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From 'medieval' to modern

Gentler biopsies lead advances in breast cancer diagnosis

Darrell Smith, MD, MSc, confers with Susan Sugarman, a breast cancer survivor, comparing her old mammogram film to her new ones.

Darrell Smith, MD, MSc, confers with Susan Sugarman, a breast cancer survivor, comparing her old mammogram film to her new ones.

For most women today, having a routine mammogram is no big deal. Uncomfortable, yes; but, in the end, neither physically nor emotionally draining. As it was a decade ago, mammography remains the standard screening method for finding breast tumors in healthy women, and the most practical, cost effective tool for early detection.

But breast cancer cannot be diagnosed by mammography alone. When abnormalities are found, a woman next undergoes a biopsy to look directly for cancer. That experience, once a surgical ordeal, has become more tolerable. A dozen years ago, it meant a procedure that took a chunk of tissue sometimes as large as a golf ball, required weeks of healing, and left a significant scar.

It frees up surgeons to do more of what they specialize in and what they want to be doing — which is treatment.

— Darrell Smith, MD, MSc

Adding insult to injury, the biopsy often showed no cancer at all. "The process was kind of medieval," says Darrell Smith, MD, MSc, director of breast imaging research and breast MRI at Brigham and Women's Hospital and Dana-Farber. "We had to do surgery to remove the lump without knowing what it was."

In 1991, all that changed with the introduction of needle core biopsies. The first generation of this minimally invasive technique used a hollow needle about a quarter-inch in diameter to insert a spring-loaded tube into the breast that cut and collected the tissue specimen.

The drawbacks were that the needle had to be reinserted for each new tissue sample, and the procedure was only about 90 percent accurate in obtaining samples of microcalcifications, the minuscule deposits of calcium salts that show up on a mammogram as tiny white flecks. These can be a sign of ductal carcinoma in situ, a very early form of cancer that is confined to the milk ducts.

Turning Point, Winter/Spring 2004

Turning Point Archive

Surgery: when less is more

Until the 1970s, a mastectomy was standard treatment for a woman with breast cancer. Today, advanced surgical techniques allow many patients to keep their breasts and lymph nodes, enhancing safety, appearance, and comfort.

For example, a more precise margin of cancer-free tissue can now be removed along with a tumor, according to Carolyn Kaelin, MD, MPH, a breast surgeon and director of the Comprehensive Breast Health Center at Brigham and Women's Hospital. During breast conservation surgery (BCS), also known as a lumpectomy, taking out this tissue along with the tumor helps minimize the chances of a cancer recurrence.
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