Question: What research is being done in regard to the surgical management of breast cancer?
Answer: I think one of the most exciting advances is in the area of surgical management of the breast. It's clear that we're moving away from radical surgery. For most patients, we do not need to remove the entire breast. We can perform breast conservation surgery. As sentinel node mapping begins to replace axillary node dissection, we're going to have the next big question on the drawing board is, "Well, do you really need to take the patient to the operating room at all? Is there a way to take care of the primary tumor in the breast without a surgical knife?"
We have several pilot studies going on at M.D. Anderson. One is to use a radio frequency ablation in which we use heat to try to destroy the primary tumor. In our current protocol, all those patients still get the standard surgery. But if our success rate still holds true, in that the first 15 patients had 100 percent tumor cells killed, the next step would be to do the radio frequency ablation as a stand alone, in place of the surgery.
Another pilot study we're looking at is the use of MRI-guided, high-intensity ultrasound. Now, this would truly be the 'Star Trek' wave of the future because with a high-intensity ultra sound, we will not even need to make a needle stick in the skin. In that, we will hold the ultrasound transducer above the skin and direct the high-intensity sound waves below the skin's surface, so there will be no invasive procedure done to the breast itself. This also works with the use of thermal energy.
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