Doctors in England and Arkansas are working on a technique that someday may be able to treat small breast cancers in the time it takes to go to the dentist ... without leaving so much as a scar.
"We think we may have a simple technique. It's looking promising for treating small cancers without the need for surgery, as an alternative to surgery, and any further treatment for those patients would be along conventional lines," says Stephen G. Bown, MD. Bown is director of the National Medical Laser Center in London, England.
Along with researchers at the University of Arkansas for Medical Sciences in Little Rock, the British researchers have been using a laser to burn away the cancer. It's called interstitial laser photocoagulation, or ILP. Brown presented some early results at the Department of Defense Breast Cancer Research Program Meeting here this weekend.
It's very "attractive because we don't require [putting the patient to sleep]," no hospital stay is needed, and it's safer, Bown says. The process, adds Bown, also doesn't leave a scar or change the shape or size of the breast.
Up to four needles threaded with thin optic fibers are placed through the skin, into the breast. The needles are placed where the tumor can best be attacked. A low power laser light then gently heats and kills the cancerous tissue. The body takes care of the dead cells through its normal healing process. The patients also undergo chemotherapy or radiation therapy afterward, as would happen after traditional breast cancer surgery.
Steven E. Harms, MD, with the University of Arkansas, tells WebMD the process can be done in about an hour.
Both doctors made it clear the process is not for everyone, only those with small tumors that have not spread to other parts of the body, such as the lymph nodes. But Harms tells WebMD that about 30% of women with breast cancer would fit the category, and with the ongoing success of screening methods, that number is likely to rise to 50%.
The success of the treatment all hinges on whether an imaging procedure calledmagnetic resonance imaging, or MRI, can accurately determine if the laser has destroyed all the cancer. To do this, the researchers have performed the procedure on about 100 women. Ultimately, Bown hopes to recruit up to 500 women to prove the procedure works.
Bown tells WebMD, "We're playing with fire here," so extreme precautions are being taken to be sure the cancer is gone. The women first undergo a MRI before the procedure, then again after the procedure. But because the researchers are not sure that the MRI is adequately showing the full extent of the cancer, surgery is performed to verify the entire cancerous area in the breast. That tissue is then examined under a microscope and compared to the findings of the MRI scan.
"The real aim is to say, 'has the laser treatment completely destroyed the cancer or have we left a bit behind,'" Bown says. "If we can be confident the laser has got everything, then we will get to the stage where we don't need conventional surgery as well. We're just about getting to that stage now."
In fact, the researchers report that results so far show MRI is "remarkably good" at detecting the extent of the cancer and detecting whether the laser destroyed all of it. Harms tells WebMD it's important to note that "surgery's not perfect either" when it comes to removing all the cancer, adding "we are very confident in our MRI technology."
Harms is confident enough in the MRI that he's performed the laser process on three women, without conventional surgery afterward. The women instead are undergoing extremely vigilant follow-up for five years. One patient is still doing well one year after surgery, Harms says.
There is a third part to the research that has yielded a beneficial "side effect," Bown says. It came about because the doctors had to be sure the areas treated by the laser did in fact heal safely and did not cause an infection or other problem in the breast.
To do this, women with harmless tumors were recruited. These lumps often occur in young women, and as Bown says, "in one-third of the women, the lumps will go on enlarging, one-third will stay static, and a third [of the women] will get the procedure." By procedure, Bown means lumpectomy to remove the tumor, an option many women avoid.
Because there would be no serious consequences if part of the lump were not adequately treated, the laser procedure was done on women with these noncancerous tumors. It worked. After an average of a few months, Bown tells WebMD the researchers found "[the tumors] curling up their tails and disappearing ... we've found a very effective treatment for these fibroadenomas."
Frances M. Visco, a breast cancer survivor and chair of the National Breast Cancer Coalition in Washington, says the research is very exciting and "moving us forward in the fight against breast cancer.
"The laser surgery approach, as a woman who had a lumpectomy, I find very promising and very exciting ... and I look forward to the ultimate results," Visco says. "But I want to stress, as a consumer, too, that everything we've heard today is preliminary, and our concern as consumers is that what is presented today will tomorrow somehow be turned into clinical practice."
The U.S. Department of Defense has supported the research.
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