This article was originally published by U.S. News Health Care
Breast cancer remains a common disease with a high burden on patients, families and the health care system. One in 8 women will be affected by breast cancer in her lifetime, and the American Cancer Society estimates that doctors will identify more than 300,000 new cases this year alone.
Despite these staggering statistics, there’s room for optimism. Over my career as a breast surgeon, which has spanned more than 30 years, I’ve seen substantial progress in the field. While some of the biggest advances have come from our increasing ability to detect breast cancer earlier in the disease process, significant improvements in treatment options are also enabling better care and outcomes.
Surgical removal of breast tumors has been a mainstay of breast cancer therapy for hundreds of years. Historically, surgery has been a fairly “low-tech” approach, with few significant advances in the field over many decades. Abigail Adams Smith, the daughter of our second president, underwent a radical mastectomy in 1811, but lumpectomy, a way to preserve the breast and remove the tumor, was not introduced until the 1970s when a procedure called wire localization – or WL – was introduced.
While breast cancer will likely always be incredibly difficult for patients – before, during and after treatment – recent technological advances are giving breast surgeons reasons to feel optimistic. These advances are not only supporting improved outcomes but also making the patient journey easier on the body and mind.
Make no mistake: Breast cancer is never going to be “easy.” But I’m hopeful we’re approaching a technological tipping point.
As a society, we’re focused on the latest technological innovations that make our lives easier, such as GPS, the iPhone and Alexa. You can come home today and turn your lights on, order dinner and send emails without ever lifting a finger. But technology isn’t just about making life easier: It’s about making life better. And that requires improving health outcomes and making disease management less burdensome.
In the field of breast cancer, we’re seeing some exciting new technologies in diagnosis and treatment. In terms of diagnosis, there’s been an evolution over the past several decades that has vastly improved our ability to detect breast cancer early. First, we moved from analog mammography to digital, with the first full-field digital mammography unit approved by the Food and Drug Administration in 2000. Now, we’re transitioning to 3-D mammography, or digital breast tomosynthesis, which has the potential to further improve early detection of breast tumors.
Hologic revolutionized breast cancer screening with the introduction of the Selenia Dimensions system, approved by the FDA in 2011 as the first mammography system to offer digital breast tomosynthesis. In 2014, JAMA reported that Hologic’s 3-D mammography exams find significantly more invasive cancers than conventional mammograms. While breast tomosynthesis is not yet considered the standard of care for breast cancer screening, its uptake across the country appears to be faster than what we experienced with initial digital mammography technology. I expect that 3-D mammography will become the screening standard for all women in four to five years.
Early detection has played a critical role in allowing us to perform breast-conserving surgery for more patients. Breast-conserving surgery typically includes lumpectomy, which is the removal of the tumor and a small margin of surrounding tissue, followed by radiation. A typical lumpectomy procedure uses WL, during which a radiologist inserts a needle into the area of abnormal tissue in the breast and threads a small wire through the needle. In a separate procedure, which often takes place several hours later, the surgeon then uses the wire (taped in place on the outside of the body) to locate and remove the abnormality.
When it was first introduced, WL was a breakthrough. And while WL is still a good method, it has some disadvantages: It’s physically uncomfortable for women and, due to the potential for the external portion of the wire to break, the WL procedure is typically done within a few hours of surgery. The waiting time between the WL and surgical procedures can be anxiety-provoking for the patient. Additionally, the need for coordination between radiology and surgery departments may lead to delays in starting surgery, which can further increase patient stress and result in additional hospital costs.
As a fairly low-tech tool, WL works well for what it is. But without significant innovation, WL will continue to result in repeat procedures for some patients, because there’s a chance we won’t remove all of the cancer cells during the first procedure. Even in the hands of a highly skilled surgeon, repeat surgery may be needed simply because WL is an imprecise technology.
While there are limited ways to improve WL technologies, there are alternative localization approaches that offer better accuracy. In August 2014, the FDA cleared Cianna Medical’s SCOUT, a radar localization system that uses radiation-free radar waves.
With SCOUT, a tiny reflector that’s smaller than a grain of rice is placed in the breast up to 30 days before surgery. This means patients don’t need to have two procedures in one day, and they also aren’t waiting in the hospital for several hours with a wire protruding from their breast. This results in better patient comfort and increased flexibility in scheduling surgical procedures and ensuring that surgery begins on time. Additionally, by improving the accuracy of localization and reducing the likelihood of repeat procedures, SCOUT makes breast-conserving surgery more efficient for health care providers. Today, SCOUT is used at more than 125 hospitals across the country, and I think we’re going to see its use increase in the near future.
Improving the Patient Journey
Most women who choose breast conservation therapy will have radiation after their lumpectomy. The traditional approach for radiation therapy has been a full course of whole breast irradiation, which exposes the entire breast and surrounding critical structures to radiation and requires daily treatments for four to six-and-a-half weeks. As you can imagine, this treatment plan was highly disruptive for many women.
Fortunately, over the past several years, we’ve also seen significant advances in the recommended approach for radiation. An extensive clinical study, conducted by researchers from the Groupe Européen de Curiethérapie European Society for Therapeutic Radiology and Oncology, or GEC-ESTRO, demonstrated that a shorter and more localized course of treatment was effective in treating breast cancer. These results, evaluating nearly 1,200 patients, have prompted a shift in guidelines, and medical societies are now advocating for accelerated partial breast irradiation with brachytherapy (also called APBI brachytherapy).
With this approach, a targeted form of radiation is delivered over the course of a few days to the area of the breast where the tumor was removed. APBI brachytherapy is important for patients because it offers less radiation exposure, reduced treatment time, better cosmetic outcomes and more flexibility with respect to future treatment options. Several medical device manufacturers, including Hologic, Cianna Medical and Elekta, are currently marketing or developing innovative brachytherapy technologies with a goal of improving the patient experience and clinical outcomes.
Today’s technological advances have the potential to impact every stage of a patient’s breast cancer journey. I’m encouraged that researchers and clinicians are generating greater insights into this disease and that those of us who care for women with breast cancer have a growing array of effective treatment options, especially for women whose cancer is detected early.
Breast cancer affects so many different areas of a woman’s life and the lives of those around her. From the initial diagnosis to making decisions to beginning treatment, cancer is a scary business, and one of our greatest opportunities as clinicians is how we use technology to support our patients. Any time we utilize new advancements to improve early detection, reduce false positives or facilitate less difficult treatments, we help reduce the burden of breast cancer – and perhaps, somewhere along the way, we’ve even made the patient journey a little easier.