In the middle of pinktober, after Metastatic Breast Cancer Day (October 13), I have some thoughts on breast cancer research I would like to share:
My first wish is that more money, time, and focus would be on metastatic breast cancer research. Breast cancer does not kill, metastatic or late stage breast cancer kills. The proportion of funds spent on metastatic breast cancer is minuscule. This needs to change or more and more women (and men) will continue to die from this disease.
My second wish is that more research would be done on DCIS to determine which cases are more likely to develop into potentially fatal disease vs. those which will remain benign. The vast majority of cases of breast cancer which are diagnosed are DCIS. Many of these patients are subjected to extensive surgery without really knowing if it was necessary or not. This needs to change.
Finally a cure for cancer would be quite welcome as well. According to Star Trek, a cure for cancer was discovered in the 21st century.....
Showing posts with label breast cancer treatment. Show all posts
Showing posts with label breast cancer treatment. Show all posts
Sep 11, 2018
May 21, 2018
The rush to (over) treat
We all know the two groups of people:
The ones who get a booboo and say 'no big deal' and clean it later, even if just in the shower later on, vs. the ones who rush for the antibacterial soap, alcohol, bacitracin or neosporin, and bandaid. Well maybe they aren't two solid groups but there are two sides to the equation with scatterings in between.
With breast, or any type of, cancer, there is often a rush to say 'get it out of me!' But that is starting to change, especially in view of concerns with overtreatment of DCIS, that some people say 'I'll wait'. I can see that.
I think the typical patient has lemming traits where they agree basically with what the doctors tell them, and if they do not agree, they find another doctor who they agree more with. How often do we stop and say, 'now that I know what it is, I can wait and make a decision'. I think we need to stop and think with a diagnosis and say 'what are my choices?' and 'can I wait?' And not to skip 'what are the pros and con's of immediate treatment'.
Doctors are also starting to change their train of thought as well.
We have learned so much about the side effects of treatment that I think they need to be a big part of our medical decisions. And we should consider no treatment among the options. Its my body and my choice.
I think the typical patient has lemming traits where they agree basically with what the doctors tell them, and if they do not agree, they find another doctor who they agree more with. How often do we stop and say, 'now that I know what it is, I can wait and make a decision'. I think we need to stop and think with a diagnosis and say 'what are my choices?' and 'can I wait?' And not to skip 'what are the pros and con's of immediate treatment'.
Doctors are also starting to change their train of thought as well.
We have learned so much about the side effects of treatment that I think they need to be a big part of our medical decisions. And we should consider no treatment among the options. Its my body and my choice.
May 8, 2018
Good things come to those who wait
Back in 2010, I blogged about wishful thinking for a cure for lymphedema and other things, like cancer. And now, (insert drum roll here), a study is going on in the UK on 'replumbing' lymph nodes after breast cancer surgery. Barbara Jacoby over at Let Life Happen blogged about this.
So five years after first hearing about this surgery to reattach lymph nodes now there is a trial going on. This doesn't mean I can talk to my doctor about having this surgery any time soon, but I can see the progress.
The world of a patient is filled with hope and waiting. It is nice to see that progress is happening once in a while. We hear about all these breakthroughs but then it is rare to see them start to actually be rolled out. That is when good things come to those who wait.
We just sometimes get sick of waiting so long.
And I would like to point out that there is no way that I will undergo a five hour surgery under local and use my other arm to read a book or use an ipod during it. I will be fast asleep so I don't freak out. Yuck.
So five years after first hearing about this surgery to reattach lymph nodes now there is a trial going on. This doesn't mean I can talk to my doctor about having this surgery any time soon, but I can see the progress.
The world of a patient is filled with hope and waiting. It is nice to see that progress is happening once in a while. We hear about all these breakthroughs but then it is rare to see them start to actually be rolled out. That is when good things come to those who wait.
We just sometimes get sick of waiting so long.
And I would like to point out that there is no way that I will undergo a five hour surgery under local and use my other arm to read a book or use an ipod during it. I will be fast asleep so I don't freak out. Yuck.
Nov 27, 2017
Inaccurate Medical Tests
With new medical research, medical 'tests' are springing up all over to test for genetic defects in unborn babies, best treatments for medical conditions, and risks of certain diseases, among other issues. The problem is not all these tests are accurate and are leading to unnecessary surgeries, putting patients on unneeded medications, and raising medical costs.
