EXPERT PANEL SAYS BETTER OPTIONS EXIST FOR DIAGNOSING BREAST CANCER

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WOMEN'S HEALTH ALERT

October 31, 2005

EXPERT PANEL SAYS BETTER OPTIONS EXIST FOR DIAGNOSING

BREAST CANCER

Physicians should strive to replace traditional,

invasive procedures for diagnosing breast cancer with

proven, less-invasive diagnostic methods, according to

an international panel of breast cancer experts

convened at the Keck School of Medicine of the

University of Southern California (USC).

In a consensus paper published in October's Journal of

the American College of Surgeons (JACS), 23 leading

surgeons, radiologists, pathologists, and oncologists

said minimally invasive needle breast biopsies and

sentinel node biopsies should be performed more

routinely than they currently are. In the case of

breast biopsies, the experts said open surgical

biopsies should almost never be done, though experts

estimated nearly a third of the 1.7 million breast

biopsies performed in the nation are still done this

way.

" New technology has changed the face of breast

cancer, " said Consensus Panel Chair Melvin J.

Silverstein, MD, professor of surgery and Henrietta C.

Lee chair in breast cancer research at the Keck School

of Medicine. " We can do things much less invasively

than ever before, and doctors and women need to take

advantage of these advances whenever they can. "

The American Cancer Society estimates 211,240 women

will be diagnosed with invasive breast cancer and more

than 40,000 will die from the disease this year.

The panel concluded minimally invasive needle breast

biopsy is " the procedure of choice for image-detected

breast abnormalities " and keeps the majority of women

with noncancerous findings out of the operating room.

For those who do have breast cancer, needle biopsies

allow for better preoperative planning for breast

surgery.

A needle biopsy is performed through an incision about

the size of a match head, requires no stitches, and

can be done in a doctor's office. According to the

American Cancer Society, about 8 of every 10 breast

biopsies performed turn out to be benign.

The panel added vacuum-assisted needle biopsies are

preferred for microcalcifications, a common breast

finding, because of the biopsies' high accuracy and

more complete tissue removal than conventional needle

biopsies. The panel also said minimally invasive

needle breast biopsies can result in significant cost

savings.

" The way breast cancer is diagnosed often affects the

way it is treated, " said Silverstein, chief of the

breast service at LAC(Los Angeles County)+USC Medical

Center and director of the Harold E. and Henrietta C.

Lee Breast Center at USC/Norris Comprehensive Cancer

Center. " If a surgeon knows the abnormality is breast

cancer before an operation, he or she can more

precisely plan the optimal location of the incisions

in the breast for breast conservation. With

preoperative planning, more complete and precise

removal of the cancer is more likely, generally

sparing patients a second surgery. A biopsy is for

diagnosis, surgery is for treatment. "

The panel called the less invasive sentinel lymph node

biopsy the " preferred method " for accurately staging

image-detected breast cancer in most patients. The

traditional procedure is axillary node dissection, the

removal of nearly 15-30 lymph nodes. In sentinel lymph

node biopsy one-three lymph nodes are removed

resulting in fewer complications, faster recovery, and

a lower probability of lymphedema, a painful swelling

of the arm.

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The panel also looked at the emerging role of magnetic

resonance imaging, or MRI, in diagnosing breast

cancer. The panel concluded evidence supports MRI's

use in diagnosing disease among young patients at high

risk for breast cancer and that it can be helpful for

diagnosis when mammography, ultrasound, and clinical

findings are inconclusive.

In the area of radiation therapy, the panel concluded

that accelerated partial breast irradiation (APBI)

" may allow more patients to undergo breast-conserving

therapy more quickly, at lower cost, and with less

risk of long-term complications. " Traditionally,

radiation oncologists treat the entire breast, which

can result in breast shrinkage, as well as side

effects on the heart and lungs. Until definitive data

are collected, though, the panel recommended

restricting APBI use only to clinical trials.

Finally, the panel recommended surgeons train in

oncoplastic surgery, the combination of plastic

surgery and cancer surgery, to help avoid poor

cosmetic results and increase the number of women who

can be treated with breast-conserving surgery rather

than mastectomy.

" We hope this consensus encourages doctors to review

the methods they currently use and helps women become

more aware of their options, " Silverstein said.

The consensus paper, " Image-Detected Breast Cancer:

State-of-the-Art Diagnosis and Treatment, " was

developed from a conference sponsored by USC/Norris

Comprehensive Cancer Center and the Keck School

earlier this year and was supported by an educational

grant from Ethicon Endo-Surgery, Inc., a &

company. It updates a JACS consensus article

published September 2001.

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