Medical experts and facilities throughout the region are offering patients new opportunities in the areas of breast cancer diagnosis and treatment.

Continuing to improve diagnosis and treatment options for breast cancer patients is crucial, according to local medical professionals.

“The diagnosis and treatment of breast cancer has evolved significantly over the years, resulting in earlier detection, more effective treatments, less risky procedures, better survival rates and better quality of life,” said Dr. Jennifer Wu, a general surgeon at Gem City Surgical Associates. “However, there are still a significant number of people diagnosed with breast cancer in whom we are unable to halt the progression of (the) disease. As more information continues to be acquired through breast cancer research, it is clear that there is still more progress in treatment that needs to be made.”

We asked doctors what you should know about five new tools and techniques that are helping breast cancer patients in our region.

1. Radioactive seed localization of breast masses

Dr. Cari Ogg, co-medical director of The Jewish Hospital — Mercy Health Breast Center, director of Robotic Surgery at The Jewish Hospital — Mercy Health, and associate program director for General Surgery Residency at The Jewish Hospital — Mercy Health, brings you the facts on radioactive seed localization of breast masses.The Jewish Hospital — Mercy Health started offering this treatment in January.

Description

“Radioactive seed localization is a state-of-the-art technology used in the treatment of breast lesions. Radioactive seed localization identifies the site of the breast lesion (cancer or not) in question. With the aid of a placement needle and using mammography or ultrasound as a guide, the radiologist implants a radioactive seed the size of a grain of rice into the affected area of the breast to mark the precise site of the lesion. The second step of the procedure happens in the operating room, when the surgeon locates the radioactive seed using a hand-held probe. The surgeon then removes the lesion and recovers the seed. The amount of radiation emitted by the seed is less than that from a standard X-ray.”

Advantages

“Radioactive seed localization is an alternative technique to identifying the area of concern in the patient’s breast. Previously, a radiologist inserted a guide wire into the breast to mark the site of the tumor. The guide wire protruded from the breast, and the patient was taken directly to surgery for a lumpectomy. There are several advantages to using radioactive seed localization as opposed to traditional technique: improved cosmetic outcomes because the surgeon has the ability to select his or her approach; localizing the surgical site can be done up to five days prior to surgery versus immediately prior to surgery as with needle localization; and higher likelihood that all cancer will be removed from the breast in the initial operation or lumpectomy.”

Risks or disadvantages

“The greatest risk and/or disadvantage of the procedure is misplacement of the seed and/or seed migration.”

More information

“The procedure is user-friendly. (A) patient may have less breast tissue removed, shorter operative times and a quicker return to their daily life. For a surgeon, there is increased accuracy of lesion location, increased confidence in complete removal of the lesion and a better cosmetic outcome.”

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2. Digital breast tomosynthesis

Dr. Elizabeth Weaver, co-medical director of The Jewish Hospital — Mercy Health Breast Center, gives you information on 3D mammography, or digital breast tomosynthesis, for breast cancer screening, which The Jewish Hospital — Mercy Health began offering in August. Kettering Health Network also offers this tool.

Description

“During the tomosynthesis screening, unlike a traditional mammogram, the X-ray tube moves around the breast, taking multiple, low-dose images of the breast at different angles. These images produce a series of one-millimeter thick ‘slices’ that expert radiologists view as a 3D reconstruction of the breast, much like a CT scan provides a 3D view of the body. Because the tool takes successive images at different angles, it offers views of anything that might be hidden behind fibroglandular tissue.”

Advantages

“Breast tomosynthesis produces a three-dimensional view of the breast tissue that helps radiologists identify and characterize individual breast structures without the confusion of overlapping tissue. Breast tomosynthesis will benefit all screening and diagnostic mammography patients. When combined with a conventional 2D mammography, this technology has demonstrated a higher cancer detection rate than conventional 2D mammography alone and has shown to reduce the number of callbacks by 30 to 40 percent.”

Risks or disadvantages

“Tomosynthesis uses slightly higher radiation; however, it is still well below the national standards.”

More information

“Tomosynthesis increases sensitivity and specificity, which are important to early detection and reducing the number of call backs for patients.”

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3. Nipple-sparing mastectomy

Dr. Thomas Heck, a partner in the Gem City Surgical Associates and the co-director of the Samaritan Breast Center, tells you about a procedure called nipple-sparing mastectomy, which he started performing approximately two years ago. Kettering Health Network, Mercy Health and Community Mercy Health Partners also offer this procedure.

Description

“A standard mastectomy involves removing all of the breast tissue along with the nipple and areola. A moderate amount of skin is also removed in this operation. With a nipple-sparing mastectomy, an incision is made along the outer portion of the breast toward the arm pit. No skin is removed, and the nipple and areola are preserved. Through this incision, all of the breast tissue is still able to be removed. Following this, the plastic surgeon immediately proceeds with breast reconstruction.”

Advantages

“The advantage of this procedure is in the cosmetic results. The goal of removing all breast tissue is met, and the patient has immediate reconstruction with her nipple and areola still intact. Her self-image is remarkably preserved, which is so important in breast surgery.”

Risks or disadvantages

“The risks are similar to a standard mastectomy. There is a small chance of infection and loss of the nipple and areola due to poor healing. In addition, the patient has to realize that she will never be able to breastfeed and that she will have altered nipple sensitivity.”

