Brachytherapy and breast cancer unproven and with complications

In a rather bizarre report from Reuters, it seems in America, some oncologists have started treating breast cancers with brachytherapy a treatment used for prostate cancer in the UK. And there do not seem to be any Clinical Trials on this treatment.

’We were very surprised to see that brachytherapy is as commonly used as it is, particularly given that there is no clear evidence that it offers better cancer outcomes,’ said Dr. Cary P. Gross of Yale University School of Medicine in New Haven, Connecticut. (Journal of Clinical Oncology).

In America it seems as many as one in six women on Medicare, the government’s health insurance program for people over 65, end up getting the new therapy following breast-conserving surgery. And that figure varies by area with more than 70 per cent receiving the treatment in some areas.

Most usually the whole breast is irradiated from the outside over several weeks, but in brachytherapy the radiation is delivered from inside the breast. With the MammoSite device, for instance, a small balloon is inflated in the cavity that remains after the tumor is removed. It delivers high-dose radiation in less than a week and has been used on more than 50,000 women so far, according to its Massachusetts-based manufacturer Hologic.

The report was illuminating in other ways. Not just is an un-researched treatment now being widely used (so much for placebo controlled double blind clinical trials and all that mumbo jumbo), but previous studies on women receiving brachytherapy have shown acute complications. (35 per cent of women who got brachytherapy had a complication over the following year - usually an infection or other problem related to the wound or skin.)

On radiotherapy after breast tumour operations the report states that  not all patients will benefit from radiation treatment, but in many cases doctors recommend it to reduce the chance that the cancer will return. 18 per cent of women receiving standard radiotherapy have complications (almost one-in-five women).

’There is often a great deal of excitement for new treatments, but just because something is new doesn’t mean it’s better," said Gross. "Women should ask their providers to discuss with them, ’What do we really know about the risk and benefits of different treatment options?’



Dr. Jennifer Malin of the University of California, Los Angeles, writes, ’After a capital investment has been made to acquire the device () uptake of the new technology occurs even in the absence of evidence of improved or even comparable outcomes’.



UK ladies would do well to heed the above if being offered new treatments for breast cancer.
October - December Cancer Watch 2012
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