Laura Seitz, Deseret News
SALT LAKE CITY — Medical research often focuses on new drugs and rarely advances surgical treatments, but a recent finding may mean less surgery for breast cancer patients.
Years ago, surgery for breast cancer included cutting the cancer out, as well as much or all of the breast and all of the surrounding lymph nodes — just to be safe. It led to miserable side effects for some and researchers have since found that removing all the lymph nodes is unnecessary, said Dr. Teresa Reading, a surgeon who specializes in breast cancer at Intermountain Healthcare's LDS Hospital.
"Almost everyone who has breast cancer needs surgery at some point," she said.
Reading, who will be participating in the Deseret News/Intermountain Healthcare Health Hotline on Saturday, said an axillary lymph node dissection means that doctors can remove some but not all of the lymph nodes in a woman's arm, and patients end up with less surgery to recover from and less morbidity.
"People are having nicer outcomes as far as the cancer goes," she said.
The advancement means that with the patients, physicians can estimate what treatment will be necessary, eliminating some of the unknown about an often fearsome cancer diagnosis.
Reading said there may come a day when breast cancer can be treated with just radiation and/or therapy, but for now, surgery is the best way to quickly rid the body of malignant tumors and their harmful effects.
Depending on the stage of the disease, women — and rarely, men — have the option of having a mastectomy, or removal of all breast tissue and then immediate, delayed or no reconstruction at all; or having a lumpectomy and likely subsequent radiation treatment; or having a lymph node evaluation and axillary dissection. None of the available options completely eradicates the disease, but a mastectomy leaves about a 5 to 7 percent chance of the cancer returning, and a 30 percent chance remains following a lumpectomy without radiation.
"Unfortunately, we can't see cancer cells," Reading said, adding that once an incision is made, surgeons rely on imaging technology and "a best, but educated guess" as to where the cancer has spread. Various independent companies are trying to find ways to identify cancer cells within the body, but they have yet to succeed, she said.
"You want to take enough, but not too much," Reading said. But microscopes in the operating room help make surgery more of an exact science, providing immediate feedback on the removal of cancerous cells.
Reading said breast cancer is becoming more prevalent, and is appearing more in younger women.
Once thought to only plague older women in their 60s and 70s, women in their 40s are increasingly being evaluated.
"We don't even know what causes cancer," Reading said, adding that cancer may have something to do with environmental exposures, or may be due to cumulative exposure over the years.
"For most people, breast cancer takes quite a long time to grow and before it shows up on a mammogram," she said. The earlier it is detected, however, she added, the less treatment is needed.
Regardless of the logistics of breast cancer, Reading said, "there is still a lot of fear surrounding the disease."
"Anyone who gets a diagnosis of breast cancer has quite a sense of fear about them," she said. "The more information they get, helps to make it not as fearful."
Advancements in treatment and more information becoming available is helping doctors reassure patients and better determine the risk for recurrence.
Reading, along with Dr. Brett Parkinson, a radiologist at Intermountain's Breast Care Center, will be taking questions from the public from 10 a.m. until noon on Saturday. Interested individuals may call 1-800-925-8177, toll-free, or post questions on the Deseret News Facebook page, www.facebook.com/deseretnews during that time.
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