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HOUSE CALL: Breast cancer treatments becoming less invasive

 


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Currently, approximately 180,000 cases of breast cancer are diagnosed every year in the United States. Although this is a very traumatic and frightening diagnosis, the vast majority of the women will be cured of breast cancer.

The surgical treatment of breast cancer has undergone radical changes, becoming less and less invasive, while achieving these results.

In other words, cure rates are at least as good, if not better, with less invasive breast surgeries than more radical surgeries. Plus, less invasive operations deliver better cosmetic results, and less physical trauma to the patient.

Here is a look at breast cancer treatments:

Radical Mastectomy

In the last decade of the 19th century, Dr. William Hallstead of Johns Hopkins University Hospital developed radical mastectomy, the origin of modern breast surgery. This procedure removed the breasts and nipple, along with lymph nodes in armpit and underlying pectoralis muscle.

This was the first effective operation for the treatment of breast cancer. Although effective, it was a very radical operation, leaving the arm physically disabled. This operation remained the best breast cancer treatment for decades.

Modified Mastectomy

In the mid 20th century, doctors discovered that the removal of the underlying pectoralis muscle was unnecessary and did not typically improve survival rates.

Modified radical mastectomies remove the nipple, breast and axillary lymph nodes but spare the trauma of removing the underlying muscle. This option is still used today.

Lumpectomy

One of the more important advances in breast surgery has been the lumpectomy. This involves removing the cancer and a surrounding margin of normal breast tissue, but spares the breast itself.

At Missouri Baptist's Breast program, we do 75-80 percent lumpectomies.

Lumpectomies are preferred today because they offer women less trauma, a superior cosmetic result and quicker return to activities.

They are best-suited for single, small cancers. Mastectomies are for larger operations, but they are suitable for women who have multiple or recurrent breast cancers or a strong family history.

Oncoplastic surgery, a newer technique for lumpectomies and mastectomies, effectively removes the cancer while working for the best cosmetic result possible.

Sentinel Lymph Node Biopsy

Until approximately 10 years ago, surgeons removed the majority of lymph nodes under the arm, but this was very disabling. Today, sentinel lymph node biopsy uses X-rays to find the sentinel lymph nodes, which are the first lymph nodes affected. Currently, we remove an average of one to three sentinel lymph nodes, as opposed to removing 20-30 axillary lymph nodes.

We then biopsy the small group of lymph nodes to see if the cancer has spread. This results in fewer side effects, such as lymphedema or swelling of the arm, for the patient.

Remember, the earlier the cancer is detected, the less invasive the surgery, the faster your recovery, and the better the chances of cure. Many women can even avoid chemotherapy if the cancer is caught in its earliest stages.

Finally, 28 percent of breast cancers are detected in women between the ages of 40-50. So be sure to have your yearly mammogram screening starting at age 40.


G. Paul Yazdi, a board-certified breast surgeon, is surgical director, Multidisciplinary Breast Clinic at Missouri Baptist Medical Center and a member of the BJC Medical Group. He received his medical degree from the University of Missouri-Kansas City School of Medicine, and completed his internship, surgical residency and fellowships in general surgery at the University of Missouri Hospital and Clinics. He did a fellowship in surgical oncology at Ellis Fischel Cancer Center. He is a Fellow of the American College of Surgeons.


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