Breast cancer - what is this SAVI stuff?

[hamsterjill]

My sister was recently diagnosed with DCIS breast cancer, stage zero. She is 74 years old. The medical professionals have recommended a lumpectomy, radiation and hormone therapy. My sister has opted to have the lumpectomy, and then decide as to what other steps she takes. There is some relatively new evidence that radiation for this type of cancer is not beneficial for women over 65.

The path to get to the diagnosis and now to have a plan for treatment has been a nightmare. Appointment after appointment with stress and irritation. Just seems like there should be a better way.

My question is: when they do the breast biopsy and place the titanium marker, why in the hell don’t they just place the SAVI disc at the same time? It seems inhumane to me for a woman to have to undergo this same (basically, at least) procedure. I mean, couldn’t they use the SAVI (rather than the marker) for subsequent mammograms, etc. if the biopsy was benign?

[live love laugh]

1. I had the same diagnosis 10 years ago.

I never did hormone therapy which poses it’s own risk but I completed radiation and a lumpectomy.

In hindsight I don’t know if I would have opted for radiation due to the risks of affecting the heart which I don’t remember being explained at the time.

I have not experienced any cardiovascular symptoms but I am not totally confident that my heart wasn’t affected.

I wish the best outcome for your sister. Early stage detection is half the battle.

[hamsterjill]

4. There are new studies that talk about radiation affecting the heart.

Particularly if it’s the left breast, and that is where my sister’s issue is located. I was amazed that the surgeon we visited with today was not aware of new information that has been published. When I got home today, I called the Susan B. Komen Foundation. They don’t yet have updated information on these studies as to radiation for older women, but the rep that I spoke with said they are getting a lot of calls asking about it. So word is getting out.

Thank you for sharing your experience.

[Docreed2003]

2. I'm sorry that your sister is having such a complicated/frustrating treatment course

I'll try to answer some of your questions.

With regards to radiation therapy in patients with DCIS, it really depends on the pathological characteristics of the tumor itself. You are correct in that not all patients are required to undergo radiation therapy after lumpectomy, but if it's being recommended it's likely that there is something about the pathology that is concerning for risk of local recurrence without radiation.

With regards to SAVI, SAVI is a very new technology that is being used at many centers to replace wire localization in lumpectomy. Traditionally, if a patient opts for lumpectomy, a wire is place around the area of concern, or the titanium clip, and this provides the surgeon a means of knowing exactly how much breast tissue to remove. Once the lumpectomy is completed, an X-ray of the specimen is obtained and the surgeon can verify that the mammographic abnormality has been removed. To do that, a wire is placed the morning of surgery very similar to the way the biopsy was obtained. SAVI allows for a marker that can be placed instead, up to 30 days prior to surgery. Surgeons are then able to use a probe in the OR to tract the SAVI capsule and ensure an adequate resection. SAVI is only placed after the patient has a diagnosis of malignancy and has opted for lumpectomy. The reasons for that are multiple but namely: the 30 day lifespan of the SAVI capsule and the fact that not all patients will require a subsequent surgery after a stereotactic or US guided biopsy. Not to mention the fact that not all patients will opt for lumpectomy or are even candidates for lumpectomy. To use SAVI on every patient who receives a biopsy would be a waste of medical resources.

I hope that answers your questions and sending best wishes to your sister on her cancer journey.

[hamsterjill]

3. Thank you.

Very informative.

But I’ve got to say that when it comes to wasting medical resources, it should still be about patient wellbeing. And having an older patient - who is already scared shitless to the point of her blood pressure was 180 today - have to go through yet another needle stuck in her breast is absurd. Medical science needs to do better.

[Docreed2003]

5. Unfortunately, it's either that or a needle stick the day of surgery for the wire

That's just the downside to lumpectomy. It certainly is terrible but it's part of the package with regards to lumpectomy. There just isn't a better way to remove the area without some type of marker, at least not yet. In the future, there may very well be better alternatives, but there just isn't one yet.

[hamsterjill]

6. There is no concern for the patient.

Do the doctors not realize that women don’t want long needles stuck in their breasts with only local anesthetic?

We are all about mental health these days. But there is never any concern over what patients, particularly women, must go through.

There should be some discussion at the time the needles biopsy is performed as to the fact that a SAVI may be needed and the option to have it done in ONE procedure rather than two needs to be available. We didn’t have any idea she would have to go through this before having the lumpectomy. The stress from all of this is doing way more damage than the breast cancer is at this moment in time.

It’s all just about the money. Welcome to America’s healthcare. It’s pretty sad.

[NoRethugFriends]

7. No, it's not all about money

Some is, most isn't

[hamsterjill]

10. Oh yes it is.

It it wasn’t, we would all be treated much differently. Medical care today is like running people through a cattle chute. As quick and fast as possible so that the doctors can bill the most they can because they have to try to make as much as they can. They have bills to pay, too.

We need a better system.

[Docreed2003]

8. I'm not suggesting that the system isn't screwed up

It certainly is a messed up system, but, understand this same process would have occurred anywhere in the world. This isn't a money driven issue as much as a limitation of technology issue. There's no way at the time of initial biopsy to know whether a lesion is cancer or not. The conversation with regards to breast conservation with lumpectomy vs mastectomy wouldn't even occur until after a diagnosis of cancer has been made. SAVI is a great tool for lumpectomy, but ,much like all of medicine, it has its limitations as well and timing of placement is a big limitation. If SAVI isn't used and the patient opts for lumpectomy, they still have to have a wire place into the breast the morning of surgery. There's just no great options currently with regards to localizing mammographic abnormalities that aren't invasive, so a patient has to have a second needle stick, either for SAVI or wire localization.

