By Jana Soeldner Danger
A breast-cancer diagnosis is always frightening. Today, however, there are new weapons in the arsenal to lessen the discomfort and fear of testing.
Mapping the human genome has drastically changed the way breast cancer, as well as other cancers, can be identified. “We used to think of cancer types as the site of origin, and we designed treatments that way,” says Dr. Charles Vogel, medical director of the Women’s Center at Sylvester Comprehensive Cancer Center in Deerfield Beach. “Now we can identify the mutations in the tumor and do genetic sequencing to find out what’s driving the tumor. It may be a mutation that has not previously been associated with breast cancer.”
Sylvester is part of a clinical trial that treats specific mutations.
“We’ve identified at least six different mutations that we know we have drugs to target,” Vogel says. “In the future, instead of thinking of breast cancer as a separate disease, we will think of specific mutations and develop drugs that cross disease lines.”
Three-dimensional mammography helps doctors see the breast more accurately than 2D, which shows it as one flat image. With 3D, the machine takes multiple images of tissue in one-millimeter slices, which the radiologist can scroll through like pages in a book. 3D imaging, which works in conjunction with 2D, discovers more cancers and decreases the false-alarm rate.
“But previously it also increased the radiation dose,” says Dr. Mary Hayes, chief of breast imaging at Memorial Healthcare System in Hollywood.
More recent low-dose 3D mammography delivers 40 percent less radiation by eliminating the 2D step, Hayes says. “It creates a composite using information from 3D images to create a zero-dose, virtual 2D image called C-view.”
Some women avoid mammograms because they fear the compression will be painful. Boca Raton Regional Hospital is testing a new mammography compression paddle that measures optimum pressure according to breast size rather than force, says Dr. Kathy Schilling, medical director of the Christine E. Lynn Women’s Health & Wellness Institute in Boca Raton. LEDs on the paddle identify different pressure levels.
“They alert the technician when optimum pressure for the specific patient is reached,” Schilling says. “This may encourage patients to comply with screening guidelines, as the exam is more comfortable.”
Women at high risk may be tested with MRIs instead of mammograms, but technology being studied at BRRH may soon replace that kind of screening. A patient is injected with an iodinated contrast substance which is tracked with a mammogram.
“Cancer cells get hungry, and the tumor releases chemicals into surrounding tissue and steals blood vessels to feed itself,” Schilling says.
But the stolen vessels are weak.
“The iodine contrast goes into them and leaks out around the cancer so we can see it,” Schilling says, adding that the test takes five minutes compared to 45 for an MRI and is significantly less expensive.
A new tool called the SAVI Scout makes the preoperative experience easier and more convenient for the patient and helps the surgeon be more precise.
A lumpectomy has two parts: preoperative tumor localization followed by surgical removal. Standard wire localization requires a woman to go into the hospital the day of surgery to have a guide wire inserted into her breast to determine the tumor’s location.
“A wire shouldn’t stay in the breast for more than a few hours, so the patient has to arrive at the hospital early, and having a wire protruding from the breast can be uncomfortable,” says Dr. Erica Bloomquist, a breast surgical oncologist at Memorial Cancer Institute’s Breast Center in Hollywood.
The SAVI Scout employs a non-radioactive reflector inserted through a tiny incision up to seven days prior to surgery. During surgery, the doctor places a probe on the breast that emits an infrared signal. When the reflector detects the signal, the probe beeps.
“I know exactly where to make the incision, and the SAVI Scout has the benefit of no radiation, unlike some other localization methods,” Bloomquist says.
A lumpectomy is followed by radiation, and standard protocol is 33 high-energy treatments delivered to the whole breast over a period of six weeks. For patients who qualify, new Intrabeam technology may prevent recurrence with a single dose of low-energy radiation delivered only to the target tissue immediately following the lumpectomy.
A spherical applicator is placed directly on the tissue.
“It penetrates only one or two centimeters,” says Dr. Irina Grosman, a radiation oncologist at Dorothy Mangurian Comprehensive Women’s Center at Holy Cross Hospital. “No other organs, like the heart and lung, get any radiation.”