IORT: A treatment option for early stage breast cancer

Jan. 21, 2014
As health-care professionals who are familiar with the detection, treatment, and prevention of disease, dental hygienists have an important opportunity to assist female patients in detecting breast cancer.

By Joan L. Gilpin, RDH, MA

As health-care professionals who are familiar with the detection, treatment, and prevention of disease, dental hygienists have an important opportunity to assist female patients in detecting breast cancer. When collecting information for a patient’s health history, the hygienist can provide a reminder about breast self-exams and regular mammograms. Most doctors feel that early detection of breast cancer can save thousands of lives each year if women took advantage of screening exams, such as mammograms and regular breast self-exams.1

Early detection provides the foundation for a better outcome of early stage breast cancer. A relatively new treatment option available to some women with early stage breast cancer is intraoperative radiation therapy (IORT).

What is IORT?

IORT combines surgery with radiation to treat early stage breast cancer. The collaborative efforts of the surgeon, oncologist, and radiation oncologist are utilized in IORT. During the procedure, the surgeon removes the tumor and the radiation oncologist administers radiation into the cavity where the tumor was located.2

There are significant benefits to this treatment option. The radiation is localized and delivered to the area of the breast where there is most likely to be a recurrence of the cancer.2 Because the radiation treatment is done at the same time as surgery, the patient can often avoid whole breast radiation treatments that are administered after healing from surgery. Sometimes these treatments are needed for five days a week for up to five weeks. IORT allows patients to reduce the amount of time and inconvenience required for extended radiation treatments, which interrupt their normal life and work routines. In addition to the convenience of completing radiation therapy at the time of surgery, this procedure can reduce the undesirable side effects of red rashes and skin irritations that whole breast radiation can cause.2

When is IORT an appropriate treatment option?

Criteria for patient selection for IORT can vary among cancer treatment centers. In general, this procedure is most beneficial when radiation therapy is needed for patients in the early stages of breast cancer who have small tumors that have not metastasized.

As Michael D. Alvarado, MD, from the University of California put it, “IORT trials are demonstrating that less-aggressive interventions are effective for women with lower-risk tumors. This is a significant achievement for women and much-needed progress in the ability to tailor treatments for women with early-stage breast cancer. If we can safely accomplish the same outcome in a more efficient, more convenient, and less invasive manner, the medical community should be the first to consider early adoption of this new technique.”3

It is desirable that all treatment options — along with their risks and benefits — are discussed betwen the patient and her health-care providers.

Why is early detection important?

The size of a breast cancer and how far it has spread are important factors in predicting the prognosis for a woman with this disease. Breast cancers, which are discovered because they can be felt, tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found on mammograms are more likely to be small and still confined to the breast.1 Breast X-rays have been done for more than 70 years, but the modern mammogram has only existed since 1969.1

Current mammogram equipment designed for breast X-rays uses very low levels of radiation. A diagnostic radiographic procedure that has recently been approved by the Food and Drug Administration is a 3D mammography technique called tomosynthesis.4

What is tomosynthesis?

Tomosynthesis creates a 3D image by taking multiple images of the breast within four seconds. The 3D image shows breast tissue in one millimeter slices which increase the visibility for the radiologist to see tissue details that were previously not viewable.Tomosynthesis is performed in conjunction with the standard mammogram and is especially helpful for women at increased risk of breast cancer and those with dense breast tissue.5 The enhanced accuracy of 3D imaging can contribute to earlier breast cancer detection, a decrease in biopsies and a decrease in recalls to repeat mammograms.5

When dental hygienists include reminders about breast self-exams and mammograms as part of their routine interactions with female patients, they can be providing a life-saving measure for their patients.

Ms. Gilpin works as a public health dental hygienist and coordinates a school-based dental health program in Iowa. She was employed for over 20 years in private practice dental hygiene and as a clinical instructor of dental hygiene. She has authored several articles on preventive oral health care and has provided educational presentations at national and international dental hygiene meetings.



Resources for additional information about breast cancer: