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St Gallen Consensus meeting votes for TARGIT
TARGIT-A Trial discussed at the St Gallen Breast Cancer Conference, 2011
19 March 2011
At the 12th International St.Gallen Breast Cancer Conference
16-19 March 2011 / St.Gallen, Switzerland,(~4200 delegates) at the Consensus session on the last day of the conference voted in favour of using intraoperative radiotherapy.
The members of the consensus panel are listed here
The questions were as follows:
In association with breast conserving surgery, partial breast irradiation (intraoperative) is acceptable – Instead of external beam boost to tumour bed?
Yes= 60.9%, No=17.4%, Don’t know= 21.7%
In association with breast conserving surgery, partial breast irradiation (intraoperative) is acceptable – As definitive radiation, without any external beam therapy?
Yes= 48.9%, No=35.6%, Don’t know= 15.6%
Should partial breast radiotherapy be applied in selected patients (including intraoperative) – Elderly (> age 70) ?
Yes = 86.7%, No=6.7%, Don’t know=6.7%
Overdiagnosis with mammographic screening for breast cancer
What is overdiagnosis ?
Overdiagnosis means an increase in cancer diagnosis that occurs while looking for ‘early and curable’ cancers with screening.
This happens because mammography also finds dormant/quiescent cancers and pre-cancers that may never grow in a woman’s lifetime. Under the microscope they cannot be easily distinguished from those that would indeed grow and cause trouble. So one feels that prudently, they should be treated, just like a dangerous cancer with surgery, radiotherapy, hormone therapy and chemotherapy as required. Arguably, in some women such a treatment would have been unnecessary but one cannot tell which cancer could be safely left alone. As a healthy person participating in screening one should be aware of this dilemma.
What is the chance of overdiagnosis?
If 2000 women are invited for 10 years, 43 women will be diagnosed with breast cancer, instead of 33 who would have been diagnosed without screening. This means 10 additional cancers will be diagnosed, and, about 3 less deaths (10 deaths instead of 13) from breast cancer will be avoided1.
On an individual level, suppose you were 50 years old and were not invited to participate in a screening mammography programme, you would have a 1 in 60 chance of being diagnosed with breast cancer over the next 10 years. Whereas, if you were invited to participate in a screening mammography programme, you would have a 1 in 45 chance of being diagnosed with breast cancer over the next 10 years. This represents an increase of about 1 in 200 because of overdiagnosis.
This needs to be weighed against the benefit from being invited to regular mammography for the next 10 years, which is that you would have a 1 in 700 chance of avoiding death from breast cancer.
In other words, one needs to take the 1 in 200 chance being ‘unnecessarily’ diagnosed and treated for breast cancer in order to benefit from the 1 in 700 chance of avoiding death from breast cancer; or for every 3 women with unnecessary breast cancer diagnoses 1 death from breast cancer is avoided.
Note: as regards mammographic radiation causing new cancers:
The radiation used during mammography can also induce cancers – it is estimated 2 that about 1 in 1200 women who have annual mammography from 40-55 and every two years from 56 to 70 will develop a breast cancer and 1 in 9000 will die from it.
The above calculation assumes every woman to have 22 mammograms, but in the UK the National Health Service Breast Screening Programme invites women for 3-yearly mammograms, so women undergo only 7 mammograms between 50 and 70. If the risk is dose-dependent, one can expect it to be reduced by two thirds. This means women in the UK face a 1 in 3500 risk of developing cancer and 1 in 27,000 risk of dying because of breast cancer induced by mammography.
References
1. Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2009(4):CD001877.
2. Yaffe MJ, Mainprize JG. Risk of Radiation-induced Breast Cancer from Mammographic Screening. Radiology 2010.
Initial draft and final approval by Jayant S Vaidya, comments and editorial changes by Mitzi Blennerhassett, Miriam Pryke and Bernard Junod. Thanks also to all members of the breast-screening group who have commented on it.
Latest changes (bold) based on interpretation of Professor Richard Peto’s talk at European Breast Cancer Conference, Vienna, March 2012. http://bit.ly/petoebcc2012
TARGIT-A trial results and news coverage
9 July 2010
The TARGIT-A paper published in The Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60837-9/abstract
5 June 2010:
TARGIT-A trial results published in The Lancet Online First
News articles about the TARGIT trial results
October 2010
Oncology NEWS International.
October 2010, Vol. 19 No. 10
Front page: Trial finds single-dose RT effective in early breast ca
http://www.cancernetwork.com/breast-cancer/content/article/10165/1698196#
August 2010
Future Oncology
August 2010, Vol. 6, No. 8, Pages 1207-1209 , DOI 10.2217/fon.10.103
(doi:10.2217/fon.10.103)
Lead story: Hitting the TARGIT pg 1207
http://www.futuremedicine.com/doi/pdf/10.2217/fon.10.103
25 August 2010
Journal of National Cancer Institute: News
Early Breast Cancer: Single Dose of Radiation During Surgery Gains Support
http://jnci.oxfordjournals.org/cgi/content/extract/djq351
Jul 8, 2010
Medical Physics Web
TARGIT delivers local breast cancer control
Recently published results demonstrate that targeted intraoperative radiotherapy (TARGIT), which involves only selective irradiation of the breast, is equally effective in preventing local breast cancer recurrence as conventional whole-breast radiotherapy (Lancet doi: 10.1016/S0140-6736(10)60837-9).
http://medicalphysicsweb.org/cws/article/research/43137
TARGIT-A data show intraoperative RT equals whole-breast radiation
By Cynthia E. Keen
AuntMinnie.com staff writer
http://www.auntminnie.com/index.asp?Sec=sup&Sub=roc&Pag=dis&ItemId=91119
ecancerTV- Prof Gordon McVie talks about ASCO highlights
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Presentation of the main results of the TARGIT-A trial
The TARGIT-A trial results were presented in the TARGIT-A symposium on 6 June 2010 during the ASCO 2010 conference in Chicago, IL, USA.