For many years, the primary treatment available to women with breast cancer was a complete mastectomy. This consisted of a modified radical mastectomy with axillary lymph node dissection, which removes the affected breast and lymph nodes from under the arm. Through advances in technology and continued studies, treatment options have greatly improved. Early stage breast cancer is now being treated with lumpectomy (partial breast removal) and biopsy of the sentinel lymph node, which are evaluated because this is the first area of metastasis. Radiation therapy is given following surgery to prevent local recurrence.
Breast cancer detection
Breast cancers are detected through examination or mammography (breast imaging). Mammography detects early stage cancers, while masses in the breast can be found through self- and provider examination. These tumors are usually larger because it has taken time for cells to grow to the point of having a mass that is detectable on examination, which is why screening mammography is highly recommended for women older than 40. Mammography can detect tiny nonpalpable lesions. Radiologist may do ultrasounds or additional views to evaluate the abnormality.
Digital mammography — including tomosynthesis (3D digital mammograms), ultrasounds, breast MRIs, needle localizations and biopsies are available at Mount Nittany Health’s Breast Care Center, located at 1850 E. Park Ave.
Biopsy and evaluation
Abnormal mammogram results lead to recheck testing within a certain time interval or the recommendation of a breast biopsy as determined by the radiologist. This can be performed using ultrasound or MRI imaging, which gives guidance to the location of the tumor. The biopsy is taken and a marker is left at its location. The biopsy is then sent to the pathologist for evaluation.
If the biopsy shows cancer cells, the patient will go on to have further surgery. If the mass was found to be palpable, or substantial, a lumpectomy can be performed. This would include a sentinel lymph node biopsy to evaluate for metastasis, which is when the cancer has spread from the original site. If the mass was not palpable, a wire localization lumpectomy and a sentinel lymph node biopsy — which has been the typical procedure used for many years — may be used. Wire localization biopsies require a wire to be placed in the mammography suite prior to lumpectomy. In the operating room, the wire would be followed down to the tumor, and a specimen is removed. The specimen is then re-imaged to ensure the lesion has been removed.
Recently, a new wire-free procedure using radar technology has become available and is being used at Mount Nittany Medical Center. A small reflector called a SAVI SCOUT is placed into the tumor, which the surgeon can then find with a radar wave guide locator. This gives precise guidance to the tumor’s location. Once the lumpectomy is complete, the radar wave guide locator ensures that the area of abnormality has been removed.
Some patients will require chemotherapy either before or after their surgery. Many factors are taken into consideration, including the stage, receptor status, age, genetic testing and cell type. Early stage, estrogen positive and lymph node negative patients can undergo Oncotype DX testing, a genomic test that estimates the possibility of recurrence. This helps to determine if chemotherapy would be beneficial.
It is the standard of care that post lumpectomy patients go on to receive radiation therapy, or localized treatment, to prevent recurrence. If the sentinel lymph node biopsy for metastasis is negative, the patient can be treated with short-course radiation therapy. If the patient has metastatic disease to the axillary lymph nodes, they would go on to have radiation to the breast and regional lymph nodes also called conventional radiation therapy. If the patient has had a mastectomy and there is metastasis to the axillary lymph nodes, treatment is given to the chest wall and surrounding lymph nodes.
Some patients will ultimately elect mastectomy at the end of treatment, depending on their pathologic and genetic outcome. This can be done with or without reconstruction, and different types of reconstructive surgery are available to fit the needs of each individual.
It’s important to remember that early detection is key to a better prognosis. Women are encouraged to continue breast self-examination and yearly mammography.
Angelica Kline is a physician assistant with Mount Nittany Physician Group and works in radiation oncology. At Mount Nittany Health, she is a member of the cancer committee, tumor board, breast cancer conference, lung cancer conference, urologic cancer conference and advanced practice provider committee. She is a graduate of the physician assistant program at Saint Francis University in Loretto.
First published in State College Magazine