Improving breast-conserving surgery to decrease the need for additional surgery and improving screening and treatment uptake in rural India.

Impact

Breast conserving surgery, sometimes called lumpectomy or partial mastectomy, is standard treatment for many non-metastatic breast cancer patients. However, despite advances in imaging techniques, anywhere from 15-40 percent of women must return for additional surgery to remove all the cancer, which has negative ramifications including increased physical and psychological stress, higher healthcare costs, higher rates of infection, and higher mastectomy rates. To address these challenges, Dr. Golshan has completed a clinical trial to test new approaches to interoperative MRI (iMRI) to reduce re-excision rates. Dr. Golshan is now assessing the use of iMRI during surgery and identifying cancer biomarkers to achieve excision of the entire tumor.

Dr. Golshan is also focusing on the early detection and treatment of breast cancer in resource-poor countries. Breast cancer is among the most commonly diagnosed cancers in India, but psychosocial and cultural barriers hinder screening and treatment. Dr. Golshan is leading a program to increase screening availability and community acceptance and participation in the rural area of Assam, India.

Progress Thus Far

Breast conserving surgery relies on tumor images from the diagnostic MRI, but these are typically performed with the patient lying on their stomach facing the floor, in the prone position, but surgery is performed with the patient on their back, in the supine position. This variation in position can make the tumor more difficult to localize. Dr. Golshan completed a phase I clinical trial demonstrating that intraoperative margin evaluation using MRI guidance is feasible and that there is a substantial change in tumor location and geometry between the prone and supine position. To complement iMRI, Dr. Golshan is also testing a technique that can distinguish differences in molecular composition of cells in order to detect sub-clinical cancer in the margins during surgery. One clinical trial that took place at Dana-Farber/Harvard Cancer Center (NCT02956473) has been completed and the final results will be reported shortly. Another trial at Yale New Haven Hospital (NCT02335671) has enrolled 35 of 43 planned participants.

Dr. Golshan led a pilot study in collaboration with the Piramal Foundation in India where they screened over 28,000 patients for breast, cervical, and oral cancer in Assam, India. The DESH (Detect Early Save, Her/Him) Program is the largest screening study for these three cancers in the state’s history. Patients with screen-detected cancers were referred to the local cancer center for definitive diagnosis and treatment. Dr. Golshan was able to identify barriers in terms of belief in cancer, resources available to diagnose and treat breast cancer, and future resources necessary to help with prevention, early detection, and treatment.

What’s next

Dr. Golshan will complete the clinical trial at Yale New Haven Hospital. He aims to optimize iMRI methods for more accurate margin evaluation with fewer scans, in less time, and detecting residual cancer by identifying new biomarkers that can be evaluated. He will also
expand the DESH Program with additional studies in eight rural and urban centers in India.