The problem is when tests are run at a single facility so the FDA is relying on manufacturer reported problems including deaths or injuries to patients.
"Diagnostic tests are now regulated differently depending on where they were developed and manufactured. Products that will be sold to multiple labs — “commercial test kits” — are typically subject to FDA review before they go on the market.
Manufacturers are supposed to inform the government if they learn that their products may have contributed to a death or a serious injury, and they may have to notify the government if they recall defective products.
But for tests manufactured and used within a single laboratory, the agency has not actively enforced regulatory requirements, even though doctors around the country may submit samples to that lab for testing."
The tests included here are the OncotypeDX for breast cancer recurrence risk and the CA-125 test for ovarian cancer. Using the CA-125 test as an example:
One blood test to help detect ovarian cancer was never shown to be effective, the report said, but was used anyway. False-positive tests may have led to “unnecessary surgery to remove healthy ovaries.”
According to the American Cancer Society:
"In studies of women at average risk of ovarian cancer, using TVUS and CA-125 for screening led to more testing and sometimes more surgeries, but did not lower the number of deaths caused by ovarian cancer. For that reason, no major medical or professional organization recommends the routine use of TVUS or the CA-125 blood test to screen for ovarian cancer."
There are also studies out looking at the validity of these two tests and others. The current administration as well as much of Congress is looking at ways to close loopholes and require additional testing and validation of the tests to ensure patients are not harmed or subject to unneeded treatments.
My doctors have never mentioned either of these two tests for me. I do not think they are used at the hospital where I am treated either. Sometimes I have wondered why these tests were not offered. But now I am happy I didn't make any decisions based on their results.
The problem is when tests are run at a single facility so the FDA is relying on manufacturer reported problems including deaths or injuries to patients.
"Diagnostic tests are now regulated differently depending on where they were developed and manufactured. Products that will be sold to multiple labs — “commercial test kits” — are typically subject to FDA review before they go on the market.
Manufacturers are supposed to inform the government if they learn that their products may have contributed to a death or a serious injury, and they may have to notify the government if they recall defective products.
But for tests manufactured and used within a single laboratory, the agency has not actively enforced regulatory requirements, even though doctors around the country may submit samples to that lab for testing."
The tests included here are the OncotypeDX for breast cancer recurrence risk and the CA-125 test for ovarian cancer. Using the CA-125 test as an example:
One blood test to help detect ovarian cancer was never shown to be effective, the report said, but was used anyway. False-positive tests may have led to “unnecessary surgery to remove healthy ovaries.”
According to the American Cancer Society:
"In studies of women at average risk of ovarian cancer, using TVUS and CA-125 for screening led to more testing and sometimes more surgeries, but did not lower the number of deaths caused by ovarian cancer. For that reason, no major medical or professional organization recommends the routine use of TVUS or the CA-125 blood test to screen for ovarian cancer."
There are also studies out looking at the validity of these two tests and others. The current administration as well as much of Congress is looking at ways to close loopholes and require additional testing and validation of the tests to ensure patients are not harmed or subject to unneeded treatments.
My doctors have never mentioned either of these two tests for me. I do not think they are used at the hospital where I am treated either. Sometimes I have wondered why these tests were not offered. But now I am happy I didn't make any decisions based on their results.
May 1, 2017
This is just too perky for me
My gag reflex is kicking in. This woman has metastatic breast cancer and is successfully being treated by Ibrance according to her perky oncologist. It isn't news, it feels like an Ibrance commercial.
I have the urge to barf. I'm sorry but its true. And yes its that really expensive new treatment.
And my inner marketing person says this kind of news article is really a type of advertising. I am not saying that anyone in the video did anything wrong. But marketing comes in all forms. And Pfizer is making big bucks on Ibrance.
And my inner marketing person says this kind of news article is really a type of advertising. I am not saying that anyone in the video did anything wrong. But marketing comes in all forms. And Pfizer is making big bucks on Ibrance.
You can read that article here. Okay, my inner witchy cynic is showing this morning. Maybe I need a nap or something.
