most common cancer among women and in both countries it remains as the leading cause of cancer mortality in women.

Most breast cancer patients will consult a surgeon be it a general or specialised breast surgeon prior to seeing the medical or radiation oncologists. This is by default the usual practice in both countries as given the strong advocacy for preventive screening initiated decades ago, the cancer is usually found at an early enough stage that surgery is the main treatment option.

PMRT benefits wider than previously thought

There has been numerous life-saving treatment advances against breast cancer, all of which brings new hope and encouragement. The overwhelming facade of treatment choices that fight the complex mix of cells in each individual cancer makes the decisions be it surgery, then perhaps radiation, hormonal therapy, or chemotherapy a tough one.

Now, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) have collectively published the new guideline update in their respective journals.

“The new guidelines say there is clear evidence that the benefit of post-mastectomy radiation therapy (PMRT) extends to women with limited lymph node involvement,” said Stephen Edge, co-chair of the expert panel that developed the guideline update and vice president for health care outcomes and policy at Roswell Park Cancer Institute in New York.

In essence, there is now enough evidence to show radiation treatment after a mastectomy decreases the risk of breast cancer recurrence, and that even women with smaller tumors and three or fewer lymph nodes involved can benefit from the therapy.

What has changed?

To develop this guideline update, the panel reviewed relevant literature published between 2001 and 2015, including a meta-analysis of 22 clinical trials published in 2014, which provides evidence that PMRT is highly effective at preventing local breast cancer recurrence.

Better knowledge of breast cancer biology now allows the cosmetic, physical and psychological stigmas of radical mastectomy to be better managed in the majority of breast cancer patients.

However, what follows after in recurrence prevention remained a controversial topic of discussion. Thus, the new guidelines help clarify what used to be a gray area in breast cancer post mastectomy, explains Janna Andrews, an attending physician in radiation medicine at Norwell Health Cancer Institute, in New York.

Andrews explained, “In the past, if a woman had a small tumor, less than 5 centimetres, and not more than three or four positive lymph nodes, many doctors would say she does not need post-mastectomy radiation therapy.”

This obviously does not apply in patients with widespread disease as once metastatic disease develops, wherein the possibility of a cure is very limited or practically nonexistent.

"We still don't have a single, validated formula that can determine who needs PMRT, but we hope that the research evidence summarised in this guideline update will help doctors and patients make more informed decisions,” added Edge.

Navigating the new post-surgery guidelines in Malaysia

In response, a local breast surgeon from Penang Adventist Hospital commented that, “The new guidelines however do not offer a one size fits all regimen as with any other form of cancer, and particularly so in breast cancer where risk factors vary significantly from age group to age group.”

Needless to say, doctors need to consider patients as a whole, and tailor their treatment regimen according to the balance of risks and benefits individually. MIMS

Read more:
Freezing out breast cancer with cryotherapy
Artificial ovaries may boost conception rates for those with endometriosis, or of more advanced age
Cancer control - a nationwide collaborative action plan by Malaysia’s Ministry of Health