Leslie Botnick, MD: What Breast Cancer Patients Need to Know About Radiation Oncology
Dr. Leslie Botnick discusses what a breast cancer patient needs to know about radiation oncology.
Dr. Botnick is the Chief Medical Officer and Founder of Vantage Oncology.
The Group Room at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium was made possible by support from:
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:
Hello and welcome to The Group Room where we’re at the 34th annual CTRCAACR San Antonio Breast Cancer Symposium. So, now I’m joined by Dr. Leslie Botnick. Dr. Botnick is a Board Certified Radiation Oncologist practicing at the Center for Radiation Therapy in Beverly Hills, California. You’re also the Cofounder and Medical Chief Officer of Vantage Oncology. What does a woman diagnosed with breast cancer really need to know in regard to radiation therapy- some of the key points that you need to drive home to these women? You have very different types of breast cancer…
Leslie Botnick, MD, Chief Medical Officer and Founder, Vantage Oncology:
That you need to have the appropriate equipment that can deliver IMRT if needed, but not necessarily always the case, but can do image guided radiotherapy, where you can actually ensure that the position on a daily basis is correct, that the planning process includes some positioning device for stability of the patient on a day-to-day basis.
As you know, and what we do, is make sure that the heart is not in the field, that the actual treatments themselves, you should be in the department for no more than a half an hour- the treatments take 5 or 10 minutes, the setup should take as long as the treatment and you can come and go by yourself, there is no nausea, there is no vomiting.
The side effects during the radiation are slight redness and itchiness of the skin; it’s rare to blister, rare to have an infection long term. Most women can’t tell which side was treated, with normal sensation, normal appearance, and it just looks normal. The main side effect you see over 10, 15, and 20 years is some loss of stretch-ability of the breast, which some women say gives them a young, perkier breast.
Selma Schimmel:
And one thing, which surprises people, and you hear this all the time, someone is going through radiation therapy, and loved ones mean well and they say, “well, it’s not chemo, it’s not a big deal.” And you know, for the patient it is a big deal, it’s every day and fatigue can accompany radiation therapy just like any cancer treatment; your hemoglobin is impacted. I always wondered why, actually, the hemoglobin gets lowered.
Leslie Botnick, MD:
I’ll correct you a little, it’s not quite the hemoglobin, it’s actually the white cell counts because there are cells that will circulate within the field of the radiation and you can see some decrease in the white cell count. You’re not immune suppressed, you’re not subject to infection; why someone gets tired, I don’t understand but I find the more you get back to your normal routine, exercise and get out, that’s less of a side effect.
We do not see a large component now of fatigue. It is a big deal because it’s got to be done accurately and done well and you should be in a place that really follows their patients because the issue of not coming back and seeing the radiation oncologist for, when you should get a mammogram, should you have a mammogram or an MRI, should you get this before radiation starts, what you should do… and just the side effects and the follow up should all be done in a joint way, with a surgeon and a medical oncologist.
Selma Schimmel:
If the medical oncologist or surgeon has not referred the patient for a consult with a radiation oncologist, what do you say? Because, that patient then maybe has to be the one to become assertive.
Leslie Botnick, MD:
You know, I personally believe that no woman today should get any more than a biopsy without seeing a radiation oncologist, first with the surgeon at the same time. And, I think, women would be better served if would they do that.
Selma Schimmel:
And even if the woman is told that they should have a double mastectomy, or single mastectomy, it would seem to me reasonable that on their own speaking to a radiation oncologist to understand what their options are to be sure also that certain decisions that one makes they can’t reverse.
Leslie Botnick, MD:
That’s correct. I think you need to get all your information and the only way to do that is actually to speak to all the deliveries of care and service that should go to you. I think patients forget that doctors actually work for them so they get very nervous about insulting their doctor, all that other stuff. We work for the patient. We could be the patient. So, we want to make sure that we deliver the appropriate service. There shouldn’t be these barriers to making these phone calls, “I’m insulting my doctor”. Hey, doctors work for you; any doctor insulted by a second opinion is a doctor you probably shouldn’t see.
Selma Schimmel:
Just like in the area of medical oncology where you have medical oncologists that will specialize or spend more time dealing with a specific tumor type, is it not so that radiation oncologists one may be more involved in treating breast cancer, another more involved in prostate cancer? Is there a benefit to seeking out a radiation oncologist that really sees a lot of breast versus the other types of cancers that get radiated?
Leslie Botnick, MD:
With the complexity of therapy today, the answer is yes. Probably 20 years ago I would not have said that. But how you contour the breast, how you contour the nodes, just like it makes a difference how you contour the prostate or head and neck, how you do that, to tumor sparing tissue- what you spare, what you do… Absolutely, I think it is very important to be with a physician and a group, if you can, that really has the best physics and those symmetry and people doing this.
Selma Schimmel:
And someone who is receiving radiation, people ask this all the time, are they of any danger to their loved ones, to their children, to their spouses?
Leslie Botnick, MD:
They are not radioactive. There is minimal scattered dose to the rest of the body, so the exposures are clearly so much less than they used to be. But they’re never radioactive unless you have radioactive material placed in you and you walk out with it. Since even with the brachytherapy is done in the department, you’re emitting no radiation.
Selma Schimmel:
And, what about radiation therapy and pregnancy? And, if you are pregnant at the time of your diagnosis?
Leslie Botnick, MD:
If it’s an early pregnancy, that’s the most dangerous time to get the radiation so most would not do that at all. We usually try either to get people past the first trimester; if we can, they’ll do the excision, they’ll do some chemotherapy. We try to delay radiation till after delivery but the safest time is probably in the last trimester, as crazy as that sounds, because the baby is formed, there is very low scatter and if you had to use radiation you could do it at that time. Most of us try very hard to not to use radiation during pregnancy.
Selma Schimmel:
Thank you, Dr. Botnick. Dr. Leslie Botnick, Cofounder and Chief Medical Officer of Vantage Oncology.
Leslie Botnick, MD:
Thank you, Selma.
END OF VIDEO