Sep 26, 2016
Another 'Upside' to Breast Cancer Treatment
Its not enough that breast cancer treatment consists of slashing, poisoning and burning. These leave a physical and emotional toll that can include additional ailments, including new cancers. One of them is nice rare one without much available research and a high mortality rate - angiosarcoma. Please read and enjoy the following:
"Physicians have long noticed that breast cancer patients who have had surgery or radiation therapy have an heightened risk of developing angiosarcoma, a rare type of cancer that originates in the lining of the blood vessels.
Now, researchers at Loyola University Health System in Maywood, Ill., have focused in on a finding that could be a possible precursor to angiosarcoma. With further research this finding could lead to more definitive markers that could predict those who are most likely to develop the disease. Angiosarcoma is a malignant, rapidly growing, highly invasive type of cancer that has a high mortality rate.
In a case study published in the Journal of the American Academy of Dermatology, researchers at Loyola identified what at first appeared to be only a tiny bruise on the right breast of a 63-year-old woman. Four years prior the woman had had a lumpectomy in the breast and radiation therapy for cancer. She had also had chemotherapy and hormone therapy.
“Normally, when you see a benign-appearing vascular lesion, you probably would pass it up,” said Dr. Joshua Mandrell, a dermatologist who co-authored the report. “But given her history, we biopsied it and it did show that it was an atypical vascular lesion.”
Atypical vascular lesions are abnormal vascular growths that are thought to form in response to trauma, such as that caused by surgery and radiation therapy, according to the study. The lesions are so rare that few medical professionals are aware of their existence. There are also no well defined prognosis factors or treatment guidelines for them.
“Atypical vascular lesions are not completely benign blood vessel growths and are not angiosarcoma. They are right in the middle. They are atypical enough that we suggest in our study that they warrant treatment,” Mandrell said. “The thought is that they could potentially become angiosarcomas.”
How lovely is that? When I searched on cancer.org's website for angiosarcoma, this is what I found:
"This form of cancer starts in cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arms of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section "How is breast cancer treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas. See Sarcoma: Adult Soft Tissue Cancer."
That was all that was listed. And when I went to the link for sarcoma, it was not even mentioned. Nice.
I can't wait. I had radiation and have lymphedema. I'll just add this to my list of crap to look out for. And if its related to cancer, it is all crap.
"Physicians have long noticed that breast cancer patients who have had surgery or radiation therapy have an heightened risk of developing angiosarcoma, a rare type of cancer that originates in the lining of the blood vessels.
Now, researchers at Loyola University Health System in Maywood, Ill., have focused in on a finding that could be a possible precursor to angiosarcoma. With further research this finding could lead to more definitive markers that could predict those who are most likely to develop the disease. Angiosarcoma is a malignant, rapidly growing, highly invasive type of cancer that has a high mortality rate.
In a case study published in the Journal of the American Academy of Dermatology, researchers at Loyola identified what at first appeared to be only a tiny bruise on the right breast of a 63-year-old woman. Four years prior the woman had had a lumpectomy in the breast and radiation therapy for cancer. She had also had chemotherapy and hormone therapy.
“Normally, when you see a benign-appearing vascular lesion, you probably would pass it up,” said Dr. Joshua Mandrell, a dermatologist who co-authored the report. “But given her history, we biopsied it and it did show that it was an atypical vascular lesion.”
Atypical vascular lesions are abnormal vascular growths that are thought to form in response to trauma, such as that caused by surgery and radiation therapy, according to the study. The lesions are so rare that few medical professionals are aware of their existence. There are also no well defined prognosis factors or treatment guidelines for them.
“Atypical vascular lesions are not completely benign blood vessel growths and are not angiosarcoma. They are right in the middle. They are atypical enough that we suggest in our study that they warrant treatment,” Mandrell said. “The thought is that they could potentially become angiosarcomas.”
How lovely is that? When I searched on cancer.org's website for angiosarcoma, this is what I found:
"This form of cancer starts in cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arms of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section "How is breast cancer treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas. See Sarcoma: Adult Soft Tissue Cancer."
That was all that was listed. And when I went to the link for sarcoma, it was not even mentioned. Nice.
I can't wait. I had radiation and have lymphedema. I'll just add this to my list of crap to look out for. And if its related to cancer, it is all crap.
