Wednesday, August 16, 2017  

What You Should Know About Breast Conservation Therapy


The focus of Breast Cancer Awareness Month this and every October is appropriately on prevention and early detection. But it’s also an excellent time to learn more about treatment options for breast cancer.
Going back to prevention for a moment, the good news is that the significant majority of screening mammograms don’t require any additional action.

If some potential abnormalities do appear in the initial mammogram, or in a physical exam, there are a number of non-invasive tests — including diagnostic mammograms, ultrasound and even breast MRI – that can be used to obtain a more conclusive finding. If further investigation is needed we can perform a breast biopsy to determine whether a lump may be cancerous. If it is, the biopsy also helps direct us in developing an effective treatment plan. When no cancer is detected, which is the case in about 80 percent of biopsies, the diagnosis of a benign, non-cancerous lump is highly reassuring.

The biopsy involves removing a 
very small sample of breast tissue and 
is usually done with a needle. Many of the breast biopsies I perform include the use of ultrasound, MRI or some other form of imaging to accurately guide the biopsy needle.

If cancer is detected, it’s good to know that a number of clinical advancements over the past decade, including the increasing frequency of breast conservation therapy, are available treatment options for women.
What is breast conservation therapy?

On the most basic level, breast conservation therapy (BCT) is an approach to treating breast cancer that’s based on two important objectives: the first is to remove the tumor and reduce the risk of cancer reoccurrence; and the second is to preserve the anatomy and natural shape of the breast as best as possible. While there are some variations, BCT is typically a combination of a surgical procedure called a lumpectomy followed by radiation therapy. As you might expect from the term, a lumpectomy is the removal of the breast tumor (the “lump”) and some of the tissue that surrounds it. It also includes the removal and testing of lymph nodes near the breast to detect any cancer cells that may be there.
Although some physicians may talk about the process as breast-conserving surgery, I prefer to refer to it in terms of an overall “therapy” since the surgical procedure itself is virtually always followed up with radiation treatment. If chemotherapy or hormone therapy is part of the treatment plan they generally precede the radiation.
When BCT is an 
effective option

The significant majority of women with breast cancer are good candidates for breast conservation therapy. The characteristics they share include 
having a single, relatively small, early stage tumor that is easily removed with surrounding tissue to yield a good cosmetic result. In addition, the ability to tolerate the surgery itself as well as the follow-up radiation therapy is a requirement. It’s important to know that extensive studies show that BCT is considered as appropriate and as successful for most women of all ages with early stage breast cancer and statistically yields the same survival 
rates as mastectomy, the surgical removal of the breast.

When mastectomy would be the recommended procedure

Although a lumpectomy followed by radiation has become the standard of care for most women with breast cancer, it’s not the recommended treatment for everyone. For example, women who have already had radiation to the same breast would not be good candidates. Other circumstances that would make some type of mastectomy the treatment of choice would be if the cancer were extensive or in two or more areas; if there’s any connective tissue disease present (like lupus); if the individual is pregnant or can’t commit to the appropriate schedule of radiation therapy; or if there were any personal reasons to choose a mastectomy. One other criterion that would indicate a mastectomy instead of BCT would be if it were not possible to remove a tumor with an adequate margin. The margin is the rim of normal tissue surrounding the tumor and it is critical to make sure that the margin is clear of any cancer cells.

Some thoughts on hereditary breast cancer

In the late spring of 2013, the well-known actress, Angelina Jolie, had a preventive double mastectomy after testing positive for a genetic mutation that put her at a much higher risk for breast cancer as well as ovarian cancer. As she explained in a New York Times op-ed column, her decision to have the surgery did not come easy, but she felt strongly that she had made the right decision. Her actions and her very public response created what a number of people in that area of healthcare have called the “Angelina effect”, a sudden surge in referrals for genetic counseling and 
DNA tests for breast cancer-specific 
gene mutations.

Fortunately, gene mutations are relatively rare in the general population and most people who develop breast cancer did not inherit an abnormal gene or even have a family history of the disease. If you have multiple family members with breast cancer, especially if it appeared at a younger age, however, you should talk with your doctor about the potential for hereditary cancer and to determine if you are at a higher than normal risk.
Tough but important conversations … and a message of hope

As a surgeon who performs breast cancer procedures, I am sometimes the first person to discuss a cancer diagnosis with women. These conversations can be emotionally charged because the news is something no one wants to hear, and it’s something I don’t want to deliver. But what’s gratifying is that treatment options now exist, including highly effective breast conservation therapy, that weren’t available when my grandmother had a radical mastectomy.

In all case, the decision about treatment choices is a very personal 
one. As long as I know the patient 
is truly well informed about the medical facts and options I totally respect that decision. Along with more choices, 
we are also living in a time of increased hope regarding a breast cancer diagnosis. In fact, the American Cancer Society reports that when detected early, when the tumor has not spread, the five-year survival rate for breast cancer is as high 
as 98 percent.
Early and more accurate than ever detection remains a vital part of this 
good news. And when a surgical solution is required, I am grateful that I can help make a lasting difference in the lives of women and their families through efforts that I consider to be a calling rather 
than a career. 

Wirt Cross, MD, served as a former Medical Officer and Battalion Surgeon in the U.S. Navy and is currently in the U.S. Navy Reserve. As part of this experience he provided advanced trauma life support capabilities in distant and often hostile locations. He, his wife and three children, are very pleased to now be living in the far more pleasurable environment surrounding the Tappahannock area.

For an appointment with Dr. Cross, please call Riverside Surgical Specialists at 804-443-6232.