Surgery for early-stage breast cancer is just the start of the battle. Typically, patients must then face between three and six weeks of daily radiotherapy sessions — meaning not only having to deal with the unpleasantness of the treatment but also the cost and inconvenience of potentially long trips to the nearest treatment center.
However, according to new research published by online journal BMJ Open, a new device delivering a single targeted dose of radiotherapy during surgery could save millions of travel miles as well as thousands of hours of women's time.
The current treatment for early-stage breast cancer is surgery — a lumpectomy — to remove the cancerous tissue followed by several weeks of external radiotherapy focused on the affected area. The new treatment — targeted intraoperative radiotherapy, or TARGIT, is applied directly to breast tissue during surgery. Although this adds around 20 to 40 minutes to the length of an operation, in most cases it means the subsequent daily radiotherapy treatments can be avoided. Previous research suggests that, in suitable patients, TARGIT is as good as regular external radiotherapy at treating early-stage cancer.
Researchers compared the journey times and environmental effect of both TARGIT and traditional treatment in 485 U.K. patients, 249 of whom had been randomly assigned to TARGIT and 236 to regular external treatment. Using Google Maps, they calculated the shortest driving distance from patients' homes to their radiotherapy unit as well as the average travel time, excluding traffic delays. This data was used to calculate the total distance travelled and time spent to complete the radiotherapy course.
The study found that participants lived, on average, 13 miles from a radiotherapy unit and that population density means two thirds of the population lived still further away. Carbon dioxide emissions were estimated for a standard family car with an average fuel consumption of 40 miles per gallon. This, the researchers calculate, would produce 299g per mile of CO2 emissions for a diesel car and 272g per mile for a petrol vehicle.
In total, TARGIT patients traveled significantly fewer miles (21,681) than their counterparts (92,591) to attend treatment sessions and indeed spent significantly less time doing so — three hours of travel for TARGIT patients compared with 14 hours. Unsurprisingly, TARGIT journeys also emitted significantly less carbon dioxide — 24.7 kg compared with 111 kg for patients undergoing regular treatment. Patients who were treated in two semi-rural radiotherapy units each saved themselves journeys of 753 miles and 30 hours of travel time meaning they spared the planet 215 kg of CO2.
There are around 50,000 cases of breast cancer diagnosed in Britain every year, around three quarters of which are treated with lumpectomy and the traditional method of radiotherapy. The researchers calculate, therefore, that if TARGIT became widely available across the U.K. — treating as many as 20,000 patients — it could save between 6 million and 15 million miles in journeys, between 1,700 and 4,300 tons of carbon dioxide as well as tens of thousands of hours of driving time every single year. The forest needed to absorb this CO2 output, they say, would be up to 300 hectares — an area covered by almost 600 football fields!
A widespread change to the new treatment would be much "greener" than the estimated environmental benefits of introducing mobile breast cancer screening, the researchers say. "The management of breast cancer has changed over the decades. However, the requirement of patients to travel to receive these specialist services is often forgotten by policy-makers," they suggest. "Introducing TARGIT as an option for appropriate patients in the U.K. will contribute significantly to saving patients time, cost, fuel and CO2 emissions."