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Proton Therapy for Breast Cancer: Getting to the Heart of the Matter

  • Shannon M. MacDonald
    Correspondence
    Reprint requests to: Shannon M. MacDonald, MD, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Yawkey 112, 55 Fruit St, Boston, MA 02114. Tel: (617) 643-7250
    Affiliations
    Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, Massachusetts
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      Proton therapy is an increasingly utilized radiation treatment alternative to photon (x-ray) therapy for malignancies of the breast. Despite a quiescent history of proton use for this disease, breast cancer is now commanding more attention from the proton community than perhaps any other malignancy. The reasons for this are many, some noble and patient-centered and some, perhaps, monetary. Breast cancer is the most common malignancy in American women (

      United States Cancer Statistics Working Group. United States Cancer Statistics: 1999-2012 Incidence and Mortality Web-Based Report. US Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015.

      ). With a 5-year survival for all-comers estimated at 89%, and an approximate incidence of this disease at 230,000 women per year, we expect an approximate absolute number of 207,000 survivors at 5 years (

      Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site. Date accessed April 2015.

      ). With this favorable prognosis, the impact of even a small decrease in cardiac morbidity would be meaningful; however, for proton therapy, which has yet to show a clear clinical benefit or reduction in harm for breast cancer, the upfront financial burden to insurers and out-of-pocket expenses for patients would be substantial. Determining the clinical benefit of proton therapy for breast cancer is of paramount importance for our patients and for our healthcare system.
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      References

      1. United States Cancer Statistics Working Group. United States Cancer Statistics: 1999-2012 Incidence and Mortality Web-Based Report. US Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015.

      2. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site. Date accessed April 2015.

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