Medical advances improve outcomes in the fight against breast cancer

Published 7:29 pm Saturday, October 28, 2023

NATCHEZ — Two Natchez surgeons say advances in the diagnosis of breast cancer, as well as refining of surgical techniques and individualized treatments all lead to better outcomes for patients than even that of five years ago.

Dr. Christopher Martin, a general surgeon at Merit Health Natchez, said diagnosing breast cancer now in the majority of cases is done using minimally invasive techniques.

“Any breast mass that is palpable or shown on imaging, can be diagnosed with a core biopsy or needle biopsy,” Martin said.

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Those procedures are done with only local anesthesia and often in a doctor’s office.

“A needle biopsy decreases trips to the operating room and leaves you more options for breast surgery, if that’s needed,” he said.

Another more common practice in fighting cancer is neoadjuvant chemotherapy, which is chemotherapy before surgery in those who have been diagnosed with breast cancer.

“Some people respond well to that and the chemotherapy shrinks the tumor, meaning someone who would have previously had a mastectomy, may now have a procedure that conserves the breast,” Martin said.

Natchez surgeon Dr. Geoffrey Flattmann, who is also affiliated with Merit Health Natchez, along with Martin heralded equipment at Merit Health Natchez, which allows for 3-D breast imaging and stereotactic mammography and biopsies.

“There has been really broad adoption of 3-D mammography, which is a huge benefit to early detection,” Flattmann said. “That technology is so precise and is now readily available. Traditional mammography has many more false negatives.”

Stereotactic mammography, used for biopsies, is a huge advancement, both surgeons said.

“Biopsies used to be not very precise and were cumbersome,” Flattmann said. “They certainly were not very comfortable for the patient. With this technology, they are very comfortable and can be done with only local anesthesia. We can more easily acquire the target and know we have removed an adequate sample.”

Martin said new ways of mapping lymph nodes have improved outcomes for patients.

“We are getting further away from complete axillary lymph node dissections,” he said. “If you go back 30 years, removing all those lymph nodes creates a disruption of the lymphatic system and leads to complications in the arms like lymphedema or swelling. That is caused not be the mastectomy but by the axillary lymph node dissections. In some situations, it’s not necessary to do that anymore.”

Flattmann said sentinel node mapping leads surgeon to just the lymph nodes to which the cancer will most likely spread.

“Now we can selectively and precisely remove nodes” needed for testing,” he said.

Both surgeons said all of that new technology is available in Natchez, from complete mastectomy to breast conservation with radiation all the way through insertion of tissue expanders, which are necessary for breast reconstruction.

“David Steckler comes to Natchez often and works with surgeons here and he does the reconstruction work after we finish, all in one operating unit,” Flattmann said.

Stecker, a native of Natchez, lives and works at his clinic in the Jackson area. He is a board certified plastic surgeon. His father, the late David Steckler, was a long-time Natchez pathologist.

Flattmann and Martin said one of the keys to surviving breast cancer is early detection. Both urged breast self exams and yearly mammograms beginning no later than 40.

“Some payer groups (insurance) are trying to adjust that up to 45, but I say 40 if you have no family history of breast cancer. If you have increased risk factors, sometimes you should start earlier than that,” Martin said. “Imaging seems to get constantly better. Screening or imaging now pick up things that are there long before they are palpable.”

Martin said no one size fits all treatment for cancer exists.

“We use the generic term cancer, but so many subsets exist and there are so many differences. Treatments can be tailored to the malignancy and to the patient. It’s never easy and never fun to tell someone they have a malignancy, but I try to emphasize to patients that they are now better off than they were just weeks before because they know they have a problem and are on the road to fixing that problem,” Martin said.

Flattmann said he spends a lot of time with his patients talking through risks and the benefit of different approaches.

“The biggest advances in cancer treatment are from an oncology standpoint. Oncologists like Jack Rodriguez (Natchez oncologist) have so much more in his repertoire in terms of molecular biology,” Flattmann said. “Their medications are better, more targeted and are associated with less adverse side effects and results are so much better.

“We are so blessed to have Jack Rodriguez to guide us through those things. We work as a team. There is no one-size-fits-all treatment process. If you come see me to have your gall bladder removed, we have one procedure to do it. But for breast cancer, we tailor the surgery to individual cases and unique tumors,” Flattmann said.

In many people, who have a history of breast cancer in their families, he urged genetic testing, particularly if you have a first-degree relative, like a mother or sister, who had breast cancer.

“The results of genetic testing in some individuals may have some effect on what we do surgically. That information is very important to patients whose first degree relatives have had cancer,” he said. “Early detection and early treatment translates to a cure.”