Breast Center Breakthroughs
Research efforts at AAMC’s Breast Center are ushering in the next generation of advances in breast cancer treatment
Who will get breast cancer? When? And why? And once a tumor has been removed, which will be the most effective medical treatment for preventing the return of the disease: hormone therapy or chemotherapy? Imagine how much treatment could advance if doctors had more reliable answers to these questions.
Answers to these and other questions may emerge from a research project undertaken jointly by doctors from the Breast Center at Anne Arundel Medical Center and the Windber/Walter Reed Clinical Breast Care Project (CBCP).
The Walter Reed CBCP is a congressionally mandated and funded endeavor that is enormous in scope. Researchers will collaborate to carry out molecular, biochemical, histologic and immunologic analysis of breast tissue and blood to provide insights into the poorly understood molecular mechanisms of breast cancer and disease development.
Lorraine Tafra, M.D., medical director of the Breast Center at AAMC, said, “The partnership is the ideal combination.” “Walter Reed recognized in AAMC a level of clinical sophistication plus a high volume of breast cases. And our commitment to research has created clinical connections between the two hospitals We are very proud that Dr. Craig Shriver, director of the Walter Reed Project, has committed to partnering with us.”
For AAMC, access to a multi-million dollar, stateof- the-art research facility makes available the additional human resources and talents needed to fulfill the manpower requirements of large-scale research. “The size and scope of Walter Reed,” said MARTIN ROSMAN, M.D., AAMC’s medical director of the project, “means we have access to the added ranks of statisticians, pathologists, technicians and other specialists that make a research project of this scale possible.”
Painstaking detective work
The scale Dr. Rosman refers to has to do with the amount of data that must be collected and analyzed, beginning with the collection of tissue samples from patients. The Tissue Repository currently contains an astounding 20,000 specimens. They also include blood, lymph nodes, and ductal fluid from the breast. Although the creation of the repository is unique and an enormous achievement in itself, the addition of the patient matched clinical data makes this project the most ambitious of any taken in research for breast disease.
As the tissue samples are collected, they will be painstakingly catalogued and then “banked” or stored. In addition to AAMC pathologists WILLIAM WEISBURGER, M.D., SANFORD ROBBINS, M.D., and JOAN WOODWARD, M.D., the O.R. staff, Lab and Clinical Trials Department are also key partners in this project. Each specimen will undergo experimental analysis of the genetic and protein contents of the cells and fluid. A computerized program will then match these results with the patients’ clinical characteristics; for example: individuals with benign breast disease, those with very high risk of developing breast cancer, and those with malignancies. By comparing the tissue analyzed and the clinical information, it may be possible to accurately predict in the future who will get breast cancer, when they will get it, and how they will do when they get it. (All the record keeping and matching is done in compliance with established privacy regulations.)
Risk Awareness: Realities and
Researchers will trace the number of matches between identified abnormalities, track the number of patients who develop breast cancer, and follow the course breast cancer takes in individual patients. As the frequency of those matches increases, eventually researchers will be able to narrow the list to those genes and proteins that are early warning signals for the onset of breast cancer, as well as which point toward the best choice for follow-up therapy.
“Clearly the effect on the prevention and treatment of breast cancer would be significantly changed for patients,” said Dr. Tafra. “It will be the difference between waiting,wondering and hoping. Instead,with their doctors, patients will take active steps to prevent the disease or to know with much more precision what the right course of treatment should be if the disease occurs.”
Breast surgery that leaves the breast totally intact? Stay tuned.
Cryoablation is the term breast surgeons use to describe the freezing of a tumor inside the breast to kill the tumor’s cells. The Breast Center has been a national leader investigating this innovative therapy. Currently the procedure is approved only for surgery to treat benign tumors. But research underway now is examining whether the procedure will be suitable to treat malignant tumors found in the very early stages of breast cancer.
Cryoablation involves guiding a very thin probe through a small incision to the tumor’s location within the breast. Surgeons use ultrasound imaging to see the tumor and guide the probe to it.
Ultra-cold argon gas is fed through the tube to freeze the tumor and the tissue nearby that surrounds it. The frozen mass thaws once and the argon is applied again to repeat the freezing and thawing sequence. The tube is withdrawn and the small incision bandaged. The surgery is performed with local anesthesia as an outpatient procedure. The mass then resorbs.
Results of early studies suggest that cryoablation may be suitable for treating malignant tumors in the breast no larger than one and a half centimeters. Researchers say that more data and study is needed to reach a final conclusion.
Dr. Tafra says that while the lumpectomy procedure used to remove small tumors is an improvement over total mastectomies, the surgery still leaves a scar and occasionally an indentation where the tumor was. “If cryoablation proves effective for the smaller malignant tumors,” she says,“we will be able to kill the tumor and leave the breast totally intact.”
Dr. Tafra said, “The goal of all the Breast Center’s innovative strategies is simple...tailor the therapy so we cure the disease and take the least toll on quality of life, cosmesis and body function. Our Breast Center will continue to search and strive for technology that allows us to accomplish this goal.”