Operative advancements
As Winer explains it, new treatment methods now in use are enabling physicians to "help women live better and longer." Among these innovative techniques is sentinel node surgery. Previously, for patients undergoing surgery for invasive breast cancer, surgeons typically needed to extract anywhere from 10 to 20 of the axillary lymph nodes from under a patient's arm to evaluate if cancer had spread to that area. This often led to lymphedema, persistent arm swelling caused by excess fluid build-up. In some cases, nerves in the underarm area and down the back of the upper arm could also be damaged, leading to a loss of sensation. Today sentinel node surgery offers a less aggressive, though still effective, alternative for some patients.
"We now understand more about the biology of breast cancer than probably any other cancer, with the exception of leukemias and lymphomas."
— Dirk Iglehart, M.D., director, DFCI's Women's Cancers Program
"The goal with sentinel lymph node mapping is to identify the first lymph node to which the cancer might travel," explains Carolyn Kaelin, M.D., one of several surgical oncologists affiliated with DFCI and Brigham and Women's who perform this innovative procedure. "That first node is examined closely, and if it's found to be tumor-free, then presumably all the other nodes under the arm are also free of disease and won't have to be removed. In these instances, the patient's chances of complications like lymphedema become much lower."
Another new procedure being carried out at Dana-Farber in partnership with BWH is image-guided needle core biopsy, in which a needle is inserted into a patient's breast to remove tissue for analysis. "Previously, surgeons would perform a needle biopsy only if they felt something in the breast," explains Phyllis Kornguth, M.D., Ph.D., a radiologist at both facilities. "Now, if we see an abnormality on a mammogram or ultrasound, we can go in with a needle and take several pieces of tissue to send to the pathologist. Since the majority of abnormalities we pick up turn out to be benign, we are saving women from a lot of invasive and expensive surgery."
For a needle core biopsy to be successful, an accurate X-ray of the breast must precede it. Although digital mammography is now available, Kornguth still favors traditional film. "Digital mammography was designed to decrease the amount of radiation used in the process, solve the problem of having to store films, and allow you to change parameters, such as the contrast and brightness of the image, to help see through denser breasts," she explains. "But the realities for digital mammography are that the dose of radiation is no lower than current film/screen techniques, the cost of equipment is very high, and, most importantly, there is no proof such images find more cancers or benign tumors. It's a potential improvement, but we're not there yet."
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