Current Practice in Breast Cancer Management

written by Dr Harjit Kaur on 29 October 2009

Current Practice in Breast Cancer Management

Surgery for Breast Diseases especially breast cancer has evolved over the years. From Radical surgeries of the past we are now moving towards minimally invasive surgeries. With the advent of aggressive promotion of screening for breast diseases, more women are diagnosed with breast cancer at an earlier stage. Early diagnosis equals to minimally invasive procedures resulting in an excellent outcome and prognosis.  From the radical mastectomies in the past we are now performing more and more breast conserving surgeries. Axillary dissection which involves removing almost 2/3 of the lymph nodes in the affected armpit often left women with many delayed side effects. Over the past years we have moved away from this procedure where possible practicing a technique called the sentinel node biopsy (SNB) where only one or sometimes up to three or four lymph nodes are removed after precise localization.
 
Sentinel Node Biopsy (SNB) for breast cancer allows accurate assessment of the axillary lymph nodes draining the affected breast. It is a precise technique using radioactive isotope to detect the first draining lymph node in a patient with breast cancer. This technique involves a trained multidisciplinary team comprising the breast surgeon, radiologist, nuclear physicist, radiographer and pathologist. It involves scars as small as 1.5 to 2.0cm. The patient recovers quickly with minimal discomfort and often no drain and may go home the same day.
 
The procedure involves injection of an isotope   in the subdermal plexus of the breast.  After a delay the sentinel node mapping is done. The lymph node(s) is identified and marked before patient is sent to the operating theatre. In the operating room, the breast surgeon locates this node using a specialized hand held gamma probe with or without blue dye combination. The node is immediately sent to the pathologist for immediate confirmation on the presence of metastases in the lymph node. This allows the entire process to be completed at one sitting. The SNB can be combined with any form of breast surgery. From lumpectomy, mastectomies, hook wire excision to skin sparing mastectomy and immediate reconstruction.
 
The SNB is the standard accepted practice in the management of breast cancer today. Axillary clearance is done only when SNB fails or confirms the presence of cancer cells in the lymph node. This markedly reduces the risk of the most dreaded complication of axillary clearance which is lymphedema. Lymph edema is the progressive swelling of the arm that may occur in some women who undergo axillary clearance. Apart from lymphedema, many women who undergo axillary clearance also face lifelong shoulder stiffness, scar pains and parasthesia. SNB reduces and sometimes eliminates all these complications. More importantly it can be done as a daycase therefore reducing the hospital stay.
 
Women with breast cancer have many options where breast surgery is concerned. Unfortunately many still believe that mastectomy is the only option and hence they delay seeking treatment for the fear of losing the breast. This problem is still very much rampant in Malaysia and many other asian countries as well.  More alarming is the fact that breast cancers are seen in younger and younger women. These young mothers and professionals suffer a major upheaval in their lives when faced with this situation. Major decisions and changes take place in their lives affecting many not only physically but emotionally and psychologically as well. 
 
Education and awareness programs are still the important key to make  a change in these perceptions. It is our hope that more women come forward and practice their regular clinical breast assessment and screening. This will ensure that the disease is picked up early allowing minimally invasive procedures possible and affording a good outcome in survival. No woman is safe from the risk of breast cancer. As we know now age is no barrier as well.
 
With the tremendous amount of research and trials taking place for breast cancer , It is our hope that a cure will be found in the near future .However until then , The key is to be breast aware and take charge of your own breast health.