EARLY BREAST CANCER & THE SMALL CLINICAL TRIAL

Early-Stage Breast Cancer

Early breast cancer is confined to either the breast and may or may not have spread to lymph nodes in the breast and armpit.

It is one of the more favourable forms of the disease as treatments are more effective when the cancer is confined to the breast.

It’s a research area for Dr Stuart McIntosh, who is a specialist breast surgeon at Belfast City Hospital and a Clinical Senior Lecturer in Surgical Oncology at Queen’s University in Belfast.

Dr McIntosh said the treatment for early breast cancer is evolving.

“Conventionally the standard treatment has always been surgery first followed by other systemic whole-body treatments like chemotherapy, hormone tablet therapy – perhaps Herceptin, as well as radiotherapy to the breast.”

“However, I would say that is beginning to change as we understand more about the biology of breast cancer and as we get better at working out which patients are going to respond to which treatments.”

“So, I think increasingly we’re seeing medical treatments like chemotherapy being used first up and the surgery then being adapted or personalised to the least amount of surgery required for good control of the cancer.”

Dr McIntosh said thanks to clinical trials research, treatments for early breast cancer have improved drastically.

“I think if you look back at the surgical treatment for early breast cancer, it has been evolving for the last 150 years and continues to evolve from the radical mastectomy, to modified radical mastectomy, breast conserving surgery and we are increasingly looking at de-escalating.”

The SMALL Breast Cancer Clinical Trial

Dr Stuart McIntosh is the lead investigator of a breast cancer clinical trial called SMALL.

“The SMALL trial is looking at women who’ve got a small screen detected invasive breast cancer,” he said.

“We know that a proportion of these are, what we call, overdiagnoses.”

“They’re cancers that would have never been found if a woman hadn’t attended a screening mammogram and they would have gone through life and died of something else unrelated.”

He said these overdiagnosis present a significant problem.

“These cancers have always been treated by surgery to remove the cancer and to do a sentinel lymph node biopsy, to look at the lymph glands.”

“But that’s a general anaesthetic, a hospital admission, there are complications, there are risks.”

The SMALL trial is comparing this standard treatment with a minimally invasive removal of the tumour.

“We will use either ultrasound or x-ray to guide a needle with an attached vacuum, which will effectively suck the tumour out and the radiologist doing the procedure will be able to tell us whether the they think it’s fully removed or not,” said Dr McIntosh.

“That’s done under local anaesthetic, it takes about 30 to 40 minutes in the x-ray department and clearly has significant benefits for the patient over having an operation if it can be done safely and effectively.”

“But before we introduce it into clinical practice, we obviously need to do a trial to provide good quality evidence that that is the case.”

Currently this trial is not available in Australia and New Zealand.

However, Dr McIntosh said he hopes to collaborate with Breast Cancer Trials researchers to bring the trial to patients in Australian and New Zealand.