ROJoson PEP Talk: Can one skip RADIOTHERAPY in Breast Cancer Treatment?

ROJoson PEP Talk: Can one skip RADIOTHERAPY in Breast Cancer Treatment?

1. April 20, 2024 1400H - 1500H Via Zoom Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management.

2. April 20, 2024 1400H - 1500H Via Zoom Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. This may take 3 years or longer depending on our enthusiasm , discipline and perseverance . We are now on our 3 rd year!

10. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. My PEP TALK today is entitled: Can one skip RADIOTHERAPY in Breast Cancer Treatment?

11. Contents Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? What is RADIOTHERAPY? What is RADIOTHERAPY in breast cancer treatment? Can one skip RADIOTHERAPY after surgery of the breast? When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and other professionals. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

12. Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? Can one skip RADIOTHERAPY in Breast Cancer Treatment?

13. Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? Oftentimes, in my practice, a lot of patients would ask me: Is radiotherapy really needed after surgery of the breast cancer? Can one skip radiotherapy after surgery of the breast cancer? Can one skip RADIOTHERAPY in Breast Cancer Treatment?

14. Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? Is radiotherapy really needed after surgery of the breast cancer? Can one skip radiotherapy after surgery of the breast cancer? These questions are an offshoot of the rampant practices of oncologists in recommending radiotherapy after surgery of the breast cancer. These rampant practices are usually the offshoot of ritualistic and maximalist mindsets of the oncologists. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Ritualistic mindset – doing things out of habit, fad and routine. Maximalist mindset – doing things in every way possible (more is more). Minimalist mindset – doing things in the most essential way possible (avoiding unnecessary things – less is more).

15. Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? Is radiotherapy really needed after surgery of the breast cancer? Can one skip radiotherapy after surgery of the breast cancer? These questions are an offshoot of the rampant practices of oncologists in recommending radiotherapy after surgery of the breast cancer. These rampant practices are usually the offshoot of ritualistic and maximalist mindsets of the oncologists. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Ritualistic mindset – doing things out of habit, fad and routine. Maximalist mindset – doing things in every way possible (more is more). Minimalist mindset – doing things in the most essential way possible (avoiding unnecessary things – less is more).

16. Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? Is radiotherapy really needed after surgery of the breast cancer? Can one skip radiotherapy after surgery of the breast cancer? These questions are an offshoot of the rampant practices of oncologists in recommending radiotherapy after surgery of the breast cancer. These rampant practices are usually the offshoot of ritualistic and maximalist mindsets of the oncologists. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Ritualistic mindset – doing things out of habit, fad and routine. Maximalist mindset – doing things in every way possible (more is more). Minimalist mindset – doing things in the most essential way possible (avoiding unnecessary things – less is more). Minimalist-mindset oncologists will say: NOT all patients will need. NOT routinely given. Do RADIOTHERAPY only when needed.

17. What is RADIOTHERAPY? Can one skip RADIOTHERAPY in Breast Cancer Treatment?

18. What is RADIOTHERAPY? Radiotherapy or radiation therapy means the use of radiation, usually x-rays and radioisotopes, to treat diseases. Radiotherapy is commonly used in cancer treatment. It uses high doses of radiation to kill cancer cells. Side note: other uses of radiation – chest x-ray, x-ray of bones, teeth, etc. – uses low dose only. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

19. What is RADIOTHERAPY? Two general types of radiotherapy depending on where the radiation is coming from: External radiotherapy – radiation comes from a machine outside the body Internal radiotherapy – radiation comes from implants or liquids placed inside the body ( eg – brachytherapy, use of radioisotopes such as radioactive iodine therapy) Can one skip RADIOTHERAPY in Breast Cancer Treatment?

20. What is RADIOTHERAPY? Two general types of radiotherapy depending on where the radiation is coming from: External radiotherapy – radiation comes from a machine outside the body Internal radiotherapy – radiation comes from implants or liquids placed inside the body ( eg – brachytherapy, use of radioisotopes such as radioactive iodine therapy) Can one skip RADIOTHERAPY in Breast Cancer Treatment?

21. What is RADIOTHERAPY? Two general types of radiotherapy depending on where the radiation is coming from: External radiotherapy – radiation comes from a machine outside the body Can one skip RADIOTHERAPY in Breast Cancer Treatment?

22. What is RADIOTHERAPY? Two general types of radiotherapy depending on where the radiation is coming from: Internal radiotherapy – radiation comes from implants or liquids placed inside the body ( eg – brachytherapy, use of radioisotopes such as radioactive iodine therapy) Can one skip RADIOTHERAPY in Breast Cancer Treatment?

