Breast cancer patients have more options

The diagnosis and treatment of breast cancer has come a long way in helping women not only survive the disease, but, in a growing number of cases, to survive breast cancer without major disfigurement, says Jackson surgeon Dean Currie.

Breast cancer is still one of the most common cancers with about 185,000 new cases diagnosed each year, said Dr. Currie, a board-certified general surgeon at Jackson Surgical Associates. Dr. Currie, who has a special interest in treating breast cancer, is a member of the American Society of Breast Surgeons.

At the same time, he said, when the cancer is caught in its early stages, women have an 80 to 85 percent chance for a long-term cure. That rate has improved during the 1990s, Dr. Currie says, largely because the increased use of mammograms is picking up the cancer at earlier stages and because of the widespread use of more aggressive and better chemotherapies.

“For all of the diseases I treat, breast cancer is the most emotionally charged,” Dr. Currie says.

Advancements in the diagnosis and treatment of breast cancer are giving surgeons like Dr. Currie and his patients more options – and better results, he says.

Diagnosing breast cancer

A patient who follows the American Cancer Society’s guidelines for routine self-breast exams, physician exams and mammograms (see related story) will most likely arrive in Dr. Currie’s office for diagnosis when the cancer is still in its early stages – and increase her chances of survival.

If the patient in his office has a lump or lesion he can feel, Dr. Currie does a needle biopsy right away, he says. If it turns out to be a benign cyst, he will drain it and assure the patient she is okay. “If it is a solid lesion, we send the tissue to a pathologist for a diagnosis.”

Increased technology helps Dr. Currie evaluate lesions that are suspicious and too small to feel. If the lesion can be picked up by ultrasound, he can use the ultrasound to guide the needle for a biopsy in the office.

One of the biggest advancements for non-palpable lesions (those that cannot be felt, but only seen on a mammogram) is stereotactic breast biopsy, Dr. Currie says. Done on an outpatient basis at Jackson’s two hospitals, this procedure uses a digital mammogram to locate the lesion and allow the physician to guide the needle for a biopsy of the lesion. “We can then make a diagnosis with minimal disturbance of the breast tissue and almost no scarring.”     

A diagnosis of cancer

Depending on her cancer, a woman these days has many options, says Dr. Currie. “I’ll first have a long, in-depth discussion with the woman about her options.” They include…

• Breast conservation therapy (a lumpectomy) allows the physician to remove the tumor with some of the surrounding normal breast tissue and to remove axillary lymph nodes (lymph nodes in the arm pit) and surrounding armpit tissue if the cancer is invasive. The breast is treated with radiation. Once treatment is finished and the effects of radiation have resolved, the patient often has a normal looking breast.

• A mastectomy involves removing the patient’s breast and axillary lymph nodes (if the cancer is invasive). Much of the time, radiation is then given only for advanced breast cancers.

Patients who choose a mastectomy have the option of breast reconstruction surgery to give them a new breast. Sometimes, reconstruction can be done during the same surgery as the mastectomy, Dr. Currie says. Women also can have reconstruction at a later date.

• A new treatment, sentinel lymph node biopsy, is revolutionizing surgical treatment of invasive breast cancer, Dr. Currie says. Instead of removing all of a woman’s lymph nodes (which results in the greatest long-term disability to the patient after breast cancer treatment), “this procedure allows us to identify and remove just those lymph nodes at greatest risk of harboring cancer.”

Since about 40 percent of patients with breast cancer have involved lymph nodes, sentinel lymph node biopsy allows 60 percent of those women to avoid complete removal of the lymph nodes and the resulting disability, Dr. Currie says.

• Again, depending on the cancer, chemotherapy also can be used as part of the treatment.

Women with breast cancer these days have more options about treatment, Dr. Currie says. “The days of automatic mastectomy are long gone.”

Still, he adds, it is an emotional and stressful time for his patients. “The patient is going through a difficult time with numerous decisions only she can make.”