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Breast Cancer Myth Busters with Dr. John McGrath
Dr. John McGrath explains how radiation may impact your body and if breast cancer patients should stay home during the COVID-19 pandemic.
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Learn more about John McGrath, MD
John McGrath, MD
John McGrath, MD is the MEDICAL DIRECTOR MASS GENERAL DEPARTMENT OF RADIATION ONCOLOGY AT EMERSON HOSPITAL.Learn more about John McGrath, MD
Transcription:
Breast Cancer Myth Busters with Dr. John McGrath
Alyne Ellis (Host): Often, after breast cancer surgery, the next step in treatment is radiation. This therapy may help in treating any remaining cancer and decrease the risk of a tumor recurrence. Here to tell us more about this procedure and answer some of the questions patients often ask, is Dr. John McGrath, the Medical Director of the Mass General Department of Radiation Oncology at Emerson Hospital. This is The Healthworks Here podcast from Emerson Hospital. I’m Alyne Ellis. Thanks so much Dr. McGrath, for joining me today.
John McGrath, MD (Guest): Thank you very much for having me. I appreciate it.
Host: Well let’s begin with how long do radiation treatments usually last for a patient?
Dr. McGrath: In general, the radiation treatment for our – when I treat with breast cancer really only take five to ten minutes. So, by the time they come into my office – into the department and leave, it’s probably about 15 to 20 minutes at the most.
Host: And how many do patients usually have in succession?
Dr. McGrath: Generally we treat with 20 treatments all together. I generally treat the whole breast for the first 16 treatments and the final four treatments we generally do a boost where the tumor was removed from.
Host: And what kind of side effects can I expect if I were to do this? Is it hair loss, or nausea like with chemo?
Dr. McGrath: Not at all. Generally the side effects are again, where we aim the radiation beam. So, during the radiation therapy, the skin may get a little red, a little irritated. You could get some itchiness with the skin. Generally one may feel some tiredness from the radiation therapy. Generally, from the radiation therapy, the first couple of weeks of treatment, not too, too much side effects but as time goes on, you may feel a bit more tired and then the tiredness can last up to two to four weeks after the radiation therapy.
Host: And as far as the skin is concerned, you could get cream for that.
Dr. McGrath: Yeah, my nurses generally meet with my patients prior to treatment with radiation therapy and we go over skincare with them. Generally we use an Aveeno gel, that’s what we use at this time.
Host: And is it safe to be around other people once the radiation has happened?
Dr. McGrath: At this time, generally we treat with 20 treatments of radiation therapy. Generally I treat the first 16 treatments to the whole breast. For the final four treatments we just aim to where the tumor is removed from. In the past, we used to treat with 30 treatments of radiation therapy. Generally 25 to the whole breast with the five to the boost area where the tumor is removed from. There have been some recent studies that have come out comparing three versus five weeks of radiation therapy, and at 10 years, there is no difference in survival, no difference in how the breast looks nor any difference of local recurrence. So, that’s the reason why we use the 20 treatments of radiation therapy.
Host: And can a patient go back and have more radiation therapy later?
Dr. McGrath: So, generally, we cannot retreat the area that we preciously treated. However, if a woman does develop a breast cancer on the opposite side; we are able to treat that breast.
Host: So, how does radiation affect the immune system?
Dr. McGrath: Really the radiation therapy when I treat with breast cancer really doesn’t affect the immune system at all. Really, the major side effect of radiation therapy as we previously talked about is really some skin irritation as well as some fatigue. How the radiation therapy weakens the immune system is when I treat the bones. It’s inside the bones have what we call the bone marrow and that’s where the -we have what’s called white blood cells which help fight infection and that’s where they like to hang out inside the bone marrow. When I treat the breast, with the radiation therapy, the only bones that we are really treating are the ribs and they have really a small amount of bone marrow as compared to other bones that I may treat like in the pelvis or the leg bone called the femur. So, because I’m just treating a small amount of ribs, I’m really not affecting the white blood cells at all again the white blood cells help fight infection. So, when my patients ask me, can they go to the store, can they go to walk and they exercise; I tell them they are really not at any greater increased risk of developing an infection or in these time, COVID than you and I. So, really, it’s because that we treat such a small amount of the bone marrow that houses the white blood cells that patients really are not prone to infection at all.
