Hope For A Good Outcome

Improvements in breast cancer treatment

By Jonathan Scott  »  Photos by Diana Matthews

“I think we can say with confidence that we're seeing more survivors than ever before.” Dr. Sushma Patel has such a bright and lively demeanor that it can be hard to remember she treats women who struggle with the serious diagnosis of breast cancer.

“She's very positive,” says Debbie, a cancer survivor and one of Dr. Patel's  patients. “She has a way of making you feel positive, too. She always gives me hope for a good outcome.”

Despite the inevitable worry, hardship, and suffering that accompany a diagnosis of breast cancer, physicians such as Sushma Patel have legitimate reasons to instill hope. “Where we're really doing better,” she says, “is improving the effects of long term treatment.”

Patel is a Radiation Oncologist at FirstHealth Moore Regional Hospital. She brings her two decades of experience to the team of Radiation Oncologists that includes Jeff Acker, M.D. and Stephen King, M.D. All three are part of FirstHealth's larger Cancer Services Team. The challenges they face are enormous and not every outcome is what they would like, but their work is literally saving people's lives.

“Most people know the importance of early detection,” says Patel. “The 3D mammography we now have can find cancers in women who may not have any signs or symptoms.”

By combining a series of standard 2D images, 3D mammography can reduce the need for follow-up imaging, improve detection in women with dense breast tissue, and detect slightly more cancers than traditional mammography. Although FirstHealth has used the method for several years, 3D mammography isn't yet available everywhere.

“One of the reasons we're seeing an improvement in long-term outcomes of breast cancer treatment is something called neoadjuvant chemotherapy,” says Patel. “If a patient has a large tumor or a positive lymph node, they get this treatment before surgery. This can reduce the size of the cancer and allow us to conserve more breast tissue. It also can address any metastatic cancer that might be floating around elsewhere in the body.

“The newest trend in radiation treatment is altered fractionation. Standard treatment is usually six weeks long, once a day, five days a week. For women 50 and over who have stage I or stage II cancer, we can often do it in 2 fractions using altered fractionation. We do this by slightly increasing the dose of each treatment, so that the total dose given by the end is the radiobiologically equivalent.”

Breastcancer.org reports on two studies that have found women diagnosed with early-stage breast cancer treated with a shorter whole-breast radiation schedule after lumpectomy have fewer side effects and better quality of life than women treated with the longer, traditional radiation schedule. Plus, as a side benefit, it's more convenient for the patients.

Quoting results of the studies of over 2,000 patients from the Journal of the American Medical Association Oncology, the website shows that women who had been given fractionation treatment had significant reduction in inflamed, itchy and darkened skin as well as less pain and fatigue.

Patel and her team also perform something called Intensity-modulated radiation therapy (IMRT). It's  an advanced mode of high-precision radiotherapy that uses computers to deliver precise radiation doses to a malignant tumor or a specific region within a tumor. “In breast cancers,” says Patel, “we use it when standard therapy may cause more side
effects—harm to the heart, lungs or the arm due to lymphedema, or swelling. It allows us to shape radiation to avoid areas we don't want to include. And the technology in this area keeps getting better.”

When asked what other areas of treatment we can expect things to improve, Patel is quick to talk about breakthroughs in the study of genes and their function. “Already we have a better understanding of the DNA of the
tumor—what we can do to target a cancer's DNA mutations using new medications to minimize toxicity. Improving our knowledge and developing new chemotherapies and immunotherapies are going to be the next steps.”

To help in these efforts, Patel and the Cancer Services Team at FirstHealth participate in national clinical trials of new drugs. As of the writing of this article, there were seven breast cancer clinical trials underway. Usually the drugs are being tested for effectiveness in randomized blind groups, with one group being given the investigative drug. Often, tests to determine the effectiveness of innovative chemotherapies are given to patients who, for various reasons, might not respond to current treatments. Patients who participate in these studies are pioneers in helping others for
the future.

The truth is, though, that breast cancer is not simply a field of chemotherapies, radiation treatment, or genetic mysteries. It's a condition of people—largely, but not exclusively, women—whose lives and those around them are permanently affected.

“I get to know all my patients,” Patel says, “but one young woman stands out in my mind. She has a young daughter and her husband's in the military and is away sometimes on deployment. I've worked with her on and off over the course of years and we've come to know each other pretty well. Her story to me is an important one because it makes real what happens in people's lives. From the beginning up to now she's always tried to do everything she could. She has an amazing amount of courage.”

The respect Patel has for this patient is evident in her voice. Also evident is Patel's characteristic optimism, even in the face of daunting odds. For someone whose professional life involves powerful medical interventions, her thoughts on this patient's prognosis are surprising. “Attitude,” she says with a characteristic sparkle in her eyes, “can make a huge difference.”