Marcia Shanahan’s regular mammogram didn’t show anything. But during a routine check-up, her doctor felt something.
“I really believed at the time it was going to be nothing,” Shanahan says. “But after the biopsy when they said the word ‘cancer,’ it got scary.”
Shanahan felt like she needed a second opinion. On the advice of a friend, she contacted James Edney, MD, a surgical oncologist at The Nebraska Medical Center.
“Women may have two surgical options when they have breast cancer,” Dr. Edney explains. “Mastectomy is one; and breast conservation, where we remove the lump and leave the breast behind is the other.”
Dr. Edney says lumpectomy is followed with a course of daily radiation that typically lasts six weeks.
“This can create a real problem for people depending on their schedule,” Dr. Edney says. “There are geographical barriers, especially when you’re in a place like Nebraska where a patient may have to drive 250 miles a day for treatment.”
He says of all women who get breast cancer, about 75-percent of them are candidates for breast conservation. However, he says only 35-40-percent of that group follows through with conservation because of the logistical barriers and time commitment. When Shanahan met with Dr. Edney to discuss her options, he explained to her a new procedure called Intrabeam, a type of interoperative radiation therapy (IORT). Instead of six weeks of treatment following surgery, Intrabeam patients have their surgery and radiation in one session lasting about 90 minutes.
“It sounded really good,” Shanahan remembers. “I said, ‘Sign me up.’”
After the surgeon removes the tumor, a special bulb-shaped applicator is inserted into the cavity where the tumor was before. The applicator is attached to a portable radiation machine through which a radiologist applies a low-dose of radiation to the affected area and its surrounding margins. The entire process typically takes between one and two hours. Dr. Edney describes it as a team effort between surgical oncologists and radiation oncologists. He also believes this approach will become much more common in the years to come.
“I think that it is our responsibility as an NCI-designated cancer center to provide those kinds of options that may not be available anywhere else.”
The Nebraska Medical Center and UNMC have played an important role in the development of Intrabeam therapy for breast cancer. Their involvement began early during clinical trials when the medical center was one of just four centers in the United States participating. With solid clinical data showing this approach to be effective, it’s now becoming more widely available, though still only available in this region here at the medical center.
“What we found with over five years of follow up, is that the results are equivalent to traditional treatment,” Dr. Edney says. “The cosmetic results were far superior with Intrabeam because we are not irradiating the entire breast and overlying skin.”
Women who undergo whole-breast radiation often deal with red, irritated skin and changes in breast density. Since Intrabeam patients only receive radiation in a small area inside the breast, those side effects are greatly reduced.
Six weeks after her Intrabeam procedure, Marcia Shanahan is back at work. She is undergoing chemotherapy to reduce the chances that the cancer will come back. As she looks back at all she’s been through in the last several months, she is very happy she asked about a second opinion.
“I wouldn’t have known if I had stayed in my original healthcare system,” she says. “I was so excited when I heard there was this option. It made a huge difference for me.”