The Uncertainty of Breast Surgery

In a few days my cousin will have breast surgery. She doesn’t know if it will be a lumpectomy or more. That uncertainty is scary.

In a few days my cousin will have breast surgery. She doesn’t know if it will be a lumpectomy or more. That uncertainty is scary.

The problem is that we are still not quite at the level of imaging and seeing inside the body that the doctor on Star Trek, “Bones,” was able to achieve with the magic wand-type device he could hold over a person and see what was wrong inside. Radiology has come a long way in the real world but in some areas the images leave doubt as to what is really inside the patient. That makes an operation for cancer, for example, an “adventure” for the surgeon and a time of anxiety for the patient and family. My family members are facing that right now. 

I understand the problem. A few years ago I helped produce a town meeting for women where the guest was Dr. Laslo Tabar, a true breast radiology world expert. He showed us how hard it can be to spot cancer among the shades of gray on a mammogram. It was literally like looking for “Where in the World is Carmen San Diego?” or “Where’s Waldo?” in those kid picture books. It takes a lot of experience of not just a general radiologist, but a breast radiology specialist. That’s why some breast cancers get missed, even with automated image analyzers now backing up most radiologists.

One step in the right direction is a new FDA approved approach called 3D tomosynthesis mammography. This is where 3D images are made of a woman’s breast as she is screened for cancer. Doctors tell me it gives them more confidence that they are spotting what could be cancer.

When something is spotted that’s questionable women typically have an ultrasound guided needle biopsy and then, often, an MRI. My cousin had that. The good news is the MRI can zero in on specific spots. But it also raises more questions as other questionable spots are seen. That’s what’s created worry for my cousin. Yes, she has breast cancer. But is it just in one place or several more? Only the surgery and pathology will determine that.

I know this problem has been around for years. We’d hoped more precise radiology would eliminate the mystery. But we are just not quite there yet. I wish my cousin all the best for her operation this week. And I remind women that, even though it’s not perfect, the yearly imaging of their breasts starting at age 40 gives them the best chance of spotting cancer at its earliest stage when it is typically most curable.

To learn more details about this and how it made a big difference for one woman, Beth Long of Chicago, see my interview with Beth and her doctor, Dr. Kevin Bethke from Northwestern Memorial Hospital.

Wishing you and your family the best of health!

Andrew