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Tuesday, October 18, 2016

Good News on a Grim Front

"It's like 'X marks the spot'."
"They [the surgeons] can see exactly where they need to go in [to remove a cancerous lump in a breast]."
"[In previous protocols] The women would be coming here very anxious. They're fasting. They're dehydrated. They're ready for surgery. It's really not an ideal time to do a procedure." 
"The patients really love it [the new procedure]. I've put [radioactive] seeds in patients who've had a previous lumpectomy for another cancer using the wire method, and they tell me this is a huge improvement."
Dr. Jean Seely, Breast Health Centre, Civic campus, The Ottawa Hospital
Dr. Jean Seely uses radioactive 'seeds' implanted in breast tumours to identify areas that need to be removed. The new technique is a safer alternative to older methods in which wires were implanted in the breast the day of the surgery. Wayne Cuddington / Postmedia
"I'd been going for regular mammograms for ten years, and there's been nothing ... so it was interesting, to say the least, when something showed up. It was so small that they said you wouldn't have found it just checking yourself."
"It's a little bit of freezing then using the ultrasound and a little bit bigger needle than normal. They guide it to where they're aiming for and just insert the seed."
Pamela Skillicorn, breast cancer patient, Ottawa
Let's face it, anything that might improve the mental turmoil and physical pressure of a diagnosis of cancer; in this instance breast cancer, should be celebrated for easing the process, making it less traumatic, speeding its way to surgery and improving efficacy. The Ottawa Hospital diagnoses roughly a thousand new cases of breast cancer yearly. Of that number 850 lumpectomies result, approximately half to remove tumours too insignificant in size to be detected by any other method. The smaller the tumour, the better the opportunity to apprehend it before it is able to spread.

At one time a wire method of locating and identifying the area was used, where women would undergo an hour-long procedure to localize the tumour the morning of their surgery, as a standard procedure pre-surgery. That was an hour of pre-preparation for surgery that left operating rooms waiting for the patient to be ready, the operating theatre unused, an inefficient use of space and time. Aside from the inconvenience to the patient with the use of an outdated procedure.

This led to the installation of a new protocol, where seeds containing Iodine-125, a radioactive isotope long used to treat other cancers, has been made use of as a marker meant to localize breast tumours. A faster, simpler, infinitely less stressful procedure for patients in comparison to the old method of inserting a metal wire in the breast for surgeons to follow, leading to the cancerous tissue to be extracted through surgery.

As the third Canadian hospital to begin using the Iodine-125 seeds, The Ottawa Hospital began its use a year ago. Studies point to its less expensive application, permitting the hospital to make more efficient use of its operating rooms. The seed planting takes little time and can be implanted up to two weeks in advance of scheduled surgery. As soon as the woman arrives at the hospital as a surgical patient the day of her surgery, it can be embarked upon with no preparatory work required.

A large-gauge needle implants the seed under local anaesthetic. Although the seed contains Iodine, as a radioactive isotope, it emits such a low dose of radiation that no harm is caused even while in diagnostic images the seed appears as a bright white spot in the middle of the tumour, guiding the surgeon with accuracy and little prior fuss. For Pamela Skillicorn, the diagnosis of a suspicious lump after an annual mammogram left her perplexed and concerned. A biopsy confirming cancer, she was scheduled for a lumpectomy.

In her case, the radioactive seed was  implanted several days prior to her surgery date. In 2015, 24,000 cases of breast cancer were diagnosed in Canada, representing about 70 on a daily basis. One in nine women can anticipate being diagnosed with breast cancer at some time in their lives, according to the Canadian Cancer Society. Survival rates have improved over the years, currently with 88 percent of women diagnosed expected to survive at least five years.

Roughly 220 men are diagnosed yearly with breast cancer, leading to 60 male deaths annually.

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