Landmark trial reduces radiation for breast cancer treatment

The PROSPECT study looked at whether an MRI and pathology test prior to breast surgery could identify patients who can safely avoid radiotherapy - due to their low risk of breast cancer recurrence.

Professor Bruce Mann, Director of Breast Services at the Royal Melbourne Hospital said the results, published in the prestigious journal The Lancet this week, were overwhelmingly positive.

“By using an MRI in this way, we have shown we may be able to identify patients in whom radiation treatment can be safely omitted with major benefits to the patients involved and the health system,” Prof Mann said.

The study was conducted at four sites including the RMH, the Royal Women’s Hospital and the Austin Hospital in Melbourne and the Mater Hospital in Sydney. It screened almost 450 patients between 2011 and 2019.

The breast screening identified other cancers or areas of pre-cancer in about 11% of that cohort, while about 200 patients were considered safe to be treated without radiation therapy.

Incredibly, of those who omitted radiation, at the five-year follow up there was only a 1% recurrence rate.

“Not only are many patients pleased to have avoided radiation, there are also various patients who had additional cancers found and treated in study who feel their lives have been saved,” Prof Mann said.

Mum-of-two Vicki Zugno (pictured) joined the trial in 2014 and said it was a “blessing” to be involved.

“No radiation? It was a no brainer as far as I was concerned,” Ms Zugno said.

“I just think where I would be if I’d have gone somewhere else. I’m cancer free and that’s all that matters.”

The 10-year anniversary of Ms Zugno’s diagnosis is coming up in June, a milestone she says she feels lucky to see.

“I can’t praise the staff and trial team enough. I’m still dancing, still going to the gym – it really has made a difference,” she said.

Prof Mann added that an additional, unexpected finding was that after five years’ median follow-up, patients who omitted radiation had no recurrences around the body from the original cancer.

“This raises the possibility of a new approach to treating breast cancer,” he said.

The study also analysed the financial impact of avoiding radiation and found this model of treatment could save up to $2900 per patient. Additionally, women who participated in PROSPECT were substantially less likely to fear breast cancer recurrence and had a better quality of life than those who did.

The trial was funded by Breast Cancer Trials supporters and donors to the Royal Melbourne Hospital Foundation, including The Rangers Foundation and Treasure Chest. This research was part supported by a grant from the National Breast Cancer Foundation Australia.