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New Options for Breast Cancer

Less Invasive Treatments, High-Tech Screening Methods, Revealed

By Sid Kirchheimer WebMD Medical News
Reviewed By Brunilda Nazario, MD on Thursday, July 22, 2004

July 22, 2004 -- Two cutting-edge, breast-saving procedures are
actively being explored as alternatives to more invasive surgery for
many women with breast cancer.

One procedure "cooks" small tumors as an alternative to surgery, and
the other delivers radiation from temporarily implanted seeds. These
techniques will allow women to avoid having a mastectomy and reduces
standard radiation therapy from six weeks to a few days.

Meanwhile, high-technology screening options are being explored to
enhance or even replace screening mammograms. If these methods prove
effective in several large studies, "we may have new (screening)
guidelines in the next one to four years," says Etta Pisano, MD, chief
of breast imaging at the University of North Carolina School of
Medicine, who is involved in some of those trials.

Pisano was one of five nationally recognized experts offering a
glimpse at what may prove to be new frontiers in fighting breast
cancer during a meeting held by the Radiological Society of North
America.

Cooking Tumors

One promising treatment being explored is thermal ablation as a
possible alternative to surgery. In this procedure, doctors use MRI or
ultrasound to delineate where small tumors start and end. Then they
insert a needle into the tumor to deliver heat from a laser or
radiofrequency energy to "cook" the cancerous tissue.

"A key advantage of image-guided ablation is that the physician can
visualize the ideal treatment zone and effectively destroy the tumor
and a margin of tissue surrounding it," says Steven E. Harns, MD,
director of imaging at the University of Arkansas for Medical Sciences
in Little Rock.

"We know that 40% to 50% of the time, there will be additional cancers
outside that area in the breast that may not be seen by physical
examination or conventional imaging."

It has only been performed on three patients as an alternative to
lumpectomy -- a surgical procedure done to preserve most of the normal
breast tissue. None of these women had a recurrence of breast cancer.

An additional 50 women underwent this procedure but had follow-up
lumpectomy to ensure that the imaging procedure used in thermal
ablation correctly sized the tumor borders. However, if thermal
ablation proves effective in studies, it would be a viable option only
for women with small tumors. In treating a 1 centimeter breast cancer
tumor, the "kill zone" would include 3 centimeters surrounding it,
says Harns

Radiation From Inside Out

Another promising treatment is accelerated partial breast irradiation
-- also known as brachytherapy -- in which tiny radioactive "seeds"
are implanted in the tissue during lumpectomy. This technique, already
being performed, is showing promise as an alternative to mastectomy;
it also delivers radiation more safely, quickly, and directly, says
Robert R. Kuske, MD, FAACE, a radiation oncologist with Arizona
Oncology Services in Scottsdale.

He explains that radiation seeds the size of a pencil tip are inserted
through plastic tubes into tissue that surrounds the lumpectomy site.
Because it's placed directly at vulnerable tissue, a maximal dose of
radiation can used without irradiating other tissue or nearby organs
such as the lungs. Traditional external beam radiation can result in
disfiguring burns to the skin.

This procedure, currently used in treating prostate and cervical
cancers, is used in women with small tumors -- less than 3
centimeters, with little or no spread of the cancer to tissue outside
the breast.

"This is kind of a magic bullet in that it puts radiation where it
needs to be, and not where it doesn't need it," says Kuske.

In 425 patients he treated in the past 13 years, only five had a
cancer recurrence -- a slightly lower rate than what's found in
studies using conventional external beam radiation therapy.
Brachytherapy only takes four to five days, compared with the standard
25 to 30 sessions of external radiation treatments done over a
six-week period. It's this long radiation schedule that makes some
women who are eligible for lumpectomy choose the more aggressive
removal of the whole breast by mastectomy.

Better Screening on Horizon?

While there's no debate that screening mammograms helps save lives,
alternative imaging technologies to supplement or even replace it
could help some 40,000 women dying of breast cancer each year, says
Pisano. She is currently involved in four studies -- studying nearly
55,000 women -- to determine whether digital mammograms, ultrasound,
and MRI can help detect breast cancers earlier that standard
mammograms. Those results are expected within the next few years.

And computer software already in use is showing promise as an
additional screening tool. Stamatia Destounis, MD, of The Elizabeth
Wende Breast Clinic in Rochester, N.Y., presented findings from her
study in the August issue of Radiology that indicate this
computer-aided detection software offered the potential to identify
71% of cancers previously missed in mammography.

In the meantime, radiologist Stephen A. Feig, MD, of Mt. Sinai School
of Medicine, says more effort should be placed to get women to be
screened yearly rather than every two years.

"Initiatives need to be explored, such as reminder cards such as the
ones people get from their dentists to come for dental checkup," he
says. "This would help people return every year for mammograms every
year. And we know screening with mammogram does save lives."

SOURCES: Radiological Society of North America media briefing, July
22, 2004. Etta Pisano, MD, chief of breast imaging; professor of
radiology and biomedical engineering, University of North Carolina
School of Medicine, Chapel Hill. Steven E. Harns, MD, professor and
director of imaging, University of Arkansas for Medical Sciences,
Little Rock. Robert R. Kuske, MD, FAACE, radiation oncologist, Arizona
Oncology Services, Scottsdale. Stamatia Destounis, MD, radiologist,
The Elizabeth Wende Breast Clinic, Rochester, N.Y.; assistant clinical
professor of radiology, University of Rochester. Stephen A. Feig, MD,
professor of radiology, Mt. Sinai School of Medicine, New York.

http://my.webmd.com/content/article/91/101002.htm