"They were pretty fast acting in response to what they found," Charlene Picard said, speaking of the time just after she received the diagnosis of breast cancer. "If anything, they were just waiting for me to get myself ready for the next step."

The next step for Picard was surgery; she opted for a lumpectomy, which was scheduled for Oct. 25, 2005. A lumpectomy, as she understands it, Picard said, is the most common form of breast cancer surgery today. In a lumpectomy, Picard's surgeon, Dr. Candace Dyer, explained, the surgeon removes only the part of the patient's breast that contains the tumor (the "lump") and some of the normal tissue that surrounds it. All the tissue removed from the breast, she said, is examined carefully to see if cancer cells are present in the margins - the normal tissue surrounding the tumor.

Most women receive five to seven weeks of radiation therapy after a lumpectomy in order to eliminate any cancer cells that may be present in the remaining breast tissue. Typically, there are two forms of radiation treatment. The standard treatment for follow-up radiation therapy is either full or partial breast radiation. Picard leaned toward partial and was told by Dyer that, even still, there were more options, she said.

Dyer told Picard that, after having a lumpectomy to remove the tumor, she would be a great candidate for a new partial breast radiation treatment called MammoSite.

Dyer explained to Picard that, with MammoSite, an alternative breast cancer treatment that was cleared by the FDA in May 2002, radiation is delivered internally only to the tumor site and, because of its targeted nature, it takes only five days to complete and minimizes radiation exposure to healthy tissues in the rest of the breast, skin, ribs, lungs and heart.

"With whole breast radiation, you tend to hit the heart and the lungs but, by treating a smaller area, you minimize the dose of radiation to any of the normal, healthy structures under the breast," Dyer said.

"First off, you do not have the long course of radiation therapy that can last over five to six or seven weeks," Dyer said. "Plus, you don't burn your bridges if you develop a second cancer in your breast 15 years down the line. You can still have a lumpectomy and whole breast radiation; the MammoSite procedure will not hinder that."

On top of everything else, there are often good cosmetic results when the MammoSite is used, Dyer said. On the flip side, though, this option is only available to a limited number of patients.

Patients must be over 50 years of age, the tumor must be a certain size, it must be in an appropriate location and the breast has to be the appropriate size. The lymphoids and the margins also have to come back clear prior to contingency approval, Dyer said.

"Very small-breasted woman wouldn't be able to use this technique either because there has to be a certain amount of tissue and small-breasted women wouldn't have that," she said.

"This treatment is not yet considered standard therapy for the treatment of breast cancer because we do not have long term follow-ups here in the U.S.," Dyer said. "In Europe, they do, and they are beginning to publish more and more of their data on this type of technique but, currently, we do not have more than five years worth of data."

"When you look at this data and compare it to historic data, what they are finding is that people who were treated with the regular standard type of radiation, their recurrence rates for five years down the road are essentially the same as someone with this treatment," said Dr. Steven Lane, the radiation oncologist from Murdock Radiation Center who performed Picard's procedure. "The numbers are not going up. The last time I saw, there was actually a minimal decline."

In the catheter technique, Lane said, multiple catheters are placed as a surgical procedure through the breast and then through the lumpectomy cavity.

"I do not favor this particular procedure," Lane said. "It is much more invasive and I see more problems associated with this type of treatment."

"With the noninvasive procedure, we use images from a CT Scan to visualize the lumpectomy cavity and then plan a course of external radiation focused to a smaller part," Lane said. "This is a newer technique and, like the MammoSite, it is one week of treatment twice a day."

With more knowledge than she knew just what to do with, Picard said, she was sent home to make up her mind about which treatment she wanted to go with.

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