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Minimal Treatments Can Mean the Best Care

Michelle Perozzi could have faced a double mastectomy, but then she met Dr. Alice Police.

Michelle Perozzi knew to do a breast self-exam monthly. She describes her adherence to that recommendation as “probably better than most women, but I wasn’t religious about it.” In other words, it wasn’t marked on her calendar, but she followed recommendations.

And it was during a self-exam in the summer of 2015 that she detected a lump. It wasn’t her first experience with a breast lump. Four years prior, Perozzi had undergone a biopsy for a small lump that turned out to be harmless.

“So I wasn’t overly concerned” about the new lump, she says. “I was nervous, but I wasn’t freaking out.” Still, she moved up an appointment for a mammogram that she’d already scheduled for later that summer.

The radiologist reading the result recommended a biopsy out of caution. “I thought my chances were 50-50,” Perozzi says. “Of course I was hoping for benign.”

The lump turned out to be stage I cancer. But after interviewing three doctors, Perozzi says, she had the good luck of finding a surgeon who provided efficient, low-risk and state-of-the-art treatment. Dr. Alice Police, a surgical oncologist who practices at the UC Irvine Health Pacific Breast Care Center, utilized three innovative treatment technologies: SAVI Scout®, MarginProbe and Zeiss Intrabeam® IORT. Use of these technologies reduced the standard three to four months of treatment to two weeks.

Police’s treatment approach was a far cry from that of another doctor who had recommended a bilateral mastectomy. “When we met Dr. Police, she was just right,” Perozzi says. The doctor was determined to cure her cancer but not go overboard.

Improved technology to locate the tumor

“The health risks of these treatments were minimized, so the upside was great,” Perozzi says. “It was the right choice for me. I strongly believe in Dr. Police’s expertise. She would do the most aggressive treatment if it was needed. But she wasn’t recommending a mastectomy for me, so I could feel confident.”

The minimal treatment was also reassuring to her high school-aged daughter and her son, who was in middle school.

“Michelle was our first patient who received all three new technologies,” Police explains. “What made her the optimal patient was she had the right kind of cancer–a small, low-grade tumor.”

SAVI Scout was one of the technologies used in Perozzi’s case. To locate a tumor during a lumpectomy, surgeons traditionally insert a wire into the breast as a guide. “The wire is uncomfortable for the patient, and it has a tendency to move around,” Police says.

The SAVI Scout system features a small device called a reflector that is delivered via a needle into the tumor days prior to surgery. To remove the lump during surgery, a wand-like device delivering electromagnetic waves is used to locate the reflector. “SAVI Scout is way more stable and comfortable and more accurate,” Police says.

Michelle was our first patient who received all three new technologies.

Avoiding a second surgery

Perozzi also benefited from the use of MarginProbe, a system that helps a surgeon determine during surgery whether cancer cells remain on the margins of excised tissue. In a traditional lumpectomy, tissue is removed and sent off for a pathology report, which can take days. In 25 to 40 percent of lumpectomy patients, a second surgery is required to remove remaining cancer tissue.

“MarginProbe may not improve cure rates,” Police says. “But it allows a surgeon to determine clear margins in the operating room. I use it on all my lumpectomy patients.”

UC Irvine Health surgeons were the first in the nation to use MarginProbe in 2013. “UC Irvine has the foresight to bring the technology in,” Police says. “It’s a real draw for patients” who want to avoid the need for a second surgery.

Perozzi also received intraoperative radiation therapy, or IORT. This is a concentrated dose of radiation delivered in the operating room and takes the place of traditional radiation therapy performed following surgery.

“With IORT, it’s one treatment during the operation versus dozens of 30-minute radiation sessions over six to eight weeks,” Police explains. “Some IORT patients joke: ‘I had a little breast cancer last week, but it’s gone now.’ Not everyone needs the whole breast radiated. A subset of patients like Michelle can have the same results [as with traditional radiation but] with fewer complications such as toxicity to the heart and lungs.”

Treating patients as individuals

Police is concerned about a growing trend for women to have bilateral mastectomies at the first sign of breast cancer. She says women should be treated individually and in accordance with the disease severity. “In two-thirds of the patients, a lumpectomy is the right treatment. There are a lot of complications to a mastectomy and subsequent reconstruction. Plus it can delay needed follow-up care such as chemotherapy or radiation.”

The three newer technologies, she says, “allow us to do a great operation the first time. Then the patient can get on with life. Patients are big fans. And if I do recommend a mastectomy, it’s because the patient really needs it.”

Breast cancer is never an easy diagnosis, Perozzi says, but the UC Irvine Health team eased the process. “Everyone was very professional. Everyone we came in contact with on the day of surgery was supportive and reassuring. I just felt like I was getting the best possible care. It was a good experience for a bad thing.”