Breast Cancer Analysis

March 5, 2006 Breast cancer is the most commonly diagnosed cancer in American women and the second leading cause of cancer death (lung cancer is the first). In 2006, the American Cancer society estimates 212,920 new cases of female breast cancer will be diagnosed in the U.S. and 40,970 women will die from the disease. Risk for breast cancer increases with age. About 77 percent of women are diagnosed after 50. Family history plays a role. Having a mother, sister or daughter with breast cancer doubles the risk of developing the disease. When two first-degree relatives are affected, risk increases five-fold. Women who have a personal history of breast cancer have a 3- to 4-fold increased risk of developing a new cancer in the same or opposing breast. Breast cancer is more common in white women than in African-American women. However, African-American females are more likely to die from it. Some other possible risk factors for breast cancer include: having a previous abnormal breast biopsy, past exposure to radiation in the chest area, early start of menstruation (before 12), late onset of menopause (after 55) and not having children (or having a first child after 30). Treating Breast Cancer Breast cancer is usually treated with surgery, chemotherapy and/or radiation therapy. Surgical removal of the breast is called a mastectomy. In a simple mastectomy, surgeons remove the breast and nipple, but none of the underlying muscle tissue or lymph nodes. A modified radical mastectomy is the removal of the breast and some of the lymph nodes under the arm. A radical mastectomy is the most extreme surgery, removing the breast, underarm lymph nodes and some of the chest wall muscles. Some women with breast cancer are candidates for breast conservation therapy (lumpectomy). In this procedure, surgeons remove only the tumor and a small margin of healthy tissue. Breast conservation therapy is generally reserved for women who have early stage breast cancer and small, confined tumors. The treatment is typically followed by radiation and sometimes chemotherapy. Lumpectomy Outcomes The goal of a lumpectomy is to remove all of the cancer and preserve as much of the natural breast as possible. The surgery can be a very effective treatment for many women with early stage or localized breast cancers. However, to reduce the risk of recurrence, doctors must be certain they have removed all of the tumor. Traditionally, complete removal of a breast tumor is determined through a technique called permanent section analysis. During the operation to remove the tumor, the surgeon palpates, or feels the tissue in the surrounding area (tumor tissue feels different from healthy tissue). Using the fingertip system for guidance, the surgeon determines how far to cut to remove the tumor. Several samples of tissue are taken from the edges of the surgical site. The samples are treated and embedded in paraffin wax, creating permanent tissue sections. The tissues are analyzed two to three days later. If cancer cells are found, the surgeon has not gotten all of the cancer and the patient may face re-excision. In many cases, by the time the pathology report is completed, the patient has already gone home and needs to return to the hospital for another operation. Another Technique Some physicians are using another technique in the operating room to try to ensure they remove all the cancer cells during breast conservation therapy. Its called frozen section analysis. After the tumor is removed, and while the patient is still on the operating table, the surgeon takes thin slices of tissue from the edges (margins) of the site. Typically, five slices of tissue are obtained (one from the top, bottom, left and right sides and area underneath the tumor). Those slices are quickly frozen and sent to a pathologist for immediate analysis. The tissue specimens are examined under a microscope. If cancer cells are found, doctors can go in and immediately remove more tissue. If no cancer is detected, the surgeon finishes the operation. In a recent study at the University of Florida Shands Cancer Center, researchers compared the results of frozen section analysis with standard permanent section analysis; 97 patients were involved in the study. Of those, frozen section analysis correctly identified the tissue sample as being free of cancer cells in 54 patients (i.e., the negative results were confirmed with the permanent section analysis). Twenty-five of the cases were correctly identified as positive for cancer cells, meaning patients required removal of more tissue. An important concern is that 18 patients had negative results on the frozen section analysis, but positive results with the permanent section analysis. In other words, the frozen section analysis incorrectly identified the tissue samples as not containing any cancer cells, when in fact, some cells were there (a false negative result). Surgeon, Juan Cendan, M.D., says by finding the cancer cells in the tissue sample during the original surgery, doctors were able to make immediate treatment decisions for 25 of the 97 patients, saving most of them from having to make a trip back into surgery at a later date to remove the rest of the cancer cells. He says that because of the number of false negatives (18.6 percent of the women), frozen section analysis should not be used alone. Permanent section analysis should continue to be done in all cases to confirm the results. AUDIENCE INQUIRY For information on breast cancer or breast cancer treatment: American Cancer Society, http://www.cancer.org, or contact your local chapter National Cancer Institute, http://www.nci.nih.gov Radiological Society of North America, public website, http://www.radiologyinfo.org BIBLIOGRAPHY Balch, Glen, M.D., et al., "Accuracy of Intraoperative Gross Examination of Surgical Margin Status in Women Undergoing Partial Mastectomy for Breast Malignancy," The American Surgeon, January 2005, Vol. 71, No. 1, pp. 22-27. "Breast Cancer," Atlanta: American Cancer Society, downloaded from website (http://www.cancer.org), February 1, 2006. "Breast Cancer," Oak Brook: Radiological Society of North America, downloaded from public website (http://www.radiologyinfo.org), February 1, 2006. "Breast Cancer PDQ®: Treatment," Bethesda: National Cancer Institute, downloaded from website (http://www.nci.nih.gov), February 1, 2006. 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Research compiled and edited by Barbara J. Fister