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 3rd
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.co
m/contents/adjuvant-
radiation-therapy-for-
women-with-newly-
diagnosed-non-metastatic-
breast-cancer
https://www.cancer.gov/n
ews-events/cancer-
currents-
blog/2024/breast-cancer-
skip-lymph-node-
radiation#:~:text=Specifica
lly%2C%20the%20new%20
findings%20suggest,target
ed%20to%20those%20lym
ph%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.co
m/contents/adjuvant-
radiation-therapy-for-
women-with-newly-
diagnosed-non-metastatic-
breast-cancer
https://www.cancer.gov/n
ews-events/cancer-
currents-
blog/2024/breast-cancer-
skip-lymph-node-
radiation#:~:text=Specifica
lly%2C%20the%20new%20
findings%20suggest,target
ed%20to%20those%20lym
ph%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 my 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!