A Gentle Touch Proves Its Power in New Breast Cancer Treatments
By the time Anne Broderick was diagnosed with breast cancer, her grandmother, her aunt, her mother, two sisters and a brother had already been found to have some form of cancer.
Her own illness, then, "wasn't a terrible shock that came out of nowhere," she said, "but it's certainly a life-changing bit of news. At the moment when you first hear the diagnosis, you have no idea of how serious it is or what the treatment will be. It's still a shock even if you’re not surprised."
It was June 2005 when, after years of twice-yearly mammograms and monthly breast self-exams, Broderick learned that she had cancer in her left breast. Her doctors classified the cancer as Stage 2. Broderick's tumor was large, but the cancer had not reached her lymph nodes.
They told her that she would have surgery, chemotherapy and radiation therapy. Those options were not unexpected, either. Her aunt had had a double mastectomy to remove her breast cancer, her sister had gone through seven weeks of daily radiation as part of her breast cancer treatment. And, Broderick said, "I'd heard all of these stories about chemotherapy."
The thought of going every day, five days a week for seven weeks was just overwhelming. When I was presented with this shorter option, I just grabbed at it.
Instead of a double mastectomy, in which both breasts are removed, Broderick's tumor was removed with a far less invasive surgery called a lumpectomy, which removes only the tumor, leaving intact as much of the breast as possible.
No longer in the dark ages
She assumed that she would have the same kind of radiation her sister had had. Broderick became a patient at Stanford Hospital & Clinics; there, she found out, something else was available.
Breast cancer was first documented by Egyptian physicians in 1600 BC. Now, nearly one in eight women will develop the disease in her lifetime. The incidence of breast cancer has remained the same in the last decade, but the number of women who survive has increased steadily as screening has become more common, imaging more sophisticated and treatment possibilities more abundant.
The history of breast cancer care has followed the same path as other medical treatments, becoming more and more refined. "In the 1960s and 1970s, surgeons performed the biggest operation possible. They would remove the breast and the surrounding muscle and lymph nodes and hope for the best," said Frederick Dirbas, MD, who heads the Breast Disease Management Group at the new Stanford Women's Cancer Center. "There was much less use of medical therapy and radiation. Physicians didn't have the information or the tools we have now to combine treatments to care for our patients."
When Broderick met with her Stanford radiation oncologist, Kate Horst, MD, she was presented with a new treatment option. She was a candidate, Horst said, for radiation that could be given in just five days, not weeks. "The thought of going every day, five days a week for seven weeks was just overwhelming. When I was presented with this shorter option, I just grabbed at it," Broderick said.
Physicians knew it was out there. People also said it's been tried and didn't work. We decided we were going to do this in a way that would make it work.
What researchers at Stanford were exploring was the idea that radiation could be delivered in a more targeted and accelerated fashion. One approach, which takes place during surgery, is called intraoperative radiotherapy. Another method uses external radiation therapy after surgery. Both approaches focus radiation beams only on the margins of the lumpectomy cavity, instead of the whole breast.
It's a technique, Horst said, that's allows patients "to continue to be physically active, to keep working and to take care of their families."
Broderick knew that it was a newer type of therapy, "but I didn’t feel I was at risk. I felt I was in very good hands. When Dr. Horst explained it to me, it made a lot of sense."
- Breast cancer is either invasive or non-invasive. The most common type of breast cancer affecting women today is invasive ductal carcinoma. It begins in the lining of the milk duct, then moves into the surrounding breast tissue.
- Some types of breast cancer have been linked to the hormones estrogen and progesterone. When hormone replacement therapy became less common, breast cancer rates began to decrease.
- Symptoms may include a lump, change in size or shape of the breast, change in the color or feel of skin and other parts of the breast. Early breast cancer usually does not cause pain; some cancers never cause any symptoms at all.
- Risk factors include age, family history of breast or ovarian cancer, early menstruation or late menopause, dense breast tissue, weight gain and obesity after menopause, not having children or having a first child after age 30.
- Diagnosis at Stanford may include an all-digital mammogram with computer-aided detection, breast MRI, ultrasound and CT scan.
- Treatment options include surgery, breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and biologics therapy. Stanford offers patients various forms of radiation therapy, including intraoperative radiation and post-operative accelerated partial breast irradiation. Stanford also offers patients a significant group of clinical trial possibilities.
- Other supportive services include nutritional counseling, a preparation for chemotherapy class, therapeutic writing, support groups, pain management, hypnosis, massage and yoga.
Making it work
Stanford was one of the very first to offer these newer forms of radiation therapy, Dirbas said. "Physicians knew it was out there. Most said it's been tried and it didn't work. We decided we were going to do this in a way that would make it work."
As important as any other advance, Dirbas believes, is an interdisciplinary collaboration among surgeons, radiologists, medical oncologists, radiation oncologists, pathologists, researchers and support programs.
The Stanford Women's Cancer Center, which opened this June, is built on that kind of collaboration and designed to bring together in one setting all those involved in breast and gynecologic cancers to provide the most comprehensive care possible. That proximity can speed the transition from breakthrough research in prevention, detection and treatment to clinical availability.
Broderick also discovered that Stanford was a resource for additional treatment elements. Healing Partners offered her a weekly meeting for six months with a practitioner expert in a type of hands-on energy therapy. "Like tai-chi and acupressure it works to get energy flowing through the body so the body can do its own work," Broderick said. "It sounded a little woo-woo to me, but there was no downside. Anything I could do that would help me, I would try."
The weekly sessions began even before her surgery. "It really felt wonderful," she said. "I felt so relaxed and peaceful." Broderick thinks that it helped her avoid any side effects from her chemotherapy, except for tiredness immediately after each session and the typical hair loss. "I wasn’t my usual peppy self. I still worked—I didn't miss a beat there," she said.
The program became "an essential part of my emotional balance," she said. "It helped me pay attention to the mind-body connection. The power of touch is something we don’t do much with in our society. It's very comforting."
The way I was treated definitely contributed to my healing. It was clear to me that people cared about me.
Sharing with others
Broderick became so enthusiastic about the technique that she trained to become a practitioner and now helps other cancer patients.
She has nothing but good things to say about her care at Stanford, from her physicians and nurses to the MRI technicians. "The way I was treated definitely contributed to my healing," she said. "It was clear to me that people cared about me. Having cancer is never a wonderful experience, but this was as pleasant as it could be."
After her surgery, chemotherapy and radiation, Broderick took another treatment drug, Herceptin, a medication proven very effective for certain types of breast cancer, for a year.
Now 72, she's continuing her career as a psychotherapist and leadership coach. "I don't think about cancer very much," she said. "When I do see women recently diagnosed with breast cancer, I tell them to take good care of themselves, to be proactive about their health care, to be sure their questions are answered."
"I tell them about the services at Stanford. If you're going to have cancer, this is the place to have it."
About Stanford Health Care
Stanford Health Care, located in Palo Alto, California with multiple facilities throughout the region, is internationally renowned for leading edge and coordinated care in cancer, neurosciences, cardiovascular medicine, surgery, organ transplant, medicine specialties and primary care. Stanford Health Care is part of Stanford Medicine, which includes Lucile Packard Children's Hospital Stanford and the Stanford University School of Medicine. Throughout its history, Stanford has been at the forefront of discovery and innovation, as researchers and clinicians work together to improve health, alleviate suffering, and translate medical breakthroughs into better ways to deliver patient care. Stanford Health Care: Healing humanity through science and compassion, one patient at a time. For more information, visit: StanfordHospital.org.