Surgical Procedures for Treating Breast Cancer
Screening, Diagnosis and Treatment
Breast cancer is diagnosed by a combination of screening methods and tissue sample analysis. The screening methods may include a physical examination by a medical practitioner, mammography X-ray, or occasionally the use of ultrasound or MRI’s (Magnetic Resonance Imaging). If possible signs of cancer are found during a screening, the diagnosis is then confirmed or ruled out by a biopsy, the examination of surgically removed tissue under a microscope. A number of procedures can be used to obtain tissue or cells for histological or cytological analysis. Such procedures include fine-needle aspiration, nipple aspirates, ductal lavage, core needle biopsy and local surgical excision. These diagnostic steps, when coupled with radiographic imaging, are usually accurate in diagnosing a lesion as breast cancer.
Occasionally, pre-surgical procedures such as fine needle aspirate may not yield enough tissue to make a diagnosis or may miss the cancer entirely. Imaging tests that are used to detect metastasis include chest X-rays, bone scans, MRI’s, CAT scans (Computed Axial Tomography), or PET scans (Positron Emission Tomography). However, while imaging studies like these are useful in determining the presence of metastatic disease, they do not in and of themselves provide a diagnosis of cancer. Only microscopic evaluation of a biopsy specimen can yield a proper diagnosis. Although the tumor marker in blood known as Ca 15.3 (carbohydrate antigen 15.3, epithelial mucin) can be used to follow disease activity over time after treatment, it is not reliable enough as a screening or diagnostic tool for breast cancer.
The mainstay of breast cancer treatment for a localized tumor is surgery, with possible chemotherapy, radiation therapy or adjuvant hormonal therapy with tamoxifen or an aromatase inhibitor. At present, the treatment recommendations after breast surgery (adjuvant therapy) follow a pattern. This pattern, however, is subject to change because every two years, a worldwide conference takes place in St. Gallen, Switzerland, to discuss the actual results of worldwide multi-center breast cancer studies. Currently, patients are divided into high risk and low risk cases, depending on clinical criteria (age, type of cancer, size, metastasis, etc.). Each risk category follows different recommendations for post-operative breast cancer therapy, including radiation therapy, chemotherapy, hormone therapy and/or immune therapy. If you have questions about these recommendations, do not hesitate to ask your surgeon.
In planning the treatment of breast cancer, surgeons can also use PCR (Polymerase Chain Reaction) tests (like Oncotype DX) or microarray tests (like MammaPrint) that predict your cancer recurrence risk based on gene expression. In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, information that could help determine how aggressively the initial tumor should be treated.