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The following pages are designed to provide you information about what
is new and now available
for breast cancer diagnosis and treatment. Each article will provide
you basic medical information about various forms of treatment or
diagnostic technology that is or will soon become available in the
US for women battling breast cancer, or those at risk of
developing this disease. The primary source of the information is the
Johns Hopkins Breast Center located at Johns Hopkins Hospital in
Baltimore, Maryland. (MSDBC's Vice President and co-founder is the
Director of Education and Outreach there.) For more detailed information about any of these topics feel free to send an email to MSDBC or visit the Johns Hopkins Breast Center website at: http://www.med.jhu.edu/breastcenter |
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For many years, the standard practice for breast cancer surgery was to
remove as many lymph
nodes from the auxillary (underarm) area as possible. This resulted in
as many as 35-50% of
women developing lymphedema as a complication of this procedure. Today,
on average, only
9 to 15 nodes are removed, dramatically reducing the risk of developing
this debilitating
disease. The mission in removing lymph nodes is to evaluate them pathologically and see if cancer has spread to them or not. It is believed that 90% of the time, breast cancer spreads from the breast to other organs via the lymphatic system. Therefore it is hoped that if the lymph nodes contain no evidence of cancer then the chance of the cancer being elsewhere is dramatically reduced. The key, however, is determining which lymph nodes the cancer may have spread to -- historically this was done by "sampling" lymph nodes in the axillary area. Today, through a clinical trial being done across the country, it is possible to do a directed sample rather than a random sample by using new technology for determining the "sentinel node." The sentinel node is the first lymph node that the breast cancer tumor drains to. By identifying it with the help of a probe guided instrument, the surgeon can remove a directed sample of lymph nodes which are the ones most likely to contain cancer, if any is present in the lymphatic system. The procedure is performed by injecting radioactive dye into the breast tumor, waiting approximately 45 minutes for it to drain from the tumor to the lymph nodes in the underarm area, then proceeding with the breast cancer surgery. The surgeon performs a probe guided resection of the radioactive sentinel node, along with other lymph nodes in the immediate proximity of the sentinel nodes. The sentinel node is marked separately for pathology to closely examine first. It is hoped that if there is no cancer in the sentinel node then it stands to reason that there will be no cancer in any other nodes as well. The goal, therefore, is to eventually only have to remove one lymph node, the sentinel node, and test it for cancer. If it is negative then no other nodes need to be removed and the risk of developing lymphedema is reduced to nearly nothing. So why are surgeons still taking out 9-15 nodes rather than limiting the removal to only one? Because, to date, the test works 98% of the time; not 100% yet. This means that 98% of the time if the sentinel node is negative for cancer the other lymph nodes are as well, but 2% of the time the sentinel node is negative for tumor and for reasons yet to be scientifically explained, the second, third or fourth lymph node in the string will contain cancer. If the surgeon only removed the sentinel node there is a 2% risk of underdiagnosing the degree of cancer spread for women with breast cancer. This underdiagnosing could be fatal. So until science can determine the cause of the cancer "skipping" the sentinel node, it will still be necessary for the surgeon to remove several more. This clinical trial, however, will not only help in eventually preventing the occurence of lymphedema for future women having this surgery, it also helps direct the surgeon in removing the most suspicious lymph nodes of concern compared to the previous method of simply doing a random sample. For a list of sites conducting this research, call 1-800-4-CANCER. Additional ways women can help reduce the risk of developing lymphedema today is to be aware of the causes of lymphedema. Many hospitals offer, preoperatively, arm exercise and lymphedema prevention programs for women who will be undergoing axillary node dissections as part of their breast cancer surgery. By doing so, the risk of lymphedema nationally is less than 15% and for some specific breast cancers with programs such the one stated above, has reduced the incidence to 5%. |
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There has been a lot of media coverage about this exciting new clinical
trial. It is
nicknamed the STAR trial. The purpose of the trial is to compare two
drugs -- Tamoxifen and
Raloxifene and determine which is better at preventing breast cancer as
well as which has the
least side effects. A few months ago, the results of a lengthy clinical trial using Tamoxifen was made public. This drug, known as an anti-estrogen, was given to post-menopausal women who were at risk for developing breast cancer. They were on the drug for more than five years. A separate group of post-menopausal women were given a placebo drug. No women nor their doctors knew which drug, Tamoxifen or the placebo, they were taking until the study ended. The results showed a 47% reduction in the incidence of developing breast cancer for the women taking Tamoxifen. This was a wonderful discovery! The drug, however, did cause an increase risk and incidence of developing uterine cancer and/or pulmonary embolus. This prompted the need to look at other drugs which are also anti-estrogens which may carry a lesser incidence of the same side effects. Women who have a first degree relative (daughter, mother, sister) who has had breast cancer are candidates for this study. If interested in more information call 1-410-614-STAR |
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