Host: And what about the heart and the lungs? Because it sure seems like all that radiation is going to be mighty close to these vital parts of your body.
Dr. McGrath: When we treat with radiation therapy for the breast cancer, we always want to try to minimize dose to the lung. And then when I treat the left breast, to minimize dose to the heart as well. So, how do we do that? So, in order to treat a patient with radiation therapy what we need to do is what’s called a planning session or a simulation where we map out the area that we want to treat, that being the breast. We have the patient lie flat on the table, their arms over their head, and they go through a CAT scan.
So, in order to minimize dose to the heart, we have a special technique called DIBH or deep inspiration breath hold. The patient is coached during our planning session by our therapists to take a deep breath in and then they hold that, and they go through the CAT scan. And what that does is it brings the heart down and away from the radiation field. The CT scan information is then transferred to my treatment planning computer where I draw on the breast tissue, I draw on the lung, I draw on the heart when I’m treating the left side. That information is then given to my physicist and it’s my physicists that come up with a plan to minimize dose to the lung as well as the heart. And we call that 3-D conformal radiation therapy.
In our treatment room, we have a system called the Vision RT which looks at one’s surface anatomy. So, my therapists know the exact breath that the patient took on the CT scan for the planning, they can replicate that on the treatment machine, and we can assure that there’s no heart in the radiation field. So, really, the risk of radiation therapy causing what we call a radiation pneumonitis or inflammation of the lung is really less than 5%. And the risk of developing what we call a radiation pericarditis or inflammation of the heart, is really less than 1%. So, it’s really because of our techniques, the hardware as well as software we’re able to minimize dose to both the lung and to the heart as well.
Host: And I assume that one can have a pacemaker and have this procedure done?
Dr. McGrath: One can. Generally, the pacemaker needs to be outside the radiation field. So, that’s why we make sure. We can also test how much dose the pacemaker is getting by putting what we call a TLD which will tell us what the dose is. There are sometimes when a woman does have a pacemaker on that side and what we are able to do is we are able to move that pacemaker. I just did that recently as well.
Host: You know it’s interesting. It sounds like this is so highly specialized now that patients really don’t need to fear going through this.
Dr. McGrath: No, I mean again, I think with our current techniques that we have now, our specialized ways that we can deliver the radiation therapy, we really kind of minimize the dose to vital organs and we’re able to do that so much better than – when I started practicing 25 years ago.
Host: So now in these times of COVID-19, what about treatment do we need to know in terms of going in to have this done? I mean just start by saying do I need to really think about staying at home and not going or how do you keep me safe?
Dr. McGrath: No, so we have a specialized protocol in our department. Prior to anyone coming into our department, my front desk staff, they call all our patients and screen them to make sure they are not having any symptoms at all. When they come into our department, my front desk also asks them specific questions in regards to COVID as well. So, again, really, they don’t need to fear in that respect. And when one is getting treatment with radiation therapy to the breast, really, again, as I was saying before, no one is at any greater risk for infection. So, my patients will ask me can I go for a walk, can I do yoga, can I do Zumba, can I go watch my kids play sports. I always say as long as they maintain social distance, wear a mask; I really encourage my patients to go out and really do things. I think overall it makes them feel good as well improves one’s mood as well.
Host: And I think the other thing that’s vital about this is that staying home and avoiding this is perhaps significantly more dangerous than having this procedure done.
Dr. McGrath: Without a doubt. We are able to very safely treat women with breast cancer at this point during COVID and I wouldn’t want patients to feel uncomfortable in any way coming into our department and being treated.
Very nice talking to you. I appreciate it. You have a very nice day and thank you very much.
Host: Dr. John McGrath is the Medical Director of the Mass General Department of Radiation Oncology at Emerson Hospital. For more information on breast cancer visit www.emersonhospital.org/breasthealth. Thanks for listening to Emerson’s Healthworks Here podcast. This episode is part of a five part series on breast cancer. Make sure to catch all the episodes by subscribing to the Healthworks Here podcast on Apple podcasts, Google podcasts, Spotify or wherever podcasts can be heard. I’m Alyne Ellis. Thanks for listening.