Sep 19, 2016
Cutting the last cord
What happens after all the treatment? Cancer patients are diagnosed and then get all kinds of care to make sure it doesn't come back (which is our greatest fear).
At the end of treatment, all of a sudden this constant care by all kinds of medical people to check you over and reassure you that it hasn't come back comes to a screeching halt. At this point, the doctors all say come back in 3, 6, or 12 months and we will check again. And the patient says 'whhhaaattt? But what if it comes back? Who will know?'
This is the most frequent time for patients to wig out and require emotional support from a support group or therapist to make sure they don't go off the deep end. It is a very stressful time. You are alone with the little thoughts in the middle of the night - what if it comes back?
With breast cancer, its a little different. You get surgery and chemotherapy. Medical personnel is all around to be aware of a single sneeze. Then some get radiation as well where you are seen daily for weeks on end. At the end of this time most go on to hormonal therapy - Tamoxifen, Femara, Aromasin, or the other one who's name I can't remember right now. That lasts for five to ten years. And then finally you are on your own and you see your oncologist maybe once a year.
I went through this a long time ago when I had thyroid cancer. At the end of about six months of doctor appointments I was left to cope on my own. And I can tell you in some ways it really sucked big time. And left me with some strong emotional issues that took a long time to recover from.
When I was diagnosed with breast cancer, I told myself I was not going to let cancer suck any happiness out of my life and went to support groups before my first surgery. Then I got a therapist at the end of radiation as well. But I was still on hormonal medication - 2 years of Tamoxifen and then Femara.
Yesterday I went to see my oncologist and she said it was time for me to end Femara - that last little pill to help prevent it from coming back. She said she had mentioned this at my visit last year but since I can't remember last week, never mind last year, I had no memory of this.
Basically while there is lots of data on the benefits of staying on Tamoxifen for ten years there is no research now to prove there is any benefit to staying on Femara or other aromatase inhibitors for longer than five years. There are ongoing studies on this but no results yet. This research will take years because they are following women after five years of Femara.
My oncologist brought up the joint pain issues I have. She said that one of the side effects of Femara was joint pain. I couldn't tell you if I am experiencing this or not. All I can remember is after chemo, I went on Tamoxifen and started feeling better because I wasn't in chemo any more. Then after two years of Tamoxifen I went on Femara and again started feeling better again because the side effects of Tamoxifen can be pretty bad. But I have no idea how I would feel not being on Femara because pre-breast cancer I was a much healthier person.
So now the plan is I am off Femara for now through Labor Day. That should give enough time for it to leave my system and see if I have any fewer pains or if I get too worried. My oncologist brought up the stress of recurrence fears, not me. She said at that time, I can always decide to go back on it if I want.
I am happy to take one less pill each day. But it has been the last stand against recurrence. So now I have to learn to live without the benefits of anything to prevent recurrence. For now, I think I can live with this. But if my mind starts playing tricks on me with this recurrence crap, I may wimp out and decide to go back on it.
At the end of treatment, all of a sudden this constant care by all kinds of medical people to check you over and reassure you that it hasn't come back comes to a screeching halt. At this point, the doctors all say come back in 3, 6, or 12 months and we will check again. And the patient says 'whhhaaattt? But what if it comes back? Who will know?'
This is the most frequent time for patients to wig out and require emotional support from a support group or therapist to make sure they don't go off the deep end. It is a very stressful time. You are alone with the little thoughts in the middle of the night - what if it comes back?
With breast cancer, its a little different. You get surgery and chemotherapy. Medical personnel is all around to be aware of a single sneeze. Then some get radiation as well where you are seen daily for weeks on end. At the end of this time most go on to hormonal therapy - Tamoxifen, Femara, Aromasin, or the other one who's name I can't remember right now. That lasts for five to ten years. And then finally you are on your own and you see your oncologist maybe once a year.
I went through this a long time ago when I had thyroid cancer. At the end of about six months of doctor appointments I was left to cope on my own. And I can tell you in some ways it really sucked big time. And left me with some strong emotional issues that took a long time to recover from.
When I was diagnosed with breast cancer, I told myself I was not going to let cancer suck any happiness out of my life and went to support groups before my first surgery. Then I got a therapist at the end of radiation as well. But I was still on hormonal medication - 2 years of Tamoxifen and then Femara.
