Innovations expand options in breast-cancer treatment

Breast-cancer treatments have become less invasive over the past 5 years, and among the latest innovations are nipple-sparing mastectomies, safer breast-reconstruction procedures and targeted radiation treatment.

An innovation in breast-cancer detection, according to Dr. Virginia Kaklamani, who is an oncologist at Northwestern Memorial Hospital in Chicago, is the core-needle biopsy, which doesn’t require the incision that a traditional biopsy requires. In a core-needle biopsy, a large, hollow needle is inserted into a tumor multiple times to draw tissue samples from different areas of the tumor for comparison.

Today, if a woman is diagnosed with breast cancer, her doctors can tailor treatment and surgical procedures to her better than ever before. This now includes a surgical method that’s aimed at saving as much of the breast tissue as possible: A nipple-sparing mastectomy leaves the breast as aesthetically intact as possible for better results from breast-reconstruction surgery.

However, proof continues to emerge that lumpectomies that are combined with radiation treatment produce similar survival rates as do mastectomies. As a result, doctors generally suggest that patients who are diagnosed in an early stage of breast cancer receive a lumpectomy, which is the removal of a cancerous tumor and the surrounding breast tissue, and radiation. “Mastectomies are bigger procedures, and mastectomy reconstruction is never easy,” Kaklamani says. However, some patients still opt for a mastectomy because it gives them greater piece of mind, she says.

The latest breast-reconstruction procedure is the DIEP (Deep Inferior Epigastric Perforators)-flap procedure, in which abdominal fat tissue is used to replace breast tissue. According to Dr. Gedge Rosson, who is a plastic surgeon who specializes in DIEP-flap procedures at Johns Hopkins Hospital, the DIEP-flap procedure is a safer one than is the traditional TRAM (Transverse Rectus Abdominis Myocutaneous)-flap procedure, in which abdominal muscle tissue is used to replace breast tissue. Removal of abdominal muscle tissue puts the patient at significantly greater risk for a hernia or an abdominal bulge after surgery than does the DIEP-flap procedure.

For women who are good candidates for a lumpectomy and radiation therapy, targeted radiation treatment is a new option. By targeting only the affected area, as opposed to the entire breast, this treatment reduces the patient’s exposure to radiation per procedure and over the duration of the treatment.

“So, instead of going to radiation for six weeks, you can go for one week,” Kaklamani says.

Not to be overlooked is the shift in the approach that many doctors take in the coordination of a patient’s care. In many hospitals, doctors now take a group approach when they treat a breast-cancer patient. Instead of a patient making separate appointments with specialists and surgeons, all of the doctors who are involved can work in tandem. The entire team discusses treatment options with a patient shortly after her diagnosis.

Kaklamani says inclusion of a plastic surgeon on the team means that a patient’s reconstruction surgery can take place immediately after a mastectomy. In the past, she says, patients had to schedule reconstruction surgery a few weeks after a mastectomy.

– K. Fanuko