My friends Breast cancer is the most common cancer among women...

My friends

Breast cancer is the most common cancer among women today. It is primarily treated by surgery. Breast cancer surgery has a long and chequered history starting with William Halstead's radical mastectomy. This evolved into competing ever more radical and mutilating surgeries of the extended super radical mastectomies, which involved resection of not only the whole breast, the underlying muscles, lymph nodes, and eventually en bloc resection of the whole forequarter including amputation of the arm. These surgeries became a test of the surgeons’ manhoods. The more radical the better! The more radical the more powerful.

Fortunately, this started to reverse in the 1980s and now the standard of practice is a lumpectomy. Things still have a long long way to go. Women are still victims of medical imaging and surgery. The first is the false positive of screening imaging necessitating a biopsy and surgery on 9 out of 10 women who do not have cancer. This is not a topic of Tiresias’s discussion today. The second and important topic, of interest to Optican, is those who actually do have cancer. Of course, the surgeon doesn’t know which of the large number who come for lumpectomy have cancer, until the pathology is done on the tissue, which now takes two or three weeks. As a result, a large percentage of women have to return for repeat surgery because, when the lump excised is examined, there is cancer at the edge of the specimen and therefore the cancer has not been completely removed. Frozen section biopsies are unreliable, slow and frustrating, and many surgeons don’t use them. There is still no satisfactory way of knowing, at the time of surgery, if there is cancer, and even if frozen section biopsy is used, and there is cancer, that all cancer has been resected. Despite availability the technology provided by Optiscan confocal 3 dimensional microscopy for real-time intraoperative digital biopsy, the surgeons still rely on their eyesight and feeling of the lump by fingers. Ahh, the “gentle art of advanced breast cancer surgery”, in the 21^st century.

As Tiresias has already outlined here, and in the post on neurosurgery, frozen section is completely inadequate. It is hopeless at detecting where the cancer ends. This is where Optiscan’s confocal microscopy comes into its own. With appropriate in vivo staining and AI assistance, and the fact that Opti scan, being a con-focal microscopy, can scan in three dimensions and can detect malignant cells below the surface of the edge, at depth, is the only way that breast cancer surgery should be done now. Tiresias is amazed that breast surgeons have not leapt at this technology. But then, of course, not surprised at all. He is fully cognizant because of perverse incentives in medicine are everywhere. Tiresias will not go into the perversity of medical economics and medical incentives except to suggest that the neglect of the use of this technology to detect cancer cells during breast surgery is nothing short of scandalous. There should be an immediate massive Australia wide trial. Tiresias realises that Optiscan itself cannot fund everything on so many fronts, but he also understands that there is not a shortage of funds for breast cancer research and a small amount, say 10 or 20 million, directed to Optiscan development, would be money very well spent, perhaps better than some of the monies he sees somewhat misdirected. Tiresias is aware of an as yet unpublished trial of Optiscan technology in breast cancer, and is looking forward and trusts that this will soon be followed up on and picked up so that breast surgery can be finally brought into the 21^st century and the digital age.