A breast cancer diagnosis once meant life had to be put on hold. Months of agonising treatment and countless trips to hospital typically followed.
But for Jane Putley, 51, from South-West London, it was over in a flash. In fact, she says: ‘It was a bit like getting a tooth taken out.’
The mother-of-two was diagnosed in February 2018, after a mammogram. Further tests revealed a small tumour, little bigger than a garden pea, growing in her right breast, and of a type that can be aggressive. Jane, who was 49 at the time, was stunned.
‘I’ve always exercised a lot, ever since my 20s,’ says Jane, a sales director. ‘And I have always been very careful about what I drink and eat. I wasn’t someone you would think would be at high risk of getting cancer.’
‘Like having a tooth out’: Jane Putley, now cancer-free, with her daughters Izzy and Lucy. The mother-of-two was diagnosed in February 2018, after a mammogram
Luckily, her prognosis was good. The cancer had been caught at an early stage and hadn’t spread. But she still faced surgery to remove the lump, followed by weeks of radiotherapy, using repeated high doses of radiation to kill any leftover cancer cells and prevent the disease from returning.
That was until she learnt of a pioneering method that could rid her of the disease in one, swift go.
The treatment, known as targeted intraoperative radiotherapy, or Targit-iort, is carried out during surgery to remove the tumour. Once the lump is out, a single 20- to 30-minute blast of radiotherapy is delivered using a small, ball-shaped device, which is placed directly inside the incision in the breast where the cancer was.
Most patients require no further treatment afterwards.
For Jane, it was a ‘no-brainer’. Within weeks of her diagnosis, she underwent the procedure privately at the Great Western Hospital in Swindon – it costs up to £17,000, but was covered by her health insurance policy.
It was over in about 90 minutes and she has been cancer-free ever since. ‘Having to go through weeks of radiotherapy would have been awful,’ she says.
‘I think it would have been mentally draining and really emotional, going to hospital every day surrounded by very sick people. But instead I had one operation for what could have been a very serious and life-threatening condition – and it was no different to going and having my tooth taken out.’
Jane’s experience is not unique. In 2017, this newspaper revealed how BBC journalist Kirsty Lang had opted for the treatment after being diagnosed with breast cancer. She was able to go home the same day as her operation and was back on Radio 4 six days later.
Crucially, mounting evidence suggests the technique works. Last month, a study led by researchers at University College London, published in medical journal The BMJ, concluded that Targit-iort was as effective as radiotherapy treatment, which involved daily visits to hospital over three to six weeks.
‘Women of working age don’t want to spend weeks travelling daily to receive radiotherapy,’ says Nathan Coombs, a senior breast surgeon at Great Western Hospital who has treated 64 patients using the method. ‘This study shows that giving a single dose of radiotherapy is just as effective, and it can save women from significant travel and hassle. One patient I treated would have otherwise faced a 100-mile round trip every day to receive treatment.’
Success: Karen Davis, 52, from Newcastle-under-Lyme in Staffordshire, was part of the Fast-Forward trial after she was diagnosed with breast cancer in 2013
The study’s findings have prompted calls for more women to have the treatment on the NHS. However, only a handful of hospitals have the special equipment needed to administer it.
‘With Targit-iort, women can have their surgery and radiation treatment for breast cancer all at the same time,’ says Professor Jayant Vaidya, lead author of the study and professor of surgery and oncology at University College London. ‘It should be discussed with patients when surgery for breast cancer is being planned.’
So is the treatment the breakthrough that breast cancer patients have been waiting for? According to some experts, the reality is a little more complex.
Targit-iort was first developed by experts at University College London in 1998.
Between 2000 and 2012, the method, suitable for women over the age of 45 with small tumours up to 1½in in size, was tested in a trial involving more than 2,000 patients. One group of patients received the pioneering method. The remainder were treated with standard treatment at the time – radiotherapy over the course of three to six weeks.
Patients would typically have to go to hospital between 15 and 30 times to receive a dose of external radiotherapy – a beam of high energy X-rays – to the entirety of the affected breast.
The results, published last week, show that five years later, two per cent of those treated with the new method had seen their cancer return. This compared with one per cent of those treated with standard radiotherapy – a difference not considered to be significant.
But some cancer specialists have raised concerns about the way the study was carried out.
One fifth of the women treated with Targit-iort also required further doses of standard external radiotherapy, after it emerged that their cancer was more aggressive than first thought.
Patients would typically have to go to hospital between 15 and 30 times to receive a dose of external radiotherapy to the entirety of the affected breast (file photo)
Experts also say breast cancer care has evolved dramatically since the study was first designed, thanks to game-changing UK research which has led to shorter, more precise treatment.
