by Eleni Tousimis, M.D.

This year, approximately 240,000 women will be diagnosed with breast cancer in the United States. The majority of these patients (77 percent) will be over the age of 50 at the time of diagnosis. Thanks to earlier detection of smaller tumors with the use of mammography, ultrasound and breast MRI, women have better, less-invasive treatment options available to them.

As a surgeon, this is a very exciting time to be treating women with breast cancer. These newer less-invasive treatments enable women to return to their normal lives without disfiguring scars or significant side effects. Early detection has allowed a growing number of women to choose breast-conserving surgery over mastectomy.

Breast-conserving surgery includes tumor removal followed by six weeks of whole breast radiation to decrease the likelihood of recurrence. Multiple studies have shown equivalent survival between the two treatment options; however, lumpectomy followed by radiation has better cosmesis with less risk of postoperative complications as compared to mastectomy.

For some patients who opt for breast-conserving surgery, the conventional six-week course of whole breast radiation after lumpectomy has not been appealing because of the time commitment, travel burden and potential associated side effects.

Also, when a breast cancer recurs in the breast, it tends to recur in the same area where the cancer was originally located. Therefore, whole breast radiation may not be necessary in all cases to prevent recurrences.

Many newer radiation techniques have been proposed with shorter courses and smaller radiation fields only localized to the tumor bed. These techniques are called partial breast radiation and the most common in use is Mammosite balloon radiation therapy.

Mammosite radiation therapy was developed to provide women with a targeted, five-day radiation treatment directly to the tumor bed. This minimizes radiation exposure to surrounding healthy tissue and organs including the rest of the breast, skin, ribs, lungs and heart.

During the surgery, after the lumpectomy is performed, a Mammosite balloon is placed inside the tumor resection cavity. The tube connected to the balloon remains outside the breast. The patient then returns to the hospital to receive the radiation treatment as an outpatient through the balloon tube for five consecutive days. At the conclusion of therapy, the balloon is deflated and removed.

Since FDA approval in 2002, more than 32,000 women have been treated with Mammosite partial breast radiation. Women with breast cancer who are eligible for its use must be older than 45, have small tumors and no involvement of their lymph nodes. 

In May 2007, the first clinical trial on the use of Mammosite targeted therapy showed no local recurrences, excellent cosmesis and very high patient satisfaction.

This and many other minimally invasive treatments have become excellent alternatives to women with less side effects while maintaining equivalent local recurrence and survival when compared to older techniques.

Eleni Tousimis, M.D., is associate program director of surgical education and assistant professor of surgery at the Cornell Medical Center in New York City.

Ed. note: For more on breast-conserving surgery, see this brochure from BMJ (PDF)

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