Yesterday I went to see my oncologist and she said it was time for me to end Femara - that last little pill to help prevent it from coming back. She said she had mentioned this at my visit last year but since I can't remember last week, never mind last year, I had no memory of this.
Basically while there is lots of data on the benefits of staying on Tamoxifen for ten years there is no research now to prove there is any benefit to staying on Femara or other aromatase inhibitors for longer than five years. There are ongoing studies on this but no results yet. This research will take years because they are following women after five years of Femara.
My oncologist brought up the joint pain issues I have. She said that one of the side effects of Femara was joint pain. I couldn't tell you if I am experiencing this or not. All I can remember is after chemo, I went on Tamoxifen and started feeling better because I wasn't in chemo any more. Then after two years of Tamoxifen I went on Femara and again started feeling better again because the side effects of Tamoxifen can be pretty bad. But I have no idea how I would feel not being on Femara because pre-breast cancer I was a much healthier person.
So now the plan is I am off Femara for now through Labor Day. That should give enough time for it to leave my system and see if I have any fewer pains or if I get too worried. My oncologist brought up the stress of recurrence fears, not me. She said at that time, I can always decide to go back on it if I want.
I am happy to take one less pill each day. But it has been the last stand against recurrence. So now I have to learn to live without the benefits of anything to prevent recurrence. For now, I think I can live with this. But if my mind starts playing tricks on me with this recurrence crap, I may wimp out and decide to go back on it.
Sep 6, 2016
Progesterone too?
So I have always wondered, what about progesterone in breast cancer treatment. A big part of your breast cancer diagnosis is its hormone status. My breast cancer was the most common type - ER+/PR+/Her2-. That translates to estrogen and progesterone positive and her2 negative.
This determines a big part of your treatment. If you are estrogen positive you are treated with Tamoxifen and/or one of the aromatase inhibitors. If you are Her2 positive, you can receive Herceptin. But no one ever said anything about progesterone. I always wondered why it was part of the diagnosis if it didn't affect treatment. I mean why bother?
But now things have changed. New research has found a way to control progesterone as well:
"Cancers with progesterone receptors are known for growing more slowly, however scientists have not been able to exploit this fact until they discovered the way they interact with estrogen, which causes the growth of some tumors"
"In the new study, researchers found that progesterone receptors interact with estrogen receptors in the tumor, changing their behavior and slowing the tumor's growth."
"Roughly 75 percent of women with breast cancer have tumors with the estrogen receptor, and 75 percent of those tumors also have progesterone receptors -- suggesting more than half of these patients could benefit if the treatment is shown to be successful."
And the outcome should be a cheap and safe treatment option.I'm all for this.
This determines a big part of your treatment. If you are estrogen positive you are treated with Tamoxifen and/or one of the aromatase inhibitors. If you are Her2 positive, you can receive Herceptin. But no one ever said anything about progesterone. I always wondered why it was part of the diagnosis if it didn't affect treatment. I mean why bother?
But now things have changed. New research has found a way to control progesterone as well:
"Cancers with progesterone receptors are known for growing more slowly, however scientists have not been able to exploit this fact until they discovered the way they interact with estrogen, which causes the growth of some tumors"
"In the new study, researchers found that progesterone receptors interact with estrogen receptors in the tumor, changing their behavior and slowing the tumor's growth."
"Roughly 75 percent of women with breast cancer have tumors with the estrogen receptor, and 75 percent of those tumors also have progesterone receptors -- suggesting more than half of these patients could benefit if the treatment is shown to be successful."
And the outcome should be a cheap and safe treatment option.I'm all for this.
Sep 5, 2016
Breast cancer and flabbiness
I am not sure this article tells me that much but it did try to figure out if breast cancer and its treatment cause weight gain. It discusses the results of a recent study that was recently published.
So breast cancer increases in incidence right about the same age as menopause. Therefore there has been some confusion if its menopause or cancer and its treatment that cause weight gain. But this article did nothing to help me.
First of all it looked at an average weight gain of 4 lbs for women with breast cancer who did not have chemo and of 11 lbs for women who received chemotherapy. 4 lbs or 11 lbs? That's nothing. I am more concerned about the 20 or 30 lbs weight gains. I know women who said they gained 5-10 lbs during treatment and then lost them. Those of us who gained more, even if active during treatment, have many more problems losing weight.
