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Sep. 26, 2002 |
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Browse Archives n Lung n Breast n General n Prostate n Leukemia n Lymphoma n Colon n News/Issues |
Trio of studies highlights progress for breast cancer ORLANDO, Sept. 26, 2002 -- A trio of presentations at a breast cancer conference here point to new, less invasive procedures that may save women from unnecessary surgery in the near future. The Era of Hope Department of Defense Breast Cancer meeting showcases some of the most promising developments in breast cancer research currently under way. The three studies presented this week focused on developments in biopsy, or surgery to determine how extensive a breast tumor has, or has not spread. Older women with small breast tumors, currently face two equally dreadful choices as far as determining whether the cancer has spread beyond the breast. One choice, called axillary node dissection, involves removing the network of lymph nodes that extends from the chest to the armpit. Removal of the lymph nodes often prevents the cancer from spreading and ensures long-term survival but at a high cost of life-long complications from a condition called lymphedema, in which lymph fluid builds up in the trunk and arm, causing painful swelling. The other choice for women over 65, called breast conserving surgery (BCS), involves removing the lump and either monitoring closely for signs of recurrence or cancer spread or undergoing radiation and tamoxifen therapy if appropriate. In a study presented this week, Dr. Xianglin Du of the University of Texas Medical Branch showed that these older women who have breast-conserving surgery (BCS) without lymph node biopsy or radiation therapy have poorer survival rates than those who have this procedure plus biopsy, radiation therapy, or both. "Survival of older breast cancer patients hasn't improved for 20 years," Du said in a prepared statement. "Our study suggests that one key reason may be the growing popularity of BCS for early-stage disease without nodal dissection, which can lead to under-staging and under-treatment, ultimately leading to higher recurrence and higher mortality." In a second presentation a less invasive form of lymph node biopsy appears to offer a better, choice. Called sentinel lymph node biopsy, the procedure requires only removal of the lymph nodes most likely to contain cells that have broken away from the main tumor. In the procedure, the surgeon injects the tumor with a dye that then drains to nearby lymph nodes. The dye identifies the key nodes. If they are clear of cancer then it is unlikely that the nodes further down stream will have cancer, thus sparing removal of the whole network. If the biopsy of the sentinel nodes shows cancer, then the surgeon can remove the rest of the nodal network to ensure the cancer won't spread. While the procedure is not new, the data presented came from an ongoing large clinical trial aimed at determining the accuracy and overall benefits of sentinel node biopsy. "Sentinel node biopsy has dramatically better benefits than axillary node dissection because it is less invasive and more accurate at finding whether the tumor has spread," said Dr. Lorraine Tafra, director of the Breast Center at the Anne Arundel Medical Center in Annapolis, MD. "This and other multicenter studies have shown that the surgeon's experience with the procedure is critical. Now we're investigating the role of other factors that might widen the applicability of the technique and further improve reliability." In a third presentation, Australian researchers showed a new technique called magnetic resonance spectroscopy (MRS), which combines an MRI with a high-tech chemical analysis of a small cluster of cells removed with a fine needle from the suspicious area of the breast. If a malignancy is found, a computer program evaluates the likelihood that the tumor has spread to the lymph nodes. "This technology could eliminate a lot of unnecessary surgery in women with breast abnormalities by providing both a diagnosis and a prognosis before surgery," said Dr. Cynthia L. Lean, scientific director of the Institute for Magnetic Resonance Research in Sydney, Australia, and a member of the team that developed the technology. While use of the technology is some years away, it offers one of the most promising solutions to the dilemma older women currently face. "We hope that MRS will ultimately eliminate the need for lymph node surgery and the associated risk of lymphedema," Dr. Lean said. |
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