This article is the third of a three-part series on breast cancer: diagnosis | treatment | surgery
As in other areas of breast cancer research and development, advances in surgery are also being seen, not only in improving the actual surgery techniques, but also in the methods and processes prior to and following surgery. Here is a look at some of the latest research:
A novel 3-D device, called the Bio-Zorb, has greatly improved the marking of the surgical site of the excised tumor. The implantable marker improves post-surgical treatment, such as radiation therapy, and is made of a material that allows the patient's body to absorb it, therefore not requiring surgical removal after treatment is completed.
A new technique combining MRI and optical scanning before and during surgery has improved the ability to located small breast cancer tumors. Physicians and engineers at Dartmouth have combined to develop a technique that gives the surgeon, at the time of surgery, a 3-D picture of where the cancer is in the breast.
This new method uses a pre-op MRI to map the tumor, then employs an optical scan to identify the tumor's size, shape and location. This kind of pinpoint accuracy allows for a more precise surgical excision.
To ensure that patients will not need repeat surgeries when a lumpectomy is performed, the Mayo Clinic in Rochester uses unique laboratory testing of the surrounding tissue samples. Using frozen-section analysis while the patient is still on the operating table, the surgeon quickly receives results whether or not there is still more cancerous tissue to remove, and if so, how much.
The Mayo Clinic remains the only U.S. medical center to perform frozen-section analysis. What makes the process unique, is the use of a Mayo-modified microtome enabling the pathologist to get a view completely around the lumpectomy.
The success rate is impressive. During the years reviewed (2006-2010), 13.2 percent of breast cancer lumpectomy patients nationally had to return to the operating room within a month, compared to only 3.6 percent at the Mayo Clinic.
Studies also revealed that some guidelines have been revised, leading to more conservative surgeries, with still the same results as more radical approaches. A publication in JAMA written by surgeons at the UT Southwestern Medical Center, reviewed previously-published research on the risks and benefits of sentinel node biopsy as compared with complete axillary node dissection. More than 1,000 results were examined from 17 studies.
The review concluded that there is little evidence of benefit in doing a complete axillary node dissection in women with no suspicious axillary nodes who undergo breast-conserving therapy, compared with sentinel node biopsy alone. They further concluded that avoiding axillary surgery, if possible, is important to avoid shoulder and arm symptoms, such as lymph edema, pain or numbness, and reduced range of motion. Axillary surgery also generally involves longer hospital stays.
Another study conducted at the University if Michigan looked at more than 1,400 women who had been treated for breast cancer and who had not had a recurrence. They surprisingly found that 7 percent of these women had surgery to remove both breasts. Ninety percent of these women reported being very worried about the cancer recurring.
However, a diagnosis of breast cancer in one breast, for most women, does not increase the likelihood of breast cancer recurring in the other breast. Researchers hope that a grant they have recently received from the National Cancer Institute will allow them to develop a decision tool to help better educate women to make more informed breast cancer treatment choices.
