I am proud to be one of a handful of surgeons in the country with experience in cryoablation for the treatment of breast tumors. Cryoablation is not a new technique, and in fact has been used for many years in the treatment of liver and prostate cancer. This FDA-cleared procedure involves freezing the mass inside of the breast – the freezing kills the cells of the tumor, and the dead cells are then gradually reabsorbed by the body. Instead of needing to go to the operating room, the procedure is performed in the office under ultrasound guidance and local anesthesia. The scar that results is very small (3 millimeters – a small skin puncture), and no sutures are needed. Liquid nitrogen is used to perform the freezing – it circulates through the thin hollow probe that is inserted into the tumor, and the temperature reaches -160 decrees Celsius. The majority of procedures are completed within 10-15 minutes. The discomfort after the procedure is minimal, and most patients return to normal activity relatively quickly. Because the incision is so small, there is very little, if any scarring. In addition, because no tissue is actually removed, there is little potential for change in the shape or overall appearance of the breast as may result from surgical removal. Over the course of several months, the lump gradually resolves; occasionally, a small lump of scar tissue might remain after treatment.
I have been using cryoablation for fibroadenomas since 2004. Fibroadenomas are solid, benign breast tumors, occur in approximately 10% of women between the ages of 18 and 40, and every year approximately 500,000 women are taken to surgery for removal of these tumors. Although they are not cancerous, they may increase in size, and women that have developed one fibroadenoma may develop others. In addition, they can be painful. Many women that have these masses will undergo surgery to remove them due to the anxiety that a lump in the breast causes. Traditional surgery for these lumps requires anesthesia, leaves a scar, and may require several days for recovery. The discomfort as a result of the procedure usually only lasts for a few days, but may last for as long as several months. In women that choose not to undergo surgery, it is usually recommended that they be re-examined every 3-6 months to ensure that the mass is not enlarging or changing. Often this need for frequent examination increases anxiety and worry among the patients that have these lumps. For these patients, cryoablation may be a good alternative. Cryoablation is not an appropriate treatment for all patients with fibroadenomas – as with many areas in medicine, a case-by-case approach is best. A position statement from the American Society of Breast Surgeons supports the use of cryoablation for the treatment of fibroadenomas in selected patients.
Even more exciting is the promise of treating breast cancer with cryoablation. I was one of approximately 20 surgeons nationally to participate in a large multi-institutional trial, sponsored by the Alliance for Clinical Trials in Oncology and the National Cancer Institute “A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma” . All patients in this study underwent surgery after the cryoablation, so that the tissue could be evaluated by the pathologist. The study demonstrated excellent success rates when the breast cancer was less than one centimeter in size. Future research will involve cryoablation followed by observation (no surgery). In addition to the potential to avoid surgery in some patients, there are also data suggesting that treating a breast cancer by cryoablation may result in an enhanced immune response. Cryoablation for breast cancer is still considered experimental, but we are all hopeful for the day when non-surgical treatment is an option for some women.
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