More information

“This operation is not indicated for every patient requiring a mastectomy. The most frequent indication is for high risk women who carry the BRCA mutation. These patients have an 85 percent risk of developing breast cancer during their lifetime. By performing prophylactic nipple sparing mastectomies, the risk is reduced by 90 percent. It basically eliminates their daily fear of developing breast cancer while maintaining an extremely acceptable cosmetic outcome. They feel good that they have taken an active role in maintaining their health. A much smaller group is patients who require a mastectomy because they have been diagnosed with breast cancer. Strict criteria have to be met to assure that the cancer is being treated appropriately by performing a nipple-sparing mastectomy. Studies are ongoing to assure the safety of this procedure for cancer patients.”

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4. Sentinel lymph node biopsy

Wubrings you the facts about a procedure called sentinel lymph node biopsy. The first sentinel lymph node biopsy was performed at Good Samaritan Hospital in March 2000 as part of a clinical trial. Kettering Health Network, Mercy Health, Community Mercy Health Partners and Good Samaritan Hospital offer this. At the breast centers at Miami Valley and Miami Valley Hospital South, doctors perform sentinel lymph node localization, and then the surgeon performs the dissection.

Description

“Evaluation of the axillary lymph nodes (lymph nodes under the armpit) is an important aspect of determining how advanced a person’s breast cancer is, and it affects what further treatments a patient will need after surgery. Sentinel lymph node biopsy is a technique of selectively removing the first lymph node(s) that a cancer will spread to. Previously, axillary dissection (removal of most of the lymph nodes under the armpit) was the gold standard for evaluating whether or not cancer had spread to the lymph nodes. It was then discovered that there are certain specific lymph nodes that the cancer would spread to first before it got into the remaining lymph nodes; these are the sentinel lymph nodes. These sentinel nodes act as gatekeepers; if the cancer has not spread to the sentinel node, then it is unlikely to have traveled into the remaining lymph nodes. Those patients who do not have cancer in the sentinel lymph nodes are therefore spared having to undergo a full axillary dissection.”

Advantages

“Sentinel lymph node biopsy is less invasive than a full axillary dissection, so there is less risk of the side effects that can sometimes occur after a full axillary dissection, such as chronic pain, numbness, infection, limitation of shoulder motion and arm swelling (lymphedema). Sentinel node biopsy also takes less time to perform than an axillary dissection and uses a smaller incision.”

Risks or disadvantages

“Sentinel node biopsy shares some of the same risks associated with axillary dissection (pain, numbness, infection, lymphedema) but to a lesser extent since there is less dissection being performed. There can also be occasional allergic reactions to the dye. In addition, there is a small risk of a false negative result; (for example), the sentinel node is negative, but there may be cancer that has already spread to other lymph nodes that may then go undetected.”

More information

“Although we have been using sentinel node biopsy for the last decade, we continue to learn more about the natural progression of breast cancer, and there may still be some modifications to the procedure to come. There are some recent studies that suggest that there may be some patients who have cancer in the sentinel lymph node but may not necessarily require removal of the remaining lymph nodes, and research is in progress to better define who these patients are.”

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5. Genetic testing

Julie Sawyer , a certified genetic counselor who provides care in the High Risk Breast Cancer Center at Miami Valley Hospital South, brings you the facts about genetic testing, which she usually calls BRCA 1 and 2 mutations testing. The High Risk Breast Cancer Center at Miami Valley Hospital South been offering genetic testing for BRCA 1 and 2 gene mutations since the fall of 2009. The new Comprehensive Cancer Center at Miami Valley Hospital South is planned to open in early 2013, and additional genetic counseling and genetic testing services will be available there. Kettering Health Network, Mercy Health and Good Samaritan Hospital also offer genetic testing.

Description

“During our cancer genetics risk assessment, we evaluate the chances that a person could have an inherited gene problem which puts them at high risk for breast cancer. Some of these factors could include a diagnosis of breast cancer at a young age, a diagnosis of more than one breast cancer or breast cancer and ovarian cancer in the same person, several closely related family members with the same or related types of cancer (for example, breast, ovarian, pancreatic), specific types of breast tumor markers called ‘triple negative’ breast cancer, and the presence of breast cancer in a man in the family. People with Jewish ancestry have an increased chance of carrying a BRCA 1 or 2 gene mutation and should be evaluated with even a modest family history of breast or ovarian cancer. … It is important to know that most cases of breast cancer are not caused by a mutation in one of these ‘breast cancer’ genes. Only about 10 percent of breast cancer involves a mutation in one of these genes.”

Advantages

“The testing is reliable and can identify the mutations that are known. It can definitely tell if a person has a mutation (that) is known to be present in another member of the family who has been previously tested. However, these are not the only factors that contribute to the development of breast cancer. There are other genes (both known and unknown) and other non-genetic factors (both known and unknown) that can be contributors. Knowing one’s genetic status can help determine whether a person is at high risk for breast and ovarian cancer. It can also help identify other family members who may be at risk. It can help us know the most beneficial ways to help reduce risks and screen for cancers. It can also help those who have been diagnosed with cancer make the most informed decisions about the treatments available to them.”

Risks or disadvantages

“To begin with, this genetic testing is not a test for cancer. It can tell us if a person is at increased risk to develop cancer, but not if they definitely will develop it or not. This can give additional information to help doctors formulate the best plan to screen for and in some cases, treat, breast and ovarian cancer. It cannot substitute for monthly self-breast exams, clinical breast exams and pelvic exams from a doctor, mammograms, and other evaluations for cancer. This testing is quite expensive — several thousand dollars. For people who meet the insurance carrier’s criteria, it is often covered well. However, some insurance companies do not cover the testing routinely. There are some financial assistance resources available which can offer help.”

More information

“Because genetic testing is far more complex than most other types of medical tests, it is important to be well-informed about the benefits, limitations and risks associated with the tests.”