Scripps Health cares for more breast cancer patients than any other San Diego health care provider. Depending on the stage, breast cancer may require surgery, chemotherapy, radiation, or a combination of these treatments.
Proton therapy is a highly precise form of cancer radiation treatment that enables us to target tumors within intricate areas while sparing healthy surrounding tissue.
From diagnosis and treatment to navigation and support, Scripps offers comprehensive cancer care. Learn how proton therapy further complements these services.
The clinical and scientific teams have more than 90 years of combined experience treating patients with proton therapy. Learn more about the experts at the center.
Ideally, radiation treatment for breast cancer will:
- Target the tumor only
- Protect your heart, lungs and spinal cord
- Maintain your quality of life during treatment
- Reduce side effects of radiation therapy
Radiation used to treat breast cancer must be delivered with high precision and the utmost care to maximize the dosage to cancerous cells and minimize harmful exposure beyond the tumor. This is especially important for breast cancer patients, who may face the risk of secondary cancers, lung injuries and major cardiac events later in life due to previous radiation exposure.
Radiation therapy used to treat breast cancer must be precise because:
- Radiation to healthy tissues around breast tumors can affect the heart, lungs and spinal cord. These structures are very sensitive to radiation even at low dosages, and damage to them can have significant side effects. This is especially true with tumors located in the left breast. Given the proximity to the heart, there is an increased risk of the heart receiving radiation.
- Breast cancer that has spread to the lymph nodes may require radiation even after surgery, and the radiation field may extend to the chest wall, underarm area, collarbone and sternum. When lymph nodes are included in the radiation field, the risk to the heart and lungs is higher.
- As breast cancer survival rates continue to increase, so do concerns about the long-term side effects of radiation exposure. In many cases, long-term effects may have a far greater impact on quality of life than the original cancer.
- If cancer comes back after radiation therapy, treatment options may be limited. A second round of radiation treatment is often not possible due to the high risk of injury to these vital organs and tissues.
With any radiation technique, the potential for serious complications can be high in some cases. This can lead to a difficult choice between giving:
- A less-than-optimal dose into the breast tumor (which reduces the chance of remission); or
- An ideal dose to the tumor with a higher risk of radiation to healthy tissues
Protons deposit their maximum energy directly into the tumor, so exposure to your heart, lungs, bone and healthy tissue is greatly reduced.
Intensity-Modulated Proton Therapy (IMPT), available in California only at the Scripps Proton Therapy Center, allows doctors to more selectively place high-dose radiation in your tumor, while simultaneously reducing the dose to your surrounding critical organs. This can lower the risk of side effects from the radiation treatment.
A test of treatment plans for women with left-sided breast cancer undergoing breast-conserving therapy (X-ray vs. intensity-modulated protons) found that:
- Radiation dose to the lung was reduced by 81 percent
- Radiation to the other breast was reduced by 96 percent
- Radiation dose to the heart was reduced by 99 percent
Studies have found that proton therapy provides better coverage of the lymph nodes while substantially reducing average radiation doses to the heart and lung. These reduced radiation levels have been shown to reduce the risk of reduced cardiac events, lung cancer and pneumonitis.
Partial breast irradiation (PBI) with protons provides a more even distribution of radiation and reduces exposure to the normal breast, heart and lungs compared with photon and X-ray PBI techniques. It has also been associated with excellent outcomes and reduced toxicity.
Many studies have shown an increased rate of secondary cancer in surrounding areas years after patients receive X-ray radiation therapy. Research has shown that because proton therapy lowers the dose to normal tissue, this could lower the risk of secondary cancer due to radiation.
Combined treatments of mastectomy or lumpectomy surgery, chemotherapy and radiation may be needed for some breast tumors. Proton therapy reduces the radiation-related toxicity, which increases the likelihood that patients can complete treatment with fewer interruptions or delays.
When compared with conventional passively scattered protons, Scripps Proton Therapy Center’s intensity-modulated pencil-beam scanning technique (IMPT) can treat more complex tumor shapes, vary the dosage within the tumor and reduce the amount of radiation to surrounding tissues. The radiation dose from pencil-beam scanning that extends beyond the target tumor has been shown to be substantially less than passively scattered protons and intensity-modulated X-ray therapy (IMRT).
Scripps Proton Therapy Center provides advanced radiation treatments for breast cancers including:
- Early stage breast cancer
- Locally advanced breast cancer (Stage II and III)
- Ductal carcinoma in-situ
- Triple-negative breast cancer
A patient’s breast cancer stage is determined by the severity of the disease, if it has spread beyond the breast tissue, and if so, how far. The stage of breast cancer is an important factor in selecting treatment.
Stage I: Breast cancer is relatively small at this stage and has not spread to the lymph nodes at all, or has spread only to a very small area in the sentinel lymph node.
Stage II: These breast cancers are larger than stage I cancers and/or have spread to a few lymph nodes.
Stage III: Tumors at this stage are larger than 5 cm, or the cancer is growing into nearby skin or muscle tissue or has spread to many nearby lymph nodes.
Stage IV: At this stage, cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
While surgery is the most common treatment for stage 1-3 breast cancer, radiation therapy is often recommended after surgery to reduce the risk of the cancer spreading or returning. If radiation is recommended, proton therapy is a highly precise and effective radiation treatment that can minimize side effects and reduce the risk of secondary cancer caused by radiation.
Depending on the type and stage of cancer, drug therapy such as chemotherapy and/or hormone therapy may be recommended; for women with stage IV breast cancer, drug therapies often are the main treatments. At this stage, proton radiation treatment may be used to shrink tumors or control pain.
Treatment options also are affected by the type of breast cancer, age, overall health and personal preferences.
Treating previously irradiated areas is challenging and very risky. The healthy tissues around the recurrent tumor do not “forget” the previous radiation dose, and any added dose continues to increase the risk of normal tissue injury. Proton therapy enables doctors to better concentrate the dose to the target and limit it elsewhere, allowing re-treatment with radiation in selected patients.
When you are living with breast cancer, you may need more than expert medical treatment. Our cancer specialists are here to help you and your family every step of the way, from scheduling appointments and answering questions to finding support services and other resources.
We offer a wide variety of services to help speed your recovery, including:
- Support groups, available free of charge — you do not have to be a Scripps patient to participate
- The Lymphedema Management Program, which offers an individualized treatment program that incorporates physical and occupational therapy
- The Breast Buddy Support Program, which matches a breast cancer survivor with a patient to provide support through diagnosis, treatment and recovery
- Home health care services
- Nutrition services through Scripps Center for Integrative Medicine and Scripps Center for Weight Management
- Psychological and emotional care
- Complementary cancer care provided through Scripps Center for Integrative Medicine
Proton therapy is a highly precise form of external radiation therapy that can be used for tumor control in select patients. All cancer treatments have advantages and disadvantages. Be sure to discuss these, as well as your treatment options, with your cancer specialist.
- Can proton therapy improve the therapeutic ratio in breast cancer patients at risk for nodal disease?
- Proton radiotherapy for chest wall and regional lymphatic radiation; dose comparisons and treatment delivery.
- The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials
- Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy
- Post operative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements