Dr. Annabel Barber specializes in general surgery and surgical oncology and is head of the Nevada chapter of the American College of Surgeons. Over the course of her career, Dr. Barber has witnessed the evolution of breast cancer treatment. One of the many revelations over the years is the fact that lumpectomies actually provide a benefit in patient health, over and above the cosmetic benefit, compared to a complete removal of the breast when treating cancer.
“I was still in my training when we in America started copying the Italians in doing partial breast dissection rather than total mastectomies,” explained Dr, Barber. “The past few years have shown that lumpectomies are better than mastectomies for a myriad of reasons—including some we don’t even understand yet. A normal breast has some sort of local control of tumors to a certain extent. Those patients who have some of the normal breast left after a surgery tend to do better. We want to preserve as much as we can for both appearance and health, as we now know that lumpectomy is a superior operation.”
The surgeon cited many new technologies and techniques that now aid in locating and removing cancer, but also not removing tissue unnecessarily. This includes better radiology and mammography that can occur right in the operating room. She also highlighted the importance of the shift to a multi-disciplinary approach, including the radiologist taking a much more active role during the surgical process.
MarginProbe guides the targeted removal of cancer
Dr. Barber outlined how MarginProbe is now playing such an essential role in this new approach to fighting breast cancer. MarginProbe identifies the margins on both DCIS and invasive cancers to make sure that all of the dangerous tissue is safely removed. “There’s nothing more frustrating having a positive margin and having to explain to a family that their loved one has to go through another operation. It sets the entire treatment back with the risks of additional anesthetic, an additional chance of infections, and the impact to the overall healing process. This is why MarginProbe was such a breath of fresh air. I really was very excited when I first heard about it. And I can say now that it’s made a difference in my life and my patient’s lives—this wonderful ability to be able to render someone cancer-free at the time of their surgery.”
How MarginProbe can find hidden cancer
“I have some experiences where I used MarginProbe in the operating room and I learned some things about my patient’s tumors that were not known preoperatively,” shared Dr. Barber. “I discovered that they were not candidates for breast conservation.” In the first case, she explained that a patient’s mammography and biopsies identified just one tumor foci, but during the surgery MarginProbe actually identified that the cancer was actually much more extensive.
In another case, she treated a patient where a biopsy had identified a non-invasive cancer known as ductal carcinoma in situ (DCIS). “So, I perform the surgery and use the MarginProbe,” said Dr. Barber. “But I cannot get a clear margin. I’m taking out more and I’m thinking, ‘This is crazy for DCIS.’”
“So I decide I’m going to quit and I send the specimen down for specimen radiograph, because I didn’t feel comfortable,” she continued. The radiologist informs me that the tumor is perfectly removed with good margins. But when we get the pathology back in the next few days, we find that while in fact the DCIS site was out, there was a separate invasive cancer, which changed the whole thing. The patient had an unimageable cancer that was detected only because MarginProbe was used. In both these cases the cancer was found to be very extensive and they proceeded to a Mastectomy.”
MarginProbe provides peace-of-mind
On the other end of the spectrum are patients that have their cancer removed successfully the first time thanks to MarginProbe. Dr. Barber cited the example of a patient diagnosed with a non-invasive cancer that waited months to have surgery due to insurance issues. “I saw her through the medical school clinic,” stated Dr. Barber. “We were able to get her in and have her surgery done right away. I was quite worried that she was going to have invasive cancer by that time. So, luckily we were able to do her surgery and use the MarginProbe to get her adequately excised on the first operation. Then, a week later, I was able to put partial breast irradiation care through for her. She is healed, cured, and can restart her life now.”
Dr. Barber summarizes the value of MarginProbe this way: “Some of these examples are odd cases, but I always get odd cases. The big picture is that MarginProbe gives me the confidence to tell my patients that they can make plans. That we are probably going to be finished with their lumpectomy during this (first) operation. We’ll let you heal and we have the option to do partial breast irradiation in a week. They can get their own planning, their own life, their job, their family’s jobs, on track. I can provide them with a realistic time span for treatment. I feel very privileged to have access to tools such as the MarginProbe to make it all possible.”
Dr. Annabel Barber
- General and Oncological surgeon at University Health System in Las Vegas, Nevada
- Affiliated with Mountainview Hospital, Sunrise Hospital and Medical Center, University Medical Center of Southern Nevada and Valley Hospital Medical Center
- Head of the Nevada chapter of the American College of Surgeons
- Graduated from the University of Texas Medical School at Houston in 1985
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Dilon.