Breast Cancer Myth Busters with Dr. John McGrath
Alyne Ellis (Host): Often, after breast cancer surgery, the next step in treatment is radiation. This therapy may help in treating any remaining cancer and decrease the risk of a tumor recurrence. Here to tell us more about this procedure and answer some of the questions patients often ask, is Dr. John McGrath, the Medical Director of the Mass General Department of Radiation Oncology at Emerson Hospital. This is The Healthworks Here podcast from Emerson Hospital. I’m Alyne Ellis. Thanks so much Dr. McGrath, for joining me today.
John McGrath, MD (Guest): Thank you very much for having me. I appreciate it.
Host: Well let’s begin with how long do radiation treatments usually last for a patient?
Dr. McGrath: In general, the radiation treatment for our – when I treat with breast cancer really only take five to ten minutes. So, by the time they come into my office – into the department and leave, it’s probably about 15 to 20 minutes at the most.
Host: And how many do patients usually have in succession?
Dr. McGrath: Generally we treat with 20 treatments all together. I generally treat the whole breast for the first 16 treatments and the final four treatments we generally do a boost where the tumor was removed from.
Host: And what kind of side effects can I expect if I were to do this? Is it hair loss, or nausea like with chemo?
Dr. McGrath: Not at all. Generally the side effects are again, where we aim the radiation beam. So, during the radiation therapy, the skin may get a little red, a little irritated. You could get some itchiness with the skin. Generally one may feel some tiredness from the radiation therapy. Generally, from the radiation therapy, the first couple of weeks of treatment, not too, too much side effects but as time goes on, you may feel a bit more tired and then the tiredness can last up to two to four weeks after the radiation therapy.
Host: And as far as the skin is concerned, you could get cream for that.
Dr. McGrath: Yeah, my nurses generally meet with my patients prior to treatment with radiation therapy and we go over skincare with them. Generally we use an Aveeno gel, that’s what we use at this time.
Host: And is it safe to be around other people once the radiation has happened?
Dr. McGrath: At this time, generally we treat with 20 treatments of radiation therapy. Generally I treat the first 16 treatments to the whole breast. For the final four treatments we just aim to where the tumor is removed from. In the past, we used to treat with 30 treatments of radiation therapy. Generally 25 to the whole breast with the five to the boost area where the tumor is removed from. There have been some recent studies that have come out comparing three versus five weeks of radiation therapy, and at 10 years, there is no difference in survival, no difference in how the breast looks nor any difference of local recurrence. So, that’s the reason why we use the 20 treatments of radiation therapy.
Host: And can a patient go back and have more radiation therapy later?
Dr. McGrath: So, generally, we cannot retreat the area that we preciously treated. However, if a woman does develop a breast cancer on the opposite side; we are able to treat that breast.
Host: So, how does radiation affect the immune system?
Dr. McGrath: Really the radiation therapy when I treat with breast cancer really doesn’t affect the immune system at all. Really, the major side effect of radiation therapy as we previously talked about is really some skin irritation as well as some fatigue. How the radiation therapy weakens the immune system is when I treat the bones. It’s inside the bones have what we call the bone marrow and that’s where the -we have what’s called white blood cells which help fight infection and that’s where they like to hang out inside the bone marrow. When I treat the breast, with the radiation therapy, the only bones that we are really treating are the ribs and they have really a small amount of bone marrow as compared to other bones that I may treat like in the pelvis or the leg bone called the femur. So, because I’m just treating a small amount of ribs, I’m really not affecting the white blood cells at all again the white blood cells help fight infection. So, when my patients ask me, can they go to the store, can they go to walk and they exercise; I tell them they are really not at any greater increased risk of developing an infection or in these time, COVID than you and I. So, really, it’s because that we treat such a small amount of the bone marrow that houses the white blood cells that patients really are not prone to infection at all.
