Innovations in Breast Cancer: better diagnosis, better surgery
Around 1.7 million women are diagnosed with breast cancer world-wide each year, with more than 15,000 women and over 100 men affected in Australia.
Tumours can produce very small portions of cancer just outside the main tumour mass that simply can’t be seen or felt by surgeons or be detected by screening methods. Such portions are often missed in the initial surgery, but are later detected by pathology and require repeat surgery for over one in four breast cancer patients.
This multidisciplinary team are committed to producing commercialised technologies and devices that have real outcomes. They have a number of goals for their research:
- Help women and men affected by breast cancer world-wide.
- Develop a device that can reliably assist surgeons in detecting and removing the whole cancer in a safe and effective operation.
- Develop a routine surgical tool that can distinguish between benign and malignant tissue at a microscopic level.
- Reducing the need for repeat surgery.
- Reducing costs to patients and the health care system.
Overall, the research aims to provide better, safer and more effective one stop surgery for patients, with little or no need to return for more surgery.
The large team of UWA researchers, researchers and students from UWA’s Optical + Biomedical Engineering Laboratory (OBEL) are directed by Professor David Sampson, School of Electrical, Electronic and Computer Engineering/ Head of OBEL and the projects have been co-led by senior researchers Dr Rob McLaughlin (now a Professor at the University of Adelaide) and Dr Brendan Kennedy (now also with the Harry Perkins Institute of Medical Research), in collaboration with Dr Bruce Latham (PathWest) and Dr Christobel Saunders, Professor of Surgical Oncology and breast cancer specialist.
This team are working to commercialise two technologies that they hope will provide surgeons world-wide with real time, in situ information which is far superior to what they have now.
This highly miniaturised medical imaging device is able to fit inside a needle and is capable of detecting cancer cells often missed by surgeons.
The probe uses optical coherence tomography (OCT) in projecting and detecting light through an imaging window which is etched into the side of the needle. OCT is similar to ultrasound, but uses reflections of light instead of sound waves. Different tissue types have different light scattering properties, enabling OCT to scan and produce high-resolution 3D images inside the body, just by rotating and moving the needle back and forth. It is hoped the technology will be available in hospitals in around five years’ time.
Surgeons cannot differentiate by sight whether tissue is benign or malignant; however, in breast and brain tumours, malignant tissue is often stiffer. Whilst palpation (using the sense of touch to examine) is practiced by doctors in breast cancer surgery, the degree of stiffness might be microscopic, beyond detection by touch.
This technology will enable a surgeon to press on tissue with highly sensitive device fitted to the end of a fingertip, whilst simultaneously taking high resolution images to see how tissue has moved. By measuring movements as small as one-billionth of a metre, it will allow surgeons to feel the cavity of the breast with microscopic accuracy. It is envisaged that a prototype of the device will be created in 2016 through the creation of a spin out company.
In future, these technologies could be adapted for use in many other cancers and surgical scenarios, for example, in prostate and lung cancer and brain tumours, which present similar challenges in locating malignant tissue. Also, the needle technology could be applied to any industry that requires micro-scale imaging techniques, such as for down-hole and process monitoring in the oil and gas industry.
This research has won a number of awards including The Australian Innovation Challenge in the health category and as overall winner for MiaN (2015), UWA Vice-Chancellor’s Award for Impact and Innovation (2014), WA Innovator of the Year for MiaN (2014), Start-Up Challenge Business Pitch (SPIE), San Francisco, for MiaN (2014) and was a finalist in the ANSTO Eureka Prize for Innovative Use of Technology (2012 and 2013).
This research has also had strong grant support from a number of agencies, including:
- Australian Research Council
- National Health and Medical Research Council
- Raine Medical Research Foundation
- Cancer Council WA
- National Breast Cancer Foundation
- WA Department of Health
- Perpetual Trustees
- St John of Gods Hospital, Subiaco
- Royal Perth Hospital
- Sir Charles Gairdner Hospital
Most importantly, breast cancer patients have contributed greatly to this project by allowing engineers into the operating theatre.
By taking these technologies from the bench to the operating theatre, this group of researchers offer fresh hope to cancer patients in providing peace of mind, significantly reduced post-surgery side effects, the reduced need for repeat surgery, more accurate prognosis and better health outcomes.
There has been great curiosity shown by surgeons in North America who are interested in adopting these technologies. Surgeons are keen to trial both technologies for looking at the edge of a tumour area being operated on, and in making sure no cancer cells are left behind. The possibility of performing one surgery, and confidently being able to say to the patient that all of the tumour is gone, is enormous.
How nice would it be to sweep your finger around the cavity and make sure there was no tumour left there? And assure the patient when they wake up that we know all that tumour is gone and there’s none left behind. That’s what we aim for and dream of.
Dr Christobel Saunders.
The economic impact will be less costs to the patient as well as to the health care system. In terms of the cost of breast cancer in Australia, this can equate to $25 million per year. For the health care system, the benefits translate as shorter wait times for initial surgery and more availability of medical professionals and services.
The cross disciplinary research team of engineers and medical professionals has focused on real problems in medicine and their in fruitful and effective partnership is generating technologies that will benefit cancer patients globally.