Single-dose Radiation Therapy for Breast Cancer removes treatment barriers for underserved Black Women

Posted on Mar 2, 2021 in Uncategorized | 0 comments

March is Women’s History Month and February was Black History Month.  Single-dose radiation therapy for early stage breast cancer removes treatment barriers for underserved black women.  Black women experience longer breast cancer treatment times and may have less access to essential radiation technology, according to a recent study published in the journal Cancer on 11/15/2020.  The wider adoption of TARGIT-IORT (Intra Operative Radiation Therapy) addresses racial disparities and reduces compliance issues.  ABSMC has one of the leading IORT programs in the USA and has published.

The traditional approach to treating stage one or two breast cancer is tumor removal surgery followed by three to six weeks of daily External Beam Radiation Therapy (EBRT). Missing multiple daily treatments, having an unplanned break in treatment, or not completing the treatment course can result in a higher incidence of breast cancer recurrence and decreased long-term survival.

Transportation challenges, lack of childcare assistance, and inability to take time off work to attend radiotherapy appointments are just some of the obstacles noted across several underserved patient groups, including black women.  The arduous EBRT model is no longer necessary for many early-stage breast cancer cases. By not offering more tenable options, women risk falling through the cracks due to poor compliance. Targeted intraoperative radiotherapy can remove many of these barriers.  It provides women with the ability to complete all their necessary treatment with less interruption to their daily schedules.

TARGIT Intraoperative Radiation Therapy (TARGIT-IORT) is a single dose of targeted radiation delivered from inside the breast during surgery immediately following the removal of the tumor while the patient remains asleep. The 20-year TARGIT-A international clinical trial compared TARGIT-IORT to EBRT, and long-term data consistently demonstrated no difference in local and distant breast cancer control, breast preservation or breast cancer mortality.

The Cancer study, which assessed nearly 3,000 women enrolled in the Carolina Breast Cancer Study Phase III, found that nearly one third of all Black women have a “prolonged treatment duration” (>56 days) for EBRT, while just over a fifth of White women were in that same group. These findings are consistent with several other studies, which show that compared to white women, black women are diagnosed with breast cancer at a lower rate and at more advanced stages; receive post-surgical radiation therapy less frequently; report greater breast cancer-related financial impact; and suffer higher overall mortality.

Targeted intraoperative radiation eliminates the no-win scenario of a patient choosing between going to work and going to treatment; deciding between childcare and cancer care; or opting for mastectomy over saving her breast.  Single-dose treatment can ensure that a woman, regardless of her racial background, experiences less interruption to her daily schedule and gets back to her work and to her family sooner.

The Cancer study also looked at women across different socioeconomic strata and found that lower-income patients encountered more barriers to completing post-surgical EBRT in the time prescribed than women of higher incomes. However, within both of those income groups, black women still experienced longer treatment durations than white women.

ABSMC has been offering Intra Operative Radiation Therapy (IORT) for early stage breast cancer since 2011.  We have treated >400 patients with excellent results. 

Women with early breast cancer were eligible if they were:

1)  aged 45 years or older, 
2)  had a diagnosis of a unifocal invasive ductal carcinoma, and 
3)  suitable for wide local excision with a cancer that was ≤3.5 cm in size on imaging. 

With long term follow-up, no statistically significant difference was found between immediate TARGIT-IORT and EBRT for the following outcomes: 

local recurrence-free survival (P=0.28), 
invasive local recurrence-free survival (P=0.70), 
mastectomy-free survival (P=0.74), 
distant disease free survival (P=0.30), 
overall survival (P=0.13), and 
breast cancer mortality (P=0.54). 

Mortality from other causes was significantly LOWER (P=0.005) in the TARGIT-IORT arm.

Benefits of TARGIT-IORT during lumpectomy for early stage invasive ductal breast cancer:

less travel, thus less cost,
less pain, 
better quality of life, 
cosmetically superior
fewer non-breast cancer deaths
less risky during the CV pandemic since most patients do not need to come in every day for weeks for external radiation

and IORT bridges the health care disparity gap for women of color.

TARGIT-IORT should be offered when planning breast cancer surgery, especially in these CV-19 pandemic times.  The patient gets all her radiation during her lumpectomy with less risk.

To learn more about this treatment and the TARGIT-A trial, please visit the consumer education website www.targetbreastcancer.org.

Respectfully,

Valery Uhl, MD
Radiation Oncology, IORT Specialist at ABSMC
President, TARGIT Collaborative Group (TCG)
Cell/Text (510) 421-7808

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