Breast surgeons keep up with the latest research and technology to offer women their best chances against cancer with the least side effects.
Instead of an incision to remove a suspicious lesion, surgeons now use a needle. Where a complete mastectomy was once the standard of care, many tumors are now extracted with less-invasive lumpectomies.
“It has taken care to a new level,” Dr. Patti Stefanick said at her 939 Menoher Blvd. office in Southmont. “You try to do the least amount of surgery to find out what you need to know.”
Surgeons normally get involved when the radiologist finds a suspected cancer on a mammogram, often followed up with an ultrasound or magnetic resonance imaging study.
If the additional studies have not ruled out cancer, the surgeon or the radiologist uses new pictures from digital mammograms, ultrasound or MRI to precisely target the lump for an image-guided needle biopsy. The needle – really a small tube – is inserted into the breast and fed to the lump, where a small amount of tissue is removed for analysis.
Advances in imaging technology are helping doctors treat cancer more effectively, Stefanick said.
Digital mammography, first introduced locally in 1998 at Windber Medical Center, has become the standard across the region. Conemaugh Health System rolled out its digital mammography network earlier this year at six locations across Cambria and Somerset counties.
“Digital, that has made a ton of difference,” Stefanick said. “We are finding things really tiny. I have found so many tiny cancers in the last few months, that you’ve go to figure that has made a big difference for those ladies in Johnstown.”
Although some experts have criticized routine mammography screenings for raising patients’ fears with false positives, Stefanick said the new technology has had the opposite effect.
“I think, with the new digital mammography, there might be less false ones,” she said. “They are more clear. All the fogginess of the film is lifted.”
By eliminating the need to develop X-ray film and transport the images, results are available more quickly, Stefanick said.
“It has made a big difference in timing for these ladies,” Stefanick said.
Image-guided biopsies have helped doctors analyze tumors without the need for more invasive surgery. Stefanick performs ultrasound- and mammography-guided biopsies in her Menoher Boulevard office.
Increasingly, the analysis of the tissue not only confirms or rules out cancer, it can help doctors decide which treatment options have the best prognosis, Dr. Gerard Garguilo said at Johnstown Breast Center, 1111 Franklin St.
“The ‘new’ in cancer care is individualized treatment,” Garguilo said.
Chemotherapy, radiation treatments and surgery can all be tailored to the type of cancer cells identified and how much it has spread.
The biggest recent development is a study that has reduced the amount of tissue removed from a patient’s armpit area during certain lumpectomies, Garguilo said. The Z-11 study by American College of Surgeons Oncology Group showed patients whose breast cancer has spread to just one or two key lymph nodes in the arm do not require additional surgery to remove more lymph nodes for study.
“I think it’s a huge advantage,” Garguilo said. “We get away from a much larger operation with more chance of complications.”
Lymph nodes are small, bean-like glands distributed through the body as part of the lymphatic system that collects escaped fluids as part of the body’s natural immunity protection. The lymph nodes filter the fluids that escape from cells or tissue, so they are the first to “catch” the cancer spreading from the breast tumor.
Surgeons inject a dye with a very small amount of radioactivity into the tumor prior to surgery and track the dye to identify which lymph nodes are directly connected to the tumor, Dr. Diane Craig said at Joyce Murtha Breast Care Center in Windber.
From one to six of those nodes, called sentinel nodes, are then removed for testing at the same time as the tumor.
Until last year, if cancer was found in any lymph node, up to 30 more were removed in what is called an axillary lymph node dissection. The idea is to remove more cancer and see how far it has spread.
But the Z-11 study showed the results are the same without the dissection for patients with cancer in only one or two sentinel nodes – provided their lumpectomy is followed up with a round of full-breast radiation treatments.
Eliminating the dissection also reduces the chance of lymphedema, a painful swelling in the arm caused by disruption of the lymphatic system.
Following the new guidelines makes sense, Garguilo said.
“The chance of cancer coming back or dying from cancer was the same,” he said.
Since the results of the Z-11 study were published last year, the new recommendations have become widely accepted, Craig said.
“Most surgeons are following those guidelines,” Craig said. “It was a good study, so why not offer women less surgery and still have the same outcomes?”