- Last Updated: November 30, 2016
Breast cancer is the most common cancer in women. A study by the University of Washington estimates that more than 1.6 million new cases of breast cancer occurred among women worldwide in 2010. In the United States, according to the National Cancer Institute, breast cancer was expected to account for more than 232,000 new cases in women, more than 2,000 new cases in men, and more than 40,000 deaths in 2013. The risk for breast cancer increases with age.
Common treatment options for breast cancer include surgery, radiation, chemotherapy, hormone therapy, and biologically targeted pharmacologic therapies. Typical treatment regimens can involve combinations of several options. However, the precise treatment regimen depends on the location, type, hormonal status and stage of the cancer, as well as decisions by the patient and care team. For small tumors confined to the breast (which are not behind the nipple), the standard of care is lumpectomy and radiation.
Surgery involves either lumpectomy or mastectomy, both of which aim to eradicate the tumor and reduce the risk for recurrence. Lumpectomy involves the removal of the tumor surrounded by a rim of normal breast tissue, whereas mastectomy involves removal of the entire breast. Surgery usually includes the removal or at least sampling of lymph nodes in the arm pit.
Radiation of the breast and axilla (armpit) is used as an adjuvant to surgical removal of the lump, and is intended to kill cancer cells that might have been left behind. This can be done externally by using a radiotherapy machine to send high energy beams toward the tumor, or it can be done internally by using a needle, seed, or tube to place radioactive material directly into the area of the cancer and the cancer bed.
Chemotherapy involves the use of drugs that kill cells or stop them from dividing. The type of chemotherapeutic agents used depends on the type and stage of the tumor. Chemotherapy can be used alone or following surgery.
Hormone therapies, also called endocrine therapies, are used for patients whose tumors respond to hormones. These therapies block the production of hormones, prevent hormones from interacting with their receptors, or directly target the receptors themselves.
Targeted therapies interfere with signals required by breast tumors to survive and grow. These therapies are prescribed for patients whose tumors show abnormal production of signaling molecules such as HER2/neu.
Focused Ultrasound Treatment
Focused ultrasound offers a potentially non-invasive alternative to surgical lumpectomy. Rather than creating an incision to remove the tumor, the physician uses magnetic resonance imaging (MRI) or ultrasound guidance to identify the tumor and to direct a focused beam of acoustic energy through the skin into the tumor. This beam heats and destroys the tumor without damaging nearby structures or tissues. A follow-up MRI can determine whether the entire tumor has been ablated/ destroyed, and if necessary, focused ultrasound can be repeated.
As a non-invasive method of lumpectomy, focused ultrasound may offer the following benefits in treating breast cancer:
- fewer complications and a short recovery time, compared with surgical lumpectomy;
- no scar tissue and reduced risk for breast deformation;
- reduced risk for infection; and
- more precise treatment as a result of real-time guidance by magnetic resonance or ultrasound.
With increased precision, focused ultrasound has the potential to be a more effective lumpectomy than surgery. Thus it could potentially be a primary treatment approach for some patients.
Because there is no surgical removal of tissue involved, however, there are some potential drawbacks to focused ultrasound treatment:
- It does not allow for laboratory verification of complete removal of the tumor.
- It does not produce samples to enable analysis of the tumor for planning adjuvant therapy.
There is also potential for damage to non-targeted tissue, such as the skin.
Regulatory Approval and Reimbursement
The Model JC Focused Tumor Treatment System, which is manufactured by Chongqing Haifu Technology, has been approved in Europe for the treatment of breast cancer.
The use of focused ultrasound to treat breast cancer is not yet a procedure universally reimbursed by medical insurance providers.
While treatment is not approved in the United States, there are many sites worldwide that offer this treatment.
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