'X marks the spot' as radioactive 'seeds' help surgeons target breast cancer tumours

Posted on Thursday, October 27, 2016

“It’s like ‘x marks the spot’,” said Dr. Jean Seely of the hospital’s Breast Health Centre at the Civic campus. “They (the surgeons) can see exactly where they need to go in.”

The seed contains Iodine-125, a radioactive isotope that’s long been used to treat other cancers, but has only recently found use as a marker to localize breast tumours. It’s faster, simpler and less stressful for patients than the old method that required inserting a metal wire in the breast that surgeons would follow to the cancerous tissue.

“The patients really love it,” Seely said. “I’ve put seeds in patients who’ve had a previous lumpectomy for another cancer using the wire method and they tell me this is a huge improvement.”

The Ottawa Hospital began using the Iodine-125 seeds about a year ago, the third hospital in Canada to do so. Studies have shown it’s cheaper and allows the hospital to use its operating rooms much more efficiently. The hospital diagnoses about 1,000 cases of breast cancer a year and performs about 850 lumpectomies, about half of them on tumours too small to be detected any other way. Finding small tumours — usually through annual or semi-annual mammograms —is good because it means the cancer has been caught early and is unlikely to have spread.

Using the old wire method meant women would have to undergo an hour-long procedure the morning of their surgery to localize the tumour.

“The women would be coming here very anxious. They’re fasting. They’re dehydrated. They’re ready for surgery. It’s really not an ideal time to do a procedure,” Seely said.

That delay also meant operating theatre would sit unused until about 10 a.m. when the first patients of the day would be ready.

The radioactive seed can be implanted up to two weeks in advance, meaning the woman arrives at the hospital on the day of her surgery ready to go. The seed is implanted using a large gauge needle under local anesthetic. The radiation is too low to cause any harm —there isn’t even need for protective clothing—but in diagnostic images, the seed shows up as a bright white spot in the middle of the tumour.

Pamela Skillicorn had no family history of breast cancer so she was shocked when her annual mammogram revealed a suspicious lump last January.

“I’d been going for regular mammograms for 10 years and there’s been nothing … so it was interesting, to say the least, when something showed up,” said Skillicorn, 61. “It was so small that they said you wouldn’t have found it just checking yourself.”

After a follow-up biopsy confirmed the news, Skillicorn was scheduled for a lumpectomy on April 1. She had the seed implanted a few days before that.

Dr. Jean Seely uses radioactive 'seeds' implanted in breast tumours to identify areas that need to be removed. The new technique is a safer alternative to older methods in which wires were implanted in the breast the day of the surgery.

Dr. Jean Seely uses radioactive 'seeds' implanted in breast tumour to identify areas that need to be removed. Pamela Skillicorn (R) had the 'seed' surgery in April.

Dr. Jean Seely uses radioactive ‘seeds’ implanted in breast tumours to identify areas that need to be removed. Pamela Skillicorn, right, had the ‘seed’ surgery in April. WAYNE CUDDINGTON / POSTMEDIA

“It’s just a very quick thing. they give you a little bit of freezing then using the ultrasound and a little bit bigger needle than normal. They guide it to where they’re aiming for and just insert the seed.

Skillicorn’s surgery went off without a hitch and she was healthy enough to attend a Garth Brooks concert two days later.

October is breast cancer awareness month. Some 25,000 cases of breast cancer were diagnosed in Canada in 2015 — nearly 70 a day — and it remains the most commonly diagnosed cancer among women. One in nine women will be diagnosed with the cancer at some point in their lives, according to the Canadian Cancer Society.

But survival rates have improved, with 88 per cent of those diagnosed likely to survive for at least five years, an improvement over the 79-per cent five-year survival rate of 30 years ago when the disease was at its peak mortality rates.

The disease can strike men, too, with about 220 men diagnosed each year with breast cancer and about 60 male deaths each year.

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