23. What is RADIOTHERAPY? Two general types of radiotherapy depending on where the radiation is coming from: Internal radiotherapy – radiation comes from implants or liquids placed inside the body ( eg – brachytherapy, use of radioisotopes such as radioactive iodine therapy) Can one skip RADIOTHERAPY in Breast Cancer Treatment?

24. What is RADIOTHERAPY in breast cancer treatment? Can one skip RADIOTHERAPY in Breast Cancer Treatment?

25. What is RADIOTHERAPY in breast cancer treatment? It is the use of radiation in the treatment of breast cancer. It uses high doses of radiation to kill cancer cells. Most commonly used is the external beam radiotherapy. Not everyone with a breast cancer needs radiation therapy. There are indications on its use. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

26. What is RADIOTHERAPY in breast cancer treatment? Radiotherapy, if used, is a LOCAL TREATMENT just like surgery. This means it treats a specific part of the body where the radiation is applied / where surgery is done. For example, if one has cancer in the breast, if radiation is used, the effect will be on the breast only, not to the whole body. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Systemic treatment Chemotherapy Hormonal therapy Effect on the whole body

27. What is RADIOTHERAPY in breast cancer treatment? Radiotherapy is usually used in combination with surgery and chemotherapy and other medical therapy in breast cancer treatment. The usual sequence of combination therapy is surgery, chemotherapy and then radiotherapy. Or, chemotherapy, surgery and then radiotherapy (If at the very start, the size of the breast cancer is too big to be operated on). Chemo is used to shrink the cancer first. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

28. What is RADIOTHERAPY in breast cancer treatment? Radiotherapy (RT) is generally used in the following circumstances: After breast-conserving surgery to kill remaining malignant cells so that cancer does not return After a  mastectomy  if the tumor is larger than 5 centimeters (roughly 2 inches) or if nearby  lymph nodes  have evidence of cancer With  stage 4 breast cancer , when cancer has spread ( metastasized ) from the breast to other organs in the body – such as to the bones (RT to the bones). Can one skip RADIOTHERAPY in Breast Cancer Treatment?

29. What is RADIOTHERAPY in breast cancer treatment? The traditional schedule of whole breast radiation is five days a week, Monday through Friday, for five to six weeks. Each session lasts between 15 and 30 minutes. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

30. What is RADIOTHERAPY in breast cancer treatment? Common short-term side effects include: Fatigue  Breast swelling Skin changes (including redness, darkening, or peeling)  Can one skip RADIOTHERAPY in Breast Cancer Treatment?

31. What is RADIOTHERAPY in breast cancer treatment? Long-term side effects may also occur due to the cumulative exposure to radiation. These include: Radiation-induced fibrosis: The hardening of breast tissue, which is often accompanied by decreased breast size and difficulty breastfeeding Brachial plexopathy : Localized nerve damage, resulting in arm numbness, pain, and weakness Can one skip RADIOTHERAPY in Breast Cancer Treatment?

32. What is RADIOTHERAPY in breast cancer treatment? Long-term side effects may also occur due to the cumulative exposure to radiation. These include: Lymphedema: Lymph gland obstruction characterized by swelling of the arm and surrounding tissues Radiation-induced osteopenia: Localized bone loss, which causes an increased risk of rib fracture Can one skip RADIOTHERAPY in Breast Cancer Treatment?

33. What is RADIOTHERAPY in breast cancer treatment? Long-term side effects may also occur due to the cumulative exposure to radiation. These include: Angiosarcoma : A rare cancer arising from the cells that line blood or lymph vessels, often a complication of radiation In the past, external beam radiation posed a significant risk of heart and lung damage. Newer-generation machines have largely alleviated the risk by reducing radiation spillover. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

34. What is RADIOTHERAPY in breast cancer treatment? Common question: Is radiation for breast cancer painful? The radiation treatment itself is painless. The side effects that it may cause can be uncomfortable for some people, although this is often temporary. But the radiation itself is not painful. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

35. What is RADIOTHERAPY in breast cancer treatment? Common question: Will I lose my hair with radiation for breast cancer? Radiation does cause hair loss, but only in the area being treated. You may lose underarm hair or hair on your chest, but not the hair on your head. If you have radiation to the brain for metastases (areas where the cancer has spread), then you may experience hair loss on your head. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

36. Can one skip RADIOTHERAPY after surgery of the breast? Can one skip RADIOTHERAPY in Breast Cancer Treatment?

37. Can one skip RADIOTHERAPY after surgery of the breast? YES, one can skip RADIOTHERAPY if it is NOT needed / not indicated. When is RADIOTHERAPY not needed after surgery of the breast? Can one skip RADIOTHERAPY in Breast Cancer Treatment? The discussion here will focus on: newly diagnosed non-metastatic breast cancers (meaning Stage 3 or earlier) Adjuvant radiotherapy -meaning given after surgery Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers?

