Patient: Elizabeth Cozens, 78, a retired manager from Manchester, had cancer
When I received a letter in July asking me to attend a breast exam, I was surprised – mammograms are not routinely offered to over-70s.
As it turned out, the National Screening Program had failed, and I was one of thousands who had not been invited to my last screening at the age of 70.
Ten days after the screening, I received another letter inviting me to have a biopsy on my right breast. There they found out that a tiny lump had cancer.
I was shocked. Although I had checked myself, this lump was so small – 12mm – that I would not have felt it.
My adviser, James Harvey, said he could remove it along with a small margin of healthy tissue, and I would not need chemo or radiotherapy. Luckily, it had not spread.
Mr. Harvey explained that before the operation, they put a marker in the tumor to make it easier to find. Traditionally, this has been done by inserting a long wire into the breast on the day of surgery using a mammographic radiograph or ultrasound to facilitate guidance.
But he said the wire was very uncomfortable and the end sticking out of the chest so that it can move when it hits, meaning that the surgeon following the wire is not directed directly to the cancer and some could stay behind.
Instead, he used a tiny magnetic seed that was injected into my tumor. It would not move and he could locate it with a magnetic probe. It would be less painful and more accurate for me.
On September 26, I had surgery. The day before, a radiologist injected the semen into the chest with an ultrasound-guided long needle. I had a local anesthetic, but the strong pain still made me gasp.
Frei: She had fitted one of the implants before her surgery in September – and is now completely cleared of the disease
I had my lumpectomy the next day and left the hospital the next morning with a patch on my chest – the scar was only 2 inches small. I was told that they found the cancer easily and completely removed it.
A week later, I attended a practice session in the hospital and was already able to lift my right arm over my head. I felt great. I put it on for a few weeks, but now I'm back to my usual self
I take hormone blocker drugs for five years to reduce the likelihood of cancer recurrence, as well as annual mammograms. But I'm just so thankful that they found the cancer.
James Harvey is a breast surgeon with the Manchester University NHS Foundation Trust.
Every year, there are 55,000 new cases of breast cancer in the UK. Screenings and more sensitive mammograms, however, will help them earlier if they are easier to treat.
Most small breast cancers can be surgically treated with lumpectomy, removing the tumor and a border of healthy tissue.
Finesse: There are 55,000 new cases of breast cancer in the UK each year. Thanks to screenings and more sensitive mammograms, however, these are taken up earlier by physicians
Cancers smaller than 2 cm are too small to feel or see outside the chest. Therefore, they need to be located before surgery. This usually means that women need a scan on the day of surgery. In the past, we inserted a 20 cm long needle with a width of 1.5 mm into the chest and passed through a medical steel wire.
The wire has a barb at the end, which fixes itself in the tumor so that the surgeon can find it later.
This is unpleasant and tiring despite local anesthesia, as the wire is about 3 to 5 cm in the chest and the rest sticks out. The patient must sit very still while waiting or transferring between hospitals.
With 2 to 3 percent of women, the wire is no longer moving, so it is not an effective guide. When you start the surgery, you will need to cut more tissue to find the tumor. Also, the wire has not necessarily been threaded in the most direct manner – especially if it was introduced during a mammogram, when the breast was not compressed. Instead, I prefer to use magnetic seed as a guide. Magseed is a spiral about the size of a grain of rice made of steel and iron oxide.
Its shape stops the movement as soon as it is in the chest, so we can inject it into the tumor for up to 30 days before surgery.
We find the tumor by ultrasound or X-ray and make a local anesthetic before injecting the semen through a long needle. Some centers use radioactive seeds, but they require careful disposal. Magseed uses magnetism instead.
What are the risks?
The procedure involves the usual risks of bleeding, bruising and infection.
There is a small risk that the surgeon can not find the seed, so the patient needs a wire.
"Magseed has been well received by patients since we started it earlier this year," says Simon Pilgrim, a breast surgeon at Leicester NHS Trust University Hospital.
"The detector is easy to use and uses existing capabilities. In some cases, the operation can be a few minutes faster because the skin incision can be placed more accurately than with a wire. "
On the day of the operation, I'll check if I can detect the seeds: I use a probe that emits a magnetic field and beeps louder and higher as the magseed approaches.
Then the patient has a general anesthetic for the 40-minute surgery. I choose a place where the scar is hidden under the breast or next to the areola. I make a cut of 4 to 5 cm and use the probe to find the seed.
The initial incision is about the same size, regardless of whether a guidewire or a seed is used. However, if a wire is inserted during a mammogram while the breast is compressed, we may need to wander 10 to 20 cm through a large breast wire and take up quite a bit of surrounding tissue. With a seed we can use the shortest way.
I remove a circular section of breast tissue around the seed and tumor and remove the sentinel lymph node, where cancer first spreads. Then I close the cut with dissolvable stitches.
I see the patient two weeks later, when the pathology lab confirmed that the cancer was completely removed – in very early cancers, patients may not even need radiotherapy.
Magseed is now available in 12 locations in the UK and I would like to see it with many more. I'm conducting a national audit to compare the results for wire and magseed. So far the only drawback that I see is that it is not suitable for patients with implants like pacemakers.
Magseed costs £ 250; A lumpectomy costs £ 4,500 private and £ 2,880 for the NHS.
Next June, Mr. Harvey will race a distance of 3.041 miles for Breast Cancer Prevention at Race Across America. To learn more or donate, visit: justgiving.com/campaigns/charity/preventbreastcancer/raam