Alternative to Mastectomy

When doctors discovered last March that the slight hardening in the right breast of Eugenie Blaschko was a malignancy and that the cancer had spread to adjoining lymph nodes, they urged her to undergo a mastectomy. But Blaschko, 56, an exercise buff who swims year round in the California surf near her Long Beach home, adamantly refused to let surgeons remove the breast. Says she: "I decided I'd rather live a few years less and keep what I have."

Instead of a mastectomy, Blaschko opted for interstitial radiation therapy --the temporary implanting of tiny bits of radioactive isotopes in and around the malignant tissue. She has had no reason to regret her decision; the lump in her breast has receded, the cancer in her lymph nodes has apparently been eradicated, and she feels so well that she has taken up cycling along with her daily swimming.

Back to the Curies. Primitive variations of the treatment chosen by Blaschko date back to the turn of the century, when the Curies' discovery of radium made possible a radiation source compact enough to be placed within a tumor. Since then, the technique has been considerably refined and has long been used to treat certain cancers of the neck, head, vagina and other parts of the body difficult to cope with surgically. Now, U.S. doctors, confronted by 90,000 new cases of the disease a year, are showing an increased interest in the use of interstitial implants against breast cancer as well.

If the breast tumor is still small--no more than 4 cm. (1 1/2 in.) in diameter --doctors first excise the growth in a relatively simple surgical procedure called a lumpectomy. Larger tumors are left in place because their removal would destroy the shape of the breast. Then the radioactive material, usually the shortlived, man-made isotope iridium 192, is inserted into the tumor area. The technique requires extreme care; the iridium must be inserted precisely and in just the right quantity to avoid damage to nearby healthy tissue.

Typically, the physician pushes several hollow steel needles horizontally into the breast through the tumorous area and out the other side (see diagram). Thin plastic tubes are then threaded through the needles (which are subsequently removed) and anchored in place by small plastic buttons at either end. The iridium--in the form of tiny "seeds" embedded in a thin, stiff nylon ribbon --is inserted into the tubes. The outer layer of the seed is a steel sheathing; it blocks dangerous ionizing beta rays (electrons), but allows the escape of the high-energy gamma rays that destroy the tumor.

The radiation treatment continues for three to five days. While she may be uncomfortable, the patient experiences little pain and negligible scarring. Sometimes the breast and lymph nodes are bombarded by external radiation as well; the patient may also receive anticancer drugs to destroy malignant cells elsewhere in the body.

Growing use of the implant technique is partly a response to demand. Many women who discover that they have breast cancer are no longer willing to submit to disfiguring radical mastectomies, which involve the removal of the entire breast, underlying muscle and neighboring lymph nodes, even if they show no trace of cancer. Though mastectomies have been favored by U.S. experts as the surest route to survival in cases of breast cancer, some doctors are beginning to have doubts about them. Dr. Samuel Hellman of Harvard's Joint Center for Radiation Therapy points out that radical surgery--or any other treatment, including radiation--is frequently performed so late that the removal of additional tissue is no insurance against a recurrence of the disease; too often, cancerous cells have already spread to other parts of the body far from their original site in the breast. Thus, Hellman and other doctors are stressing local control of the cancer by destroying the primary tumor--with radiation from an external or internal source, or both--without subjecting the patient to further disfigurement.

Radiologists emphasize that implants are no sure cure for cancer of the breast or any other form of the disease --especially if it is detected late. But their experience suggests that the treatment is often just as effective as a mastectomy. For example, Dr. Nisar Syed, who has been doing implants at the Los Angeles County-University of Southern California Medical Center since 1973, says that a year or more after their treatment, 23 out of 24 patients showed no recurrence of breast cancer. In France, where he has treated some 500 women with iridium implants since 1961, Dr. Bernard Pierquin of Henri Mondor Hospital in the Paris suburb of Creteil reports a survival rate of about 75% to 80% after ten years--comparable to the results of radical mastectomies.

Some surgeons contend that there is a possibility, admittedly slight, that the radiation itself could cause future cancer. They argue, as the British Medical Journal recently said, that "cure is more important than contour." Yet Pierquin insists that for certain women between the ages of 40 and 50, there are particularly important aesthetic and psychological reasons for choosing radiation implants. As he explains it: "This is when the woman knows she is growing older and starting to lose her femininity, her power for seduction. The fact that she might undergo mutilation at this stage can be a catastrophe."

Earlier the Better. Syed sees still another benefit. Until now, he notes, many women with a suspicious lump in the breast have been extremely reluctant to go to a doctor for fear they would quickly wind up under the knife. By contrast, implants offer them a less menacing option, which may encourage them to seek help earlier--and early treatment, whatever the technique, is still the best way to beat breast cancer.

This file is automatically generated by a robot program, so viewer discretion is required.