The real concern is that weight gain can have longer term health risks.
But the study promises to follow up with the women over a longer period of time. I would like to see a study about the women who gain 20 lbs or more during cancer treatment and ensuing health issues. No one ever seems to care what I think. Or to include me in research because I have too many other issues and would skew their data.
So breast cancer increases in incidence right about the same age as menopause. Therefore there has been some confusion if its menopause or cancer and its treatment that cause weight gain. But this article did nothing to help me.
First of all it looked at an average weight gain of 4 lbs for women with breast cancer who did not have chemo and of 11 lbs for women who received chemotherapy. 4 lbs or 11 lbs? That's nothing. I am more concerned about the 20 or 30 lbs weight gains. I know women who said they gained 5-10 lbs during treatment and then lost them. Those of us who gained more, even if active during treatment, have many more problems losing weight.
The real concern is that weight gain can have longer term health risks.
But the study promises to follow up with the women over a longer period of time. I would like to see a study about the women who gain 20 lbs or more during cancer treatment and ensuing health issues. No one ever seems to care what I think. Or to include me in research because I have too many other issues and would skew their data.
Aug 7, 2015
Shorter radiation is better
Sometimes editing takes out all the important information. This took a lot of digging to find out what the hell it was talking about.
I first came across this article which says higher dose shorter radiation is better that the traditional radiation given to breast cancer patients. This makes sense because the damage from radiation is cumulative meaning that it gets worse and worse after each treatment. Other side effects such as fatigue are also lessened from the shorter course of treatment.
Well that is nice to know but how much shorter is it? I couldn't tell but did go find the referenced article, Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort, on JAMA Oncology. You got that?
How's this instead?
"Randomized trials have established that hypofractionated regimens of radiotherapy to the whole breast can provide long-term disease control that is equivalent to the excellent outcomes of more protracted conventional fractionation schedules in selected patients undergoing lumpectomy for breast cancer. Hypofractionation might also result in lower rates of late toxic effects than conventional fractionation. Although the American Society for Radiation Oncology has issued consensus guidelines to identify patients in whom hypofractionation is appropriate and endorsed consideration of hypofractionation in its Choosing Wisely campaign, uptake of hypofractionated regimens has demonstrated considerable variability worldwide and has been relatively slow within the United States."
Okay, what if I tell you this:
"Traditionally, women undergoing lumpectomy for breast cancer were treated with 5-6 weeks of daily radiation after surgery. "Hypofractionated" regimens are shorter courses of radiation, in which a slightly larger dose of radiation is given per day, allowing radiation to be delivered in a shorter period of time, most commonly in 3-4 weeks."
Finally, I get to the truth and find that 2 weeks less, slightly higher dose radiation offers fewer side effects? Why couldn't they say that first?
I first came across this article which says higher dose shorter radiation is better that the traditional radiation given to breast cancer patients. This makes sense because the damage from radiation is cumulative meaning that it gets worse and worse after each treatment. Other side effects such as fatigue are also lessened from the shorter course of treatment.
Well that is nice to know but how much shorter is it? I couldn't tell but did go find the referenced article, Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort, on JAMA Oncology. You got that?
How's this instead?
"Randomized trials have established that hypofractionated regimens of radiotherapy to the whole breast can provide long-term disease control that is equivalent to the excellent outcomes of more protracted conventional fractionation schedules in selected patients undergoing lumpectomy for breast cancer. Hypofractionation might also result in lower rates of late toxic effects than conventional fractionation. Although the American Society for Radiation Oncology has issued consensus guidelines to identify patients in whom hypofractionation is appropriate and endorsed consideration of hypofractionation in its Choosing Wisely campaign, uptake of hypofractionated regimens has demonstrated considerable variability worldwide and has been relatively slow within the United States."
Okay, what if I tell you this:
"Traditionally, women undergoing lumpectomy for breast cancer were treated with 5-6 weeks of daily radiation after surgery. "Hypofractionated" regimens are shorter courses of radiation, in which a slightly larger dose of radiation is given per day, allowing radiation to be delivered in a shorter period of time, most commonly in 3-4 weeks."
Finally, I get to the truth and find that 2 weeks less, slightly higher dose radiation offers fewer side effects? Why couldn't they say that first?