A new study shows using ultrasound to guide the surgical removal of tumors from women with palpable breast cancer is significantly better than the standard approach in ensuring that all cancerous tissue is removed while minimizing the removal of healthy tissue.
Dr. Krekel and her colleagues randomly assigned 124 patients with palpable early-stage breast cancer to either ultrasound-guided surgery or palpation-guided surgery. They found that only 3.3 percent of the margins in the ultrasound-guided surgery group contained cancer cells, compared with 16.4 percent in the palpation-guided surgery group. They also found that less healthy tissue was removed in the ultrasound-guided surgery group.
“If we get the same results in the United States, and these results can be incorporated into community practice, it will spare many women unnecessary re-excision surgery,” said Dr. Jo Anne Zujewski, head of Breast Cancer Therapeutics in NCI’s Division of Cancer Treatment and Diagnosis.
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Adding ultrasound or magnetic resonance imaging (MRI) to annual screening mammograms for women with an increased risk of breast cancer and dense breast tissue detects more new breast cancers than mammography alone but also results in more false-positive findings, according to results of a multicenter clinical trial.
Researchers found that adding ultrasound to mammography increased breast cancer detection by an average of 3.7 cases per 1,000 women screened after the second and third rounds of annual screening. The majority of cancers detected only by ultrasound were node-negative invasive cancers. Until now, it had been unclear whether continuing annual ultrasound screening would detect more cancers.
Although MRI was better at detecting cancer than mammography plus ultrasound, women found it less tolerable. “Despite its higher sensitivity, the addition of screening MRI rather than ultrasound to mammography in broader populations of women at intermediate risk with dense breasts may not be appropriate, particularly when the current high false-positive rates, cost, and reduced tolerability of MRI are considered,” the authors concluded.
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By Mary Jo Wolf, cancer survivor and Cancer Services client
My cancer journey began in November 2008, when I discovered a lump in my right breast. I didn’t panic and went about my evening as scheduled, but the thought of that strange mass lingered in my mind. I had been through an unwanted divorce in April, my family lived 6 hours away, and suddenly, I felt alone.
I went to my doctor on Monday. She examined me and immediately set an appointment for me at the Breast Diagnostic Center. On Tuesday, I had a mammogram, followed by an ultrasound. There was fluid around the mass that needed to be drained, but unfortunately, the radiologist couldn’t get it to drain. I had a total of five biopsies that day, and then made an appointment with a surgeon who would give me the biopsy results. I went to each of these appointments alone, hoping it was nothing. I didn’t believe that I might have cancer and I didn’t want to alarm anyone.
When I met with the surgeon for the biopsy results, my friend Becki came with me. She was diagnosed with breast cancer the previous year and knew I needed support. The diagnosis was DCIS (Ductile Carcinoma in Situ – noninvasive breast cancer). Becki started to cry and I was in shock. A million questions went through my mind. The surgeon recommended a lumpectomy. He would remove the lump and send it to the lab to get the exact diagnosis. He was fairly certain that no more treatment would be needed. My surgery was scheduled for Monday, November 24. My only child’s 21st birthday would be the next day. How was I going to tell her that I had cancer? Surgery went as scheduled and my wonderful daughter gave up her birthday celebration to take care of me.
Unfortunately, at my follow-up appointment , the surgeon reluctantly informed me that another surgery would be necessary because cancer cells were still present, and the mass tested positive for triple negative invasive breast cancer.
A week later, I had a second surgery, followed by complications. The incision would not heal; there was infection and a lot of pain. I met with my oncologist and she explained that I needed 20 weeks of chemo. Although my cancer didn’t spread to the lymph nodes, they had to treat it aggressively as if it did.