The current standard of care for physicians treating patients with breast cancer is that less surgery is often the best course of action. Current treatments for breast cancer now mean patients can preserve their breasts, limit recovery time, and avoid procedures such as mastectomies. New procedures also mean minimally invasive biopsies to diagnose cancer that can be done in about 15 minutes.
William L. Diehl, MD, FACS, medical director of the Breast Care Center at Summit Medical Group MD Anderson Cancer Center, recently spoke with NJ Advance Media about current standards of practice when treating breast cancer, and how patients need to be open to new treatment options.
Q: What should a patient consider when visiting a physician?
A: I think women need to understand that almost everybody with breast cancer is going to need surgery, so it’s the rare patient who can avoid it. But I think women would be well-served in being open to the option of less surgery and less aggressive intervention since they are equivalent to aggressive surgery in the appropriately selected patients with an equivalent cure rate. Many patients tend to think, ‘I have breast cancer, I want the maximum surgery.’ But there are less aggressive options that are equally beneficial.
Q: How has diagnosing breast cancer changed?
A: In the past, patients suspected of having cancer would go to the operating room for a biopsy. Now, with Interventional Radiology, we’re doing image directed biopsies, where we place a tiny device in the breast and remove a small amount of breast tissue. The worst part is the administration of local anesthesia. Patients drive themselves in, drive themselves home, and most are back to picking up their kids from school later in the day. At Summit Medical Group MD Anderson, the breast surgeons perform these biopsies instead of the radiologists because we feel it enhances continuity of care for the patient.
Q: How has treatment changed with regard to surgery?
A: Thirty or so years ago, most women were treated with a mastectomy regardless of a tumor’s size. Now, about 70 percent of women can be treated without one. A woman with a large tumor will receive chemotherapy, immunotherapy or hormonal therapy to decrease the size of the cancer and convert it to something where the patient now needs a lumpectomy. If we can decrease the tumor to a manageable size, we can take them into the operating room and preserve the breast. Not every woman is a candidate for this, and unfortunately the treatments don’t work for everybody. But in correctly selected patients, it works very well.
Another area where we are doing less surgery is with the axillary lymph nodes in the armpit. One of the most debilitating side effects of breast cancer is lymphedema, the swelling of the arm, and it is dependent on how many lymph nodes are removed.
Today, we only remove all lymph nodes for patients where there are bulky, cancerous lymph nodes. Some of those patients can receive therapy before surgery, reduce the bulk of the cancer and be candidates for less extensive axillary surgery. For patients without known cancer in the axillary nodes we do a procedure called a sentinel lymph node biopsy, which allows us to identify the one lymph node that is at greatest risk for cancer. This limits how many lymph nodes are removed.
Q: Are there new breast cancer treatments on the horizon?
A: Summit Medical Group MD Anderson is involved in a clinical trial for highly selected patients. For patients receiving upfront chemotherapy, where the cancer disappears both clinically and radiographically, we re-biopsy that area. If there is no cancer, we skip the operating room, and go straight to radiation. This trial explores the idea that some patients may be able to safely be managed without surgery at all.
For more, visit smgcancer.com.