I totally understand and empathize with your frustrations. I hope that explanation helps clarify the situation.

[hamsterjill]

9. Are you actually a doctor?

I understand the explanation. I’m just saying the process isn’t good enough and the medical community should be doing more. There is no impetus to do better, or else there wouldn’t be this “settling” with this type of issue. There is never any discussion about patient individuality or patient desire. The approach is “it’s this way or else” and that should not be be.

What else awaits down the line for her that no one has bothered to mention in all of this? (That’s a rhetorical question).

I’m just not sure the medical community understands that some people might prefer to take their chances and live stress free for a while rather than to undergo Frankenstein procedures and be afraid all the time. We shouldn’t have to accept standard when standard isn’t good enough. We should be able to have individualized care tailored toward the individual patient. All options, including those outside of “normal” procedures should’ve been discussed and that certainly has not happened in her case. Even getting to this point to have a diagnosis has taken months and been grueling, and there has been no interest by any doctor that she’s seen to understand the stupidity of what she’s been through and try to did it. It’s pretty much just “well that’s the way it is”. Why do people want to be in health care if they don’t have the “care” component? The answer is the money, and it’s sad.

Thank you again for your information.

[Docreed2003]

11. Again, let me apologize for how frustrating this has been for you and your sister

Yes, I am a physician. I'm a general surgeon and I care for breast cancer patients regularly. I can't speak as to the way treatment options or the implications of different treatment modalities were explained to you, but I can tell you that not all providers treat patients as numbers. In my experience, it's not unusual for patients to have been through a marathon of workups before they arrive in our office with a cancer diagnosis. It's frustrating and frightening and the job of unpacking that falls squaring in our laps as treatment specialists. That first visit is probably the longest, most intimate conversation and exam that patients have experienced. While a good doctor takes time to explain the what of treatment, in my book a great doctor takes time to also elaborate on the why and empower the patient to make an educated choice with regards to treatment options. At the end of the day, that doctor/patient relationship is a partnership and the patient should leave the office feeling empowered by their provider.

In some ways, the "standard" treatment of cancer, particularly breast cancer, can easily come across as cookbook and cookie cutter. It's really much more complicated than that and has to do with national and international accepted treatment practices and guidelines which are back up by decades and decades of clinical research. Changes and innovations within that framework take time and vetting. While providers, in my view, should most definitely address all treatment modalities. The vast majority of providers will steer patients towards the "traditional" treatment options because that's what's been proven to have the best outcomes for patients. Sadly, that conversation often comes across as a "my way or the highway" type discussion because doctors are trained to follow the data, especially in cancer care, and frankly not enough providers are skilled enough at patient interactions to explain that to their patients. We're experts at learning the information, but the interpersonal interactions with the patient is the real art of medicine and something that can't be taught.

All that to say, all patient interactions boil down to communication. It sounds like that piece was severely lacking. You and your sister deserved better and I'm sorry you didn't receive that level of empathy and connection.

[hamsterjill]

12. You are very kind.

Thank you. No, she did not get that level of compassion or interaction with the surgeon she saw yesterday. He was not interested in her questions or her feelings. He quickly passed her off to “staff” that he said would explain more and set up the SAVI and any other tests needed. The “staff” person turned out to be someone new who was obviously not trained well before she was put at a desk to handle patients. There was another woman who kept coming over, explaining that the lady helping us was new, and apologizing for her lack of knowledge. This compounded the already heightened stress.

My sister had seen an oncologist at the same place a couple of weeks ago who she liked very much. It was the oncologist who recommended this surgeon and the surgeon has 5-star reviews, so we were hoping for a good visit with good information that would help to alleviate stress. That obviously did not happen. Rave reviews can certainly be either wrong or outdated or a difference of opinion about what “acceptable” is, but I cannot imagine that we received even “acceptable” treatment yesterday.

We are going to Texas Oncology in San Antonio, Texas and saw Alfredo Santillan. I have no idea where you are located, but this place is like a cattle call. The waiting room was overflowing yesterday with many patients not even having a place to sit. People in the waiting room were upset and complaining. You take a number upon arrival and there were 42 people ahead of us for check in. We were in the check in area an hour before we even got back to the waiting area for Dr. Santillan - then another thirty minutes waiting for him, only to be rushed through and pushed out the door with no clear information. Again, I understand that surgeons may not have the best bed side manner, but good grief.

I already tried calling the practice manager this morning and all you get is voicemail.

[tdawnnews]

13. Breast cancer - what is this SAVI stuff?

Breast cancer is a malignant tumor that starts in the breast. A malignant tumor is a group of cancer cells that has grown into surrounding tissues in the breast. It can spread (metastasize) to the lymph nodes and to distant areas of the body. The disease occurs predominantly in women, but men can develop breast cancer, too.

[hamsterjill]

14. Why this post?

This post has nothing to do with my OP.

Weird.

[XanaDUer2]

15. I hope things are getting better nt

[hamsterjill]

16. Aw thanks for checking in.

She had the surgery and now they are telling her that they need to go back in to gain a better margin. They have a 1mm margin but they want a 2mm margin. So the second surgery is scheduled for later this week.

If it wasn’t so serious, it would be comical. We need better medical care in this country.