Small advances help make difference in fight against breast cancer

Let's face it, the only really nice part about breast cancer testing and care is when the doctor says everything is OK. But small improvements in early detection, diagnosis and treatment are making it a bit easier to reach that point.

In the past decade, the death rate from breast cancer has continued to drop as mammograms find tumors earlier and better weapons can zap those tumors before they become life-threatening.

Still, vigilance in the fight against breast cancer comes with a price, albeit a small one compared to the payoff.

Yearly mammograms can be uncomfortable and, for some women, even painful.

Suspicious spots on the mammogram can lead to a surgical biopsy - an anxiety-producing operation, even though 80 percent of breast biopsies turn up negative for cancer.

And if cancer is found, the standard treatment of lumpectomy followed by radiation can mean daily treatments for seven weeks - a long commitment for women who may be working or caring for young children.

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Studies suggest that discomfort is a major reason why women skip their recommended mammograms.

Breast cancer surgeon Dr. Gail Lebovic heard the excuse all the time in her California practice, and it drove her crazy.

"I'd ask, 'When was your last mammogram?' and all I kept hearing was, 'Do I have to go?' 'It hurts.' 'I hate it,' " said Lebovic, associate director of the Lee Comprehensive Breast Center at the University of Southern California's Norris Medical Center.

Having experienced the discomfort of a machine squeezing her own breasts between two thick glass plates to get a clear X-ray image, Lebovic set out to create a more comfortable mammogram.

Working with an engineer, she discovered a type of permeable foam that is invisible on the X-ray. With it, she created a cushion about the size and thickness of a computer mouse pad that sticks to the glass plates of the mammogram machine.

A large study of Swedish women found that the pad provides clear breast images while cutting women's discomfort complaints in half. The pad was cleared by the Food and Drug Administration in 2001.

Chris Lawlor recently had a padded mammogram at Waterbury Hospital in Connecticut. In the past, she dreaded every test on the cold, hard glass plates.

"With this (pad), it's very soft and warm," said Lawlor, who teaches radiology to students at Naugatuck (Conn.) Community College.

Each pad costs about $5 and is not covered by insurance. Patients can use one pad on the bottom plate or choose to have a second pad on the top plate too.

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Two thank-you notes are taped to the door of the breast biopsy room at Waterbury Hospital.

"Having a needle biopsy was not fun, but your support and kindness made it so much easier," was the message on one of the cards.

Until this spring, technologist Diane Nori had never received even one such card.

She thinks the new enthusiasm is generated by the arrival of a new machine that eliminates a trip to the operating room for up to 70 percent of women whose mammograms turn up suspicious findings.

The device, called the Mammotone Breast Biopsy system, allows doctors to remove and examine a significant chunk of suspicious tissue without making a large incision.

In the past, women whose mammograms flagged small tumors were sent for a needle biopsy. The needle could extract small slivers of tissue from the breast, but there was a risk that cancerous tissue might elude the needle.

The other option was an ambulatory surgical procedure in which the doctor removed a larger sample of breast tissue while the woman was heavily sedated. Recovery from anesthesia and the larger incision could keep a woman out of work or other normal activities for several days.

With the Mammotone, the woman lies face down on a table with an opening for her breast to hang into a mammogram machine below. The mammogram machine and an ultrasound device guide technicians to the suspicious tissue.

With local anesthesia, a probe about the diameter of a knitting needle bores into the breast and uses vacuum suction to remove multiple sections of suspicious tissue. Women who have had the procedure report feeling some pressure but no pain.

The procedure takes no more than two hours, from arrival to a follow-up mammogram. It does not require stitches, and while the patient is advised to take it easy for the rest of the day, she can return to her regular activities in the morning, said Dr. D.J. Belcher, an interventional radiologist at Waterbury Hospital.

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With the discovery that surgical removal of small breast lumps followed by radiation works as well as mastectomy, women have long been spared disfigurement after breast cancer.

They have, however, been burdened by daily trips to the hospital or cancer center for a course of radiation that commonly lasts seven weeks.

"To some patients, that's a huge ordeal. Some patients live or work 30 miles away," said Dr. Richard C. Shumway, director of radiation oncology at St. Francis Hospital and Medical Center in Hartford, Conn.

Studies indicating that up to 20 percent of lumpectomy patients don't receive follow-up radiation, in part because of the inconvenience, have led researchers to search for a quicker approach.

The idea is to send a mega-dose of radiation directly to the cancer site, instead of the conventional method of shooting more diffuse radiation at the whole breast.

Several technologies have been tested, but none has proved convenient or effective enough to gain widespread acceptance.

The latest attempt goes by the trade name MammoSite. The device can be inserted at the same time a lump is removed or a short time afterward. Once the tumor is out, the doctor inserts an uninflated balloon attached to a flexible plastic tube into the area where the tumor was. Saline solution is injected to inflate the balloon, creating a buffer zone between the radiation site and healthy surrounding tissue.

Irma Abramson, 81, of Bloomfield, Conn., decided to try the new treatment because her life is too busy with college reunions, grandchildren's graduations and beach vacations to set aside seven weeks for radiation.

She had the balloon installed after a small tumor was removed on April 5. She met the criteria for the shorter radiation course because her tumor was smaller than 3 centimeters, none of her lymph nodes was positive for cancer, and the tissue surrounding the tumor was also clear.

On each of five consecutive days, she and her husband drove to the cancer center at St. Francis. There, Shumway injected high-intensity radiation through the catheter and into the balloon for about six minutes. The same procedure was repeated later in the day.


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