- Associated Press - Wednesday, December 7, 2011

SAN ANTONIO (AP) - New research casts doubt on a popular treatment for breast cancer: A week of radiation to part of the breast instead of longer treatment to all of it.

Women who were given partial radiation were twice as likely to need their breasts removed later because the cancer came back, doctors found.

The treatment uses radioactive pellets briefly placed in the breast instead of radiation beamed from a machine. At least 13 percent of older patients in the U.S. get this now, and it is popular with working women.

“Even women who aren’t working appreciate convenience,” but they may pay a price in effectiveness if too little tissue is being treated, said study leader Dr. Benjamin Smith of MD Anderson Cancer Center in Houston.

Results were to be reported Wednesday at a conference in San Antonio along with a more positive development: a new test that may help show which women need only surgery for a very early type of breast cancer called DCIS. The results suggest that about three-fourths of the 45,000 women diagnosed with DCIS annually in the U.S. could skip the radiation and hormone-blocking pills usually recommended to prevent a recurrence.

About 230,000 cases of breast cancer are diagnosed each year in the U.S., most in an early stage. Typical treatment is surgery to remove the lump, followed by radiation every weekday for five to seven weeks. That’s tough, especially for older women and those in rural areas.

Doctors hoped that a shorter approach, called brachytherapy, would be just as good with fewer side effects. To do it, they temporarily place a thin tube into the cavity where the tumor was.

“You come in twice a day and there’s a machine that puts in a radiation seed that stays there a few minutes and then you go home,” Smith explained.

Treatment takes only five days and the total radiation dose is comparable to the longer method. But a smaller area _ just around the lump _ gets treated instead of the whole breast.

Although at least three companies sell equipment for brachytherapy, no big studies have tested its safety and effectiveness.

Researchers looked at Medicare records on 130,535 women who had lumps removed and radiation. Less than 1 percent chose brachytherapy in 2000 but that rose to 13 percent by 2007.

After accounting for differences in age, tumor size and other factors, researchers found that within five years, 4 percent of brachytherapy patients needed surgery to remove the breast where the original tumor had been versus only 2 percent of those given traditional radiation. Hospitalization, infections, broken ribs and breast pain also were more common with brachytherapy.

It remains experimental, and women who want it should join a more rigorous study of it going on now, said Dr. Peter Ravdin, breast cancer chief at the UT Health Science Center in San Antonio.

“I’m putting patients on the trial” and not recommending it otherwise, he said.

Brachytherapy costs about twice as much as standard radiation, estimated at $10,000 to $20,000.

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