Since 2018, health watchdog the National Institute for Health and Care Excellence (NICE) has recommended a new gold-standard technique for women with low-risk cancer. Known as partial breast radiotherapy, it involves directing beams of radiation only to the area where the tumour is found, instead of to the whole breast.
It is given in 15 doses over the course of three weeks, with fewer side effects reported. And unlike Targit-iort, which requires a machine costing £450,000, this technique can be carried out using existing radiotherapy equipment, meaning that it will be widely accessible to NHS patients.
Even more astounding – as this newspaper has previously reported – a landmark study has now suggested this method could be shortened to just a week.
The Fast-Forward trial, led by the Institute of Cancer Research in London and published in medical journal The Lancet in April, found that giving five larger daily doses of partial breast radiotherapy over the course of seven days was just as safe and effective as three weeks of treatment.
Many experts believe NICE will soon make this one-week treatment standard for women with low-risk cancer receiving whole or partial breast radiotherapy.
‘When the Targit-iort trial was designed in 2000, the international standard was a minimum of five weeks of daily radiotherapy, if you’d had a lump removed,’ says Dr Jeanette Dickson, president of the Royal College of Radiologists.
‘Now we are basically down to five days. For some women, it’s very attractive to have their treatment wrapped up in one operation. But the difference between an operation and one week of treatment is not as striking as an operation and five weeks of treatment.’
The study’s findings have prompted calls for more women to have the treatment on the NHS. But only a handful of hospitals have the special equipment needed to administer it (file photo)
Karen Davis, 52, from Newcastle-under-Lyme in Staffordshire, who runs a hairdressing and beauty business, was one of those who took part in the Fast-Forward trial after she was diagnosed with breast cancer in 2013.
After the lump in her left breast was removed, she had a week-long course of radiotherapy and has been cancer-free since.
‘I was sick with nerves before starting the treatment, so I think it was easier for me mentally to know that it was only five days,’ she told this newspaper in June. ‘It also meant I could go back to work sooner, which, when you’re running your own business, means a lot.’
Another area of contention is that advocates of Targit-iort claim women who received it were less likely to die from other cancers and heart disease in the following five years than those who received conventional radiotherapy. They say this is probably because the radiation is more targeted and doesn’t stray to nearby organs, accidentally triggering new cancers.
‘When you give radiotherapy in the traditional way, you are going to get collateral damage,’ explains Nathan Coombs, senior breast surgeon at Great Western Hospital. ‘You will try everything to stop that, but inevitably the lungs, the heart and other organs may get some radiotherapy scatter, which can cause long-term damage.
‘With intraoperative radiotherapy, you don’t get this damage, so that means you are probably sparing many of these women long-term complications.’
But Professor John Yarnold, emeritus professor of clinical oncology at The Institute of Cancer Research in London, argues that today the risk of long-term damage to surrounding organs from conventional radiotherapy is much lower. This is in part down to improved technology, which helps ensure radiotherapy is delivered exactly where it is needed, and a new technique called the voluntary breath hold.
Breast cancer fact
Globally, about 45,000 patients have now been treated with Target-iort.
This was introduced in 2018 for patients receiving radiotherapy to their left breast, near the heart.
‘Women hold their breath for 20 seconds,’ Prof Yarnold explains. ‘By breathing in, the breast and ribcage move away from the heart, so there is a big gap separating them. It costs nothing, and it reduces the cardiac dose to minute levels.
‘It also reduces the dose to the lung as well.’
Whether Targit-iort becomes more widely available on the NHS, following the publication of the University College London study, will ultimately be down to health watchdog NICE, but its future seems uncertain. In 2018, the health regulator expressed doubts over whether it would be able to recommend the treatment even if longer-term data became available. And more specialist machines which carry a hefty upfront cost would be needed to make it available to more women. Despite the prospect of one-week partial breast radiotherapy, Mr Coombs believes there is a place for Targit-iort in breast cancer care.
They stopped offering it at Great Western Hospital at the end of last year, but he hopes the new study results will encourage officials to re-introduce it. A handful of hospitals currently offer it privately.
‘With shorter-course radiotherapy, people still need to travel,’ he says. ‘You have to do two trips to the hospital beforehand for assessment and then you’ve got to come in for five treatments.
‘I’m hoping that NICE looks again at Targit-iort and recommends it as an option.’
Experts agree that women should not worry they’re not getting the best possible treatment on the NHS. Dr Dickson adds: ‘Women who are concerned should speak to their doctor, oncologist or surgeon. They will know about all the options and be able to discuss them on a case-by-case basis.’