What to do? With that fateful diagnosis (or the knowledge that BRCA1 and/or BRCA2 genes are among your chromosomes)- a lumpectomy or total breast removal? We know what Angelie Jolie chose to do. And, many European Jews (Ashkenazi) are carriers of the breast cancer genes- so they are prime targets for breast cancer.
A lumpectomy is the less radical choice; where a small amount of tissue is removed. Surgeons can only estimate the amount of tissue to be removed, based upon scans (magnetic resonance imaging- MRI) of the “lump”. The problem is that we cannot detect individual cancerous cells by this process. So, an estimate – perhaps even a “hands-on” examination is used to determine how much tissue must be excised.
The problem is that once the procedure is done, the pathology report that examines the edges of the tissue that was removed (and which takes two to three days to be available) may indicate that the surgeon failed to remove all the cancerous cells. Which entails another stint “under the knife”.
This is why Dan Hashimony (CEO and inventor) of Dune Medical Devices, Ltd. (Dune is the American unit of Dilon Technologies of Caesarea, Israel) has been developing a new device, a “MarginProbe”, which applies radiofrequency energy (RF) to the cells at the margin- the edges of the surgically removed cells. (We already have found that RF can detect and remove cancer cells- for example, in the liver.) This new probe is a hand-held device, coupled to a computer system. The transmitted RF waves produce changes in the bioelectrical fields of the cells, which can be used to differentiate between normal and cancerous cells. (See diagram below.)
The cost per use is just under $ 1000- and is not yet covered by health insurance. But, the device is now FDA approved, after the completion of a 600 person clinical trial. That trial demonstrated that 31% of those subjected to the procedure were found to still have cancerous cells; generally that would have meant additional surgery (except for the elderly or those with additional medical issues)- but more tissue could be removed on the spot. The control group (no MarginProbe used) had a “failure rate” of 42%. In addition, the study found that patients with “denser” breasts may be more difficult to have their cells differentiated at the margin.
It is possible that MarginProbe may overestimate cancer presence, requiring too much tissue removal. However, the trial proved that less than 10 ml (cubic centimeters) of tissue was removed after MarginProbe usage.
This sounds like an amazing development and relatively inexpensive. Great news Roy.
And, probably will become less costly as more folks get the treatment, Alessa!
I will be watching to see what other cancer treatments are targets (pun intended) for this analysis.
Roy, I won’t judge Angelina Jolie’s decision, because I’m not in her position, but that sort of “pre-emptive” cancer prevention rather sickens me. We never know what new developments in cancer treatment or prevention are just around the corner–like this procedure that you’ve written about–and of course you can do so much with diet and exercise to prevent cancer in the first place, whether you’re in high risk category or not.
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Well, Amy, I was with EVERY statement you made until the last 9 words.
If you are, unfortunately, blessed with both genes, BRCA1 and BRAC2, one’s chances of not developing breast cancer, then you are in a heap of trouble. The odds approach 90% for developing breast cancer, 45 to 50% for ovarian cancer… And, if you are male, there are lower- but substantial chances- for breast cancer development.
The advancements are amazing. I had a lumpectomy 12 years ago and I’m still here, with fingers crossed 🙂
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That’s the unfortunate- but fortunate- situation. I wish there was a treatment that was one time only, an immunization against it in the first place, But, 12 years is certainly cause for GREAT celebration (as long as we crossed the Rubicon of the operation in the first place.)
This sounds like a great new tool to help with making the best decision for cancer patients.
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I’m with you, Shawn. And, I figured my publicizing it would go a long way to insuring that it has a better chance of being adopted!
A new way to detect cancer cells during a lumpectomy has been approved by FDA, but isn’t approved by health insurance companies. Would they rather the doctor has to do 2 surgeries with possible hazards or just do one and done? Really!
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Let’s say the possibility could be that the therapy is too new, Ann. But, I am sure that it has as much to do with the calculations of some actuary who decided that 1 extra surgery in 5 is cheaper than 5 of these adjuncts! Too bad, the benefits for the patients are not part of those calculations.
Thanks for sharing this Roy. So far the women in my family have been breast cancer free on both sides and for several generations. It’s good to know that there is some progress being made in this area of medicine.
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Boy, is that GREAT news, Julia.
But, I would hope that the great advance would be NO surgery- a simple therapy to remove the cancer or better yet, an injection to preclude them in the first place. Given that they are not here yet, this goes a long way to making the treatment more effective.
This is great news and will improve the quality of care of many patients. Let’s hope it is the start of new developments!
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Muriel:
I would certainly hope that any woman about to undergo surgery would consider adding this device… One surgery is way more than enough. And, getting everything that’s necessary at once will go a long way towards alleviating mental anguish!
Sounds like a no-brainer to me. I wonder if there are any negative side effects to the Margin Probe? I hope that insurance companies will soon start approving this treatment – it sounds like it could save them money in the long run!
Me, too, Suerae! I hope this gets on the approved list soon. But, as I wrote to Ann, I am sure they determined it saves 1 in 5 (my random numbers) additional surgery- and this costs slightly more, so…
My husband’s side has an extensive history of breast cancer, including my mother in law, who has had (different) cancers in each breast. (She’s an almost 40 year survivor by the way). Their family genetic makeup has not been investigated, as far as I know. This is such good news.
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I’m thrilled, Alana! And, to be honest, somewhat thrilled it’s your HUSBAND’s side, which means your risk is not elevated.