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Breast preserving treatment for newly diagnosed breast cancer

            unpublished article by SGA, M.D.  April 1998

Following is a Summary by Chris Duffield.  

The original article resides on Dr. SGA's website.

“For the North American woman, the breast is the dominant cultural emblem of what it means to be female - at least as concerns her nurturing and attractive expressions.”  -- Marion Woodman

        A steady progression of breast cancer treatment towards increased preservation of the breast shows the importance of the desire to improve cosmetic results.  Radical mastectomy gave way to modified radical mastectomy, then simple mastectomy, and now lumpectomy followed by radiation and often breast reconstructive surgery.  French doctor Claude Jacquillat, before he died in 1990,  took this one step further, treating women with only radiation and chemotherapy (after diagnosis by fine needle biopsy), with five year survival statistics equal to or better than those for standard methods.  The cosmetic results for early stage cancer were excellent, although the patients did experience the usual toxic side effects from radiation and chemotherapy.

        Insulin potentiation therapy (IPT) in Mexico goes still further, using just low-dose chemotherapy as neoadjuvant (before or without surgery) treatment of breast cancer.  In one anecdotal case (Eur. J. Cancer & Clin. Oncol. 26(11/12):1262-1263, 1990), a woman experienced complete remission after 8 treatments in 6 weeks, with no side effects.  Afterwards she had a normal pregnancy and delivery, followed by normal breast feeding.

        Despite the promising results of Dr. Jacquillat and the doctors in Mexico, there is no completely breast preserving protocol currently under study.  Except by request of the patient, the only way a novel treatment may be tried is after failure of standard treatment, which begins with surgery, which in the case of lumpectomy means the removal of a minimum of one-fourth of the breast.

        A "Safe-Trial" period is proposed, in which a patient would undergo IPT treatments for one month before surgery is scheduled.  After the third week, the degree of progress would be assessed.  With good progress, the patient would continue to receive IPT.  Without it, she would go on to standard therapy.   Ideally, the patient would also be given counseling on nutrition, immune support, and mind-body techniques, both before and after this decision point.  There would be no survival risk involved in holding off on standard therapy for one month, as this often happens anyway before surgery is scheduled.  

        This "Safe-Trial" proposal balances scientific concerns with compassion and human values.

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