Host: And what about the heart and the lungs? Because it sure seems like all that radiation is going to be mighty close to these vital parts of your body.
Dr. McGrath: When we treat with radiation therapy for the breast cancer, we always want to try to minimize dose to the lung. And then when I treat the left breast, to minimize dose to the heart as well. So, how do we do that? So, in order to treat a patient with radiation therapy what we need to do is what’s called a planning session or a simulation where we map out the area that we want to treat, that being the breast. We have the patient lie flat on the table, their arms over their head, and they go through a CAT scan.
So, in order to minimize dose to the heart, we have a special technique called DIBH or deep inspiration breath hold. The patient is coached during our planning session by our therapists to take a deep breath in and then they hold that, and they go through the CAT scan. And what that does is it brings the heart down and away from the radiation field. The CT scan information is then transferred to my treatment planning computer where I draw on the breast tissue, I draw on the lung, I draw on the heart when I’m treating the left side. That information is then given to my physicist and it’s my physicists that come up with a plan to minimize dose to the lung as well as the heart. And we call that 3-D conformal radiation therapy.
In our treatment room, we have a system called the Vision RT which looks at one’s surface anatomy. So, my therapists know the exact breath that the patient took on the CT scan for the planning, they can replicate that on the treatment machine, and we can assure that there’s no heart in the radiation field. So, really, the risk of radiation therapy causing what we call a radiation pneumonitis or inflammation of the lung is really less than 5%. And the risk of developing what we call a radiation pericarditis or inflammation of the heart, is really less than 1%. So, it’s really because of our techniques, the hardware as well as software we’re able to minimize dose to both the lung and to the heart as well.
Host: And I assume that one can have a pacemaker and have this procedure done?
Dr. McGrath: One can. Generally, the pacemaker needs to be outside the radiation field. So, that’s why we make sure. We can also test how much dose the pacemaker is getting by putting what we call a TLD which will tell us what the dose is. There are sometimes when a woman does have a pacemaker on that side and what we are able to do is we are able to move that pacemaker. I just did that recently as well.
Host: You know it’s interesting. It sounds like this is so highly specialized now that patients really don’t need to fear going through this.
Dr. McGrath: No, I mean again, I think with our current techniques that we have now, our specialized ways that we can deliver the radiation therapy, we really kind of minimize the dose to vital organs and we’re able to do that so much better than – when I started practicing 25 years ago.
Host: So now in these times of COVID-19, what about treatment do we need to know in terms of going in to have this done? I mean just start by saying do I need to really think about staying at home and not going or how do you keep me safe?
Dr. McGrath: No, so we have a specialized protocol in our department. Prior to anyone coming into our department, my front desk staff, they call all our patients and screen them to make sure they are not having any symptoms at all. When they come into our department, my front desk also asks them specific questions in regards to COVID as well. So, again, really, they don’t need to fear in that respect. And when one is getting treatment with radiation therapy to the breast, really, again, as I was saying before, no one is at any greater risk for infection. So, my patients will ask me can I go for a walk, can I do yoga, can I do Zumba, can I go watch my kids play sports. I always say as long as they maintain social distance, wear a mask; I really encourage my patients to go out and really do things. I think overall it makes them feel good as well improves one’s mood as well.
Host: And I think the other thing that’s vital about this is that staying home and avoiding this is perhaps significantly more dangerous than having this procedure done.
Dr. McGrath: Without a doubt. We are able to very safely treat women with breast cancer at this point during COVID and I wouldn’t want patients to feel uncomfortable in any way coming into our department and being treated.
Very nice talking to you. I appreciate it. You have a very nice day and thank you very much.
Host: Dr. John McGrath is the Medical Director of the Mass General Department of Radiation Oncology at Emerson Hospital. For more information on breast cancer visit www.emersonhospital.org/breasthealth. Thanks for listening to Emerson’s Healthworks Here podcast. This episode is part of a five part series on breast cancer. Make sure to catch all the episodes by subscribing to the Healthworks Here podcast on Apple podcasts, Google podcasts, Spotify or wherever podcasts can be heard. I’m Alyne Ellis. Thanks for listening.