Targeting breast cancer with radioactive seeds
CHUM using more advanced procedure to help surgeons better locate tumours
Back in her village of Ste-Sabine near Sherbrooke, Marie-Ève Julien had a brave face for her family, who were stressed and scared about her cancer diagnosis.
“I’m not going to die of cancer. I’m going to get new breasts,” Julien told her 13-year-old daughter, Marianne, early Thursday morning.
However, after the 41-year-old cosmetician got a tiny radioactive seed — about the size of a sesame seed — injected into her right breast to mark the site of the tumour, here yes sparkled with brimming tears. It’s not worry, she said, it’s just the emotion of it all.
“I would do whatever it takes to spare my child. She can’t lose her mother,” Julien said, minutes before getting prepped for an operation to remove a stage II cancerous lump, followed by reconstruction surgery for both breasts.
The surgery was viewed in real time Thursday on giant screens in an auditorium at the Centre Hospitalier de l’Université de Montréal (CHUM) research centre, as part an educational symposium on breast cancer, now in its fifth year.
The CHUM is the only centre in Quebec using radioactive seeds to mark the location of difficult breast cancer tumours. A pilot project with 30 patients found that the radioactive seeds made a big difference in helping surgeons find tumours and other abnormalities that are too small to feel.
Radioactive seeds were initially used to treat prostate cancer, CHUM radiologist Julie David said. The hospital uses a titanium-covered seed of iodine-125, an isotope that is used in nuclear medicine imaging.
“This one, of course, is not active,” David said of the seed in her hand. Radiologists can also insert a thin wire into the breast to indicate the location of non-palpable cancer. But the wires are uncomfortable for the patient because they stick out of the skin, and they need to go in on the day of surgery, David said.
In comparison, the seeds can be placed up to five days prior.
The 50-year-old wire technology can lack flexibility, said Erica Patocskai, the surgical oncologist specializing in breast cancer, who introduced the radioactive-seed pilot project in 2010.
The hospital has since done more than 800 procedures.
For example, a patient may want the scar to be under the breast, or the surgeon would rather make the incision in a particular spot but that’s not possible if the wire is in the way, Patocskai said. “So it’s more esthetic and it’s also more efficient,” she added. “Because the seed can be put in days earlier, we can do one more surgery on our list. That doesn’t seem like a lot, but if you’re five breast surgeons and you’re doing five extra cases a week, it decreases the wait time for women who are waiting for breast cancer surgery.”
Although Julien had a sore breast for more than two months, she didn’t consult her doctor because of the misconception that “a sore breast in young women cannot be breast cancer,” she said. However, her family history includes a maternal aunt and a grandmother with breast cancer.
On Jan. 15, during a scheduled appointment to have her fallopian tubes removed, Julien asked her doctor for a mammogram. It took place within two days, followed quickly by a biopsy, and then an appointment with Dr. Patocskai.
“I’m so very lucky,” Julien said. “I’m in the best place possible.”