38. The objective of adjuvant radiation therapy (RT) is to eradicate any tumor deposits remaining following surgery for patients treated by either breast-conserving surgery or mastectomy. Doing so is said to reduce risk of locoregional recurrence. Some say it will improve breast cancer-specific and overall survivals. Can one skip RADIOTHERAPY in Breast Cancer Treatment? The discussion here will focus on: newly diagnosed non-metastatic breast cancers (meaning Stage 3 or earlier) Adjuvant radiotherapy -meaning given after surgery Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers?

39. In a study on effects of RT on patients after subtotal mastectomy (breast-conservation surgery), After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs (local recurrences) and reduces the breast cancer death rate (mortality rate) by about a sixth . Can one skip RADIOTHERAPY in Breast Cancer Treatment? Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trial .  https://doi.org/10.1016/S0140-6736(11)61629-2

40. In a study on effects of RT on patients after total mastectomy and axillary dissection, After mastectomy and axillary dissection, with NO positive nodes, radiotherapy had NO significant effect on locoregional recurrence or breast cancer mortality. Radiotherapy reduced both recurrence and breast cancer mortality in the women with ONE TO THREE positive lymph nodes in these trials even when systemic therapy was given. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials Lancet . 2014  Jun ;383 (9935):2127–35

41. 2024 current recommendations and ROJoson TPORs: After subtotal mastectomy (breast-conservation surgery), adjuvant RT is usually recommended. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? https://www.uptodate.com/contents/adjuvant-radiation-therapy-for-women-with-newly-diagnosed-non-metastatic-breast-cancer

42. 2024 current recommendations and ROJoson TPORs: After total mastectomy, selective adjuvant RT. Adjuvant RT usually recommended for: More than 3 positive lymph nodes Huge primary tumor – more than 5 cm Surgical margin positive or less than ideal Can one skip RADIOTHERAPY in Breast Cancer Treatment? Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? https://www.uptodate.com/contents/adjuvant-radiation-therapy-for-women-with-newly-diagnosed-non-metastatic-breast-cancer https://www.cancer.gov/news-events/cancer-currents-blog/2024/breast-cancer-skip-lymph-node-radiation#:~:text=Specifically%2C%20the%20new%20findings%20suggest,targeted%20to%20those%20lymph%20nodes.

43. 2024 current recommendations and ROJoson TPORs: After total mastectomy, selective adjuvant RT. Adjuvant RT may be skipped for: Negative and less than 3 positive lymph nodes Small primary tumor – less than 5 cm Surgical margin negative and ideally good margin Positive ERA and negative HER-2-NEU Can one skip RADIOTHERAPY in Breast Cancer Treatment? Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers? https://www.uptodate.com/contents/adjuvant-radiation-therapy-for-women-with-newly-diagnosed-non-metastatic-breast-cancer https://www.cancer.gov/news-events/cancer-currents-blog/2024/breast-cancer-skip-lymph-node-radiation#:~:text=Specifically%2C%20the%20new%20findings%20suggest,targeted%20to%20those%20lymph%20nodes.

44. Surgery and radiotherapy are both local treatment, meaning the effect will be on the site where surgery and radiotherapy are applied (NOT on the entire body). If surgery is done properly, with a good margin, then radiotherapy is not needed anymore. If surgery is done with compromise in the margin, then radiotherapy may be needed. Can one skip RADIOTHERAPY in Breast Cancer Treatment? If the tumor is large, it may be difficult to get a good margin of resection. Thus, radiotherapy may be added after surgery to reduce the chance of local recurrence. Rephrased question: When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers?

45. Summary Take Away Can one skip RADIOTHERAPY in Breast Cancer Treatment? Contents Why this topic – can one skip RADIOTHERAPY in breast cancer treatment? What is RADIOTHERAPY? What is RADIOTHERAPY in breast cancer treatment? Can one skip RADIOTHERAPY after surgery of the breast? When is adjuvant radiotherapy not needed after surgery of newly diagnosed non-metastatic breast cancers?

46. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT. Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of your health management. Can one skip RADIOTHERAPY in Breast Cancer Treatment?

47. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. This ends m y PEP TALK today on: Can one skip RADIOTHERAPY in Breast Cancer Treatment?

48. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

49. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

50. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

51. Can one skip RADIOTHERAPY in Breast Cancer Treatment? Empowerment objective - for laypeople to have an essential  understanding on WHETHER ONE CAN SKIP RADIOTHERAPY IN BREAST CANCER TREATMENT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!