Moving away from mastectomy
Posted on 2 Nov 2021
Breast-conserving surgery and the Magtrace lymphatic tracer are revolutionising breast cancer treatment.
On hearing the words breast cancer, most people – lay or in the medical community – immediately think of a mastectomy as the only solution. But this is no longer the case, says Dr Johannes Scheepers, a pioneering general surgeon at Mediclinic Hermanus in the Western Cape.
As one of South Africa’s foremost advocates of modern, non-invasive treatments and procedures for breast cancer, he says breast-conserving surgery has proven as effective – if not more – than full or partial mastectomy. Whereas mastectomy has traditionally been the go-to treatment for breast cancer, Dr Scheepers feels strongly that it must be an absolute last resort.
“For decades, when it came to breast cancer, physicians felt the more you cut out, the better,” he explains. The most common procedure was a Halsted mastectomy, in which everything was removed – the breast, chest muscles and all the lymph nodes under the arm.
“It was and still is extremely traumatic for patients, who are disfigured for life. In later years the chest muscles were preserved, but the disfiguration caused by a mastectomy remained, necessitating breast reconstructive surgery.”
New hope for recovery without a mastectomy
Dr Scheepers says researchers have found that the size of the tumour does not determine whether a woman with breast cancer will live or die. This has led to the realisation that a mastectomy has little effect on the patient’s outcome and that it’s necessary to look at other factors, such as the biology of the cancerous tumour.
“Today we start with radiology.” Dr Scheepers says. “It gives us a better idea of the type of cancer and where it has spread. From a biopsy, the pathologist can give us even more information about the type of cancer. We’ve created markers according to which each type of cancer can be classified. currently we are using 4 markers daily in practice with selective patients undergoing a MammaPrint gene analysis, which looks at 70 different gene expressions.”
Dr Scheepers insists that most breast cancer patients recover equally well – if not better – without a mastectomy. In most cases, once the tumour has shrunk through chemotherapy, surgeons only need to make a small incision in the breast to remove the tumour. It’s done in such a way that the integrity and natural appearance of the breast is preserved.
An essential piece of diagnostic equipment is the non-radioactive Magtrace tracer for lymphatic mapping in patients with breast cancer. Magtrace is made of a state-of-the-art material called superparamagnetic iron oxide (SPIO). Used in conjunction with the Sentimag probe, it allows surgeons to determine whether the breast cancer has spread to the lymph nodes.
Dr Scheepers explains the process: “The Magtrace magnetic marker liquid is injected into the breast from where the tiny organically coated iron oxide particles pass through the lymphatic system, following the route that cancer cells are most likely to take when they spread from the primary tumour.”
The oxide particles become temporarily magnetised when the probe is near, marking the precise location of the sentinel (nearest) lymph node via audible and visual signals on the monitor. This first lymph node can then be removed and sent to the pathologist to determine if the cancer has spread to the lymph nodes or not.
This means surgeons don’t have to remove all the lymph nodes, which avoids painful complications for the patient and ensures a much quicker recovery period.
“Breast-conserving surgery, along with lymphatic tracing and the sentinel node biopsy procedure, has helped thousands of women avoid unnecessary and more invasive surgery”, says Dr Scheepers.
“The only reason why so many patients still demand a mastectomy is a lack of knowledge of modern breast cancer treatments that can save the breast. But we’re working on fixing that.”