Breast cancer remains the most common cancer affecting women globally, with an estimated 2.3 million cases diagnosed in 2020 alone. Fortunately, advancements in medical technology have led to a significant decline in breast cancer mortality rates. One of the most promising advancements in this fight is the increasing use of minimally invasive procedures (MIPs) for both diagnosis and treatment.

What are Minimally Invasive Procedures (MIPs) in Breast Cancer?

Instead of large incisions and extensive tissue dissection, Minimally Invasive Procedures utilise smaller incisions and specialised instruments like needles, lasers, or robotic arms. These procedures offer several benefits over traditional, open surgeries:

• Reduced recovery time: Smaller incisions and less tissue manipulation lead to faster healing and a shorter recovery period. This allows patients to return to their daily lives more quickly and with less pain.
• Improved cosmetic outcomes: Smaller incisions often leave minimal scarring, leading to better cosmetic outcomes, which can be a significant concern for many breast cancer patients.
• Lower risk of complications: MIPs are generally associated with fewer risks of complications like infection, bleeding, and nerve damage compared to traditional surgeries.
• Enhanced patient experience: Minimally invasive procedures can be performed on an outpatient basis or with a shorter hospital stay, leading to a less disruptive experience for patients.

Types of Minimally Invasive Procedures in Breast Cancer Treatment

A study published in the Journal of Minimally Invasive Breast Surgery reported that the use of sentinel lymph node biopsy (SLNB) in India has increased from 20% to 50% over the past decade, indicating a positive shift towards minimally invasive procedures for breast cancer. Several minimally invasive procedures are playing an increasingly important role in different aspects of breast cancer treatment:

1. Diagnosis

• Needle biopsy: This procedure involves using a thin needle to extract a tissue sample for analysis under local anaesthesia. It can be used to diagnose suspicious lumps or abnormalities detected on mammograms or other imaging tests.
• Vacuum-assisted core biopsy: This variation uses a larger needle and suction to remove a larger tissue sample, offering a more definitive diagnosis compared to a standard needle biopsy.
• Image-guided procedures: These procedures utilise real-time imaging, like ultrasound or X-ray, to guide the needle placement for biopsies, ensuring accuracy and minimising the risk of complications.

2. Surgery

• Lumpectomy: This procedure removes only the cancerous tissue and a small margin of surrounding healthy tissue, preserving the majority of the breast.
• Oncoplastic surgery: This combines cancer removal with techniques to improve the cosmetic outcome, such as nipple-sparing mastectomy or breast reconstruction using tissue from other areas of the body.
• Sentinel lymph node biopsy: This procedure identifies and removes only the first lymph node(s) where cancer is most likely to spread, reducing the need for extensive lymph node dissection and potential complications like lymphedema.

3. Treatment

• Radiofrequency ablation (RFA): This uses heat generated by radio waves to destroy cancer cells. It is still under investigation for breast cancer but may offer an alternative to surgery in specific situations.
• Cryotherapy: This technique uses extreme cold to freeze and kill cancer cells. It is also under investigation for breast cancer but may have potential in treating small, early-stage tumours.

Benefits of Minimally Invasive Procedures

The benefits of minimally invasive procedures in breast cancer treatment extend beyond the physical aspects. Here are some additional advantages:

• Reduced pain and discomfort: Smaller incisions and less tissue manipulation typically lead to less pain and discomfort during recovery.
• Faster return to normal activities: Shorter hospital stays and quicker recovery allow patients to return to work, family, and daily activities sooner.
• Improved emotional well-being: Minimally invasive procedures can be less psychologically taxing, potentially leading to a more positive outlook and improved quality of life.

Important Considerations

While minimally invasive procedures offer many advantages, it's important to remember:

• Not everyone is a candidate: Certain factors like tumour size, location, and other medical conditions may affect eligibility.
• Discussion with a healthcare professional is crucial: Patients should discuss their individual situation and treatment options with their doctor to determine the best approach for their specific case.
• Minimally invasive procedures are still evolving: Research and development are ongoing to further refine and improve these techniques, and their long-term effectiveness is still being evaluated in some cases.

Technological Advancements Driving Minimally Invasive Breast Cancer Treatment

The evolution of technology has been instrumental in advancing the treatment and management of breast cancer:

1. Advanced Imaging Modalities: High-resolution imaging techniques such as MRI, ultrasound, and mammography enable precise preoperative planning and intraoperative navigation, enhancing the accuracy of minimally invasive procedures.
2. Robotics and Laparoscopic Surgery: Robotics-assisted and laparoscopic surgical platforms offer surgeons enhanced dexterity and visualisation, facilitating complex procedures with smaller incisions. These technologies minimise tissue trauma and improve surgical outcomes.
3. Targeted Therapies and Immunotherapy: Beyond surgical interventions, targeted therapies and immunotherapy represent promising avenues in breast cancer treatment. By selectively targeting cancer cells while sparing healthy tissues, these therapies complement minimally invasive procedures, offering a multifaceted approach to disease management of breast cancer.

Overcoming Challenges and Addressing Concerns

While minimally invasive procedures offer significant advantages, challenges remain:

1. Learning Curve: Mastery of minimally invasive techniques requires specialised training and expertise, posing challenges for surgeons transitioning from traditional open surgeries.
2. Risk of Complications: Although minimally invasive procedures are generally safe, complications such as bleeding, infection, and organ injury may still occur. Vigilant patient monitoring and adherence to established protocols are essential for mitigating these risks.
3. Patient Selection: Not all breast cancer patients are suitable candidates for minimally invasive procedures, particularly those with advanced disease or complex anatomical considerations. Careful patient selection and thorough preoperative assessment are imperative to optimise outcomes.

The Future of MIPs in Breast Cancer Treatment

Research and development efforts are ongoing to refine existing MIP techniques and explore new possibilities. Some promising areas include:

• Further refinement of ablation technologies: Enhancing the effectiveness and precision of ablation procedures to treat larger or more complex tumours.
• Minimally invasive reconstruction: Developing minimally invasive techniques for immediate breast reconstruction after lumpectomy, offering a more streamlined and comprehensive treatment experience.
• Personalised medicine: Integrating advanced imaging and genetic testing with MIPs to tailor treatment plans based on individual patient characteristics and tumour biology.

Summing Up

The emergence of minimally invasive procedures represents a significant positive shift in breast cancer treatment. These techniques offer many advantages over traditional surgeries, providing faster recovery, improved cosmetic outcomes, and a less disruptive experience for patients. As research continues to advance, we can expect even more refined and effective MIPs in the future, leading to a brighter outlook for breast cancer patients.