MAMI Now Freezes Breast Tumours as a Non-Surgical Option

Each year, many women book their routine screening at Melrose Arch Mammography, known as MAMI, without realising that the same Johannesburg practice can also treat certain breast cancers on site. Instead of removing a tumour surgically, MAMI can freeze it. Breast Cancer Awareness Month has now ended, and the practice is spending November explaining cryoablation, which it presents as an alternative to surgery for selected breast cancers.

MAMI is what the Parklane Women's Imaging Centre has become. The staff, radiologists and equipment are unchanged, and they now work from a larger new department in Melrose Arch. According to the practice, no other practice offers breast cancer cryoablation. Dr Peter Schoub, a diagnostic radiologist and the managing director, brought cryoablation for breast cancers into the unit in 2020.

How cryoablation works

The name has two parts. "Cryo" means cold, and "ablation" means destroying tissue. The radiologist uses ultrasound to guide a thin probe, or needle, into the tumour. Liquid nitrogen runs through it. Ultrasound lets the probe be placed precisely, so the tumour sits in the middle of the area that will freeze. The nitrogen stays inside the needle the whole time, but the tissue around the tip freezes fast and forms an ice ball that surrounds the tumour. Repeated cycles of freezing and thawing kill the cancer cells, and the ice ball is watched as it grows to keep the procedure safe.

The procedure from the patient's side

Before the probe goes in, a local anaesthetic fully numbs both the skin and the deeper tissue. MAMI says the procedure does not hurt. The incision is 2 mm long and is placed where it works best both technically and cosmetically. The treatment takes 30 to 40 minutes in the practice's own rooms. There is no general anaesthetic and no hospital stay, and patients go home shortly afterwards.

The breast is usually bruised for one to two weeks. Any pain tends to be mild and can be managed with anti-inflammatories and paracetamol. A lump can still be felt where the tumour was. This is scar tissue left behind once the tumour has been destroyed, and it clears within six to 12 months. Mammography, ultrasound and MRI are then used at follow-up to confirm that no cancer is left.

Its place in the treatment plan

MAMI is careful to say that cryoablation takes the place of a lumpectomy, not of any other treatment an oncologist may recommend. After the procedure, most patients still need long-term endocrine treatment to reduce the chance of the cancer coming back, and some also need radiotherapy, just as they would after a lumpectomy. The practice says cryoablation was developed as a breast cancer treatment about 15 years ago. Published results from three large clinical trials, two of which are still running, together with several smaller studies, show successful ablation in over 95% of tumours under 1.5 cm. Frostbite of the skin above the ice ball is the most significant complication that has been reported.

With no hospital admission, MAMI highlights lower costs, less risk of infection and a faster return to everyday life. The cosmetic result is also good and the breast is not disfigured.

The link to early detection

Small tumours suit cryoablation best, so the treatment depends heavily on screening. A yearly Mammogram aims to catch cancer at its earliest stage, when it is smallest and easiest to treat. MAMI advises that annual mammography from age 40 saves the most lives. It says gaps of more than a year are not ideal, because most breast cancers grow from microscopic cells into a lump that can be detected within 18 to 24 months. The practice adds that today most breast cancers are found while still under 2 cm, mainly because of mammography and ultrasound.

The practice uses advanced 3D mammogram machines. These rely on tomosynthesis to give a detailed scan with very little compression and a very low radiation dose, and they are used together with ultra-high resolution ultrasound. Most medical aids, even on a basic hospital plan, cover Mammograms from screening benefits and not from medical savings. The practice can check cover or quote a cash price over the phone.

Doing a regular Breast Examination at home is still worthwhile between visits. Any change in the breast should be imaged quickly and not left until the next annual screening.

One part of a larger team

MAMI is part of a multidisciplinary breast cancer team that includes breast surgeons, reconstructive surgeons, oncologists, pathologists and radiologists. When a patient is diagnosed at the practice, she is referred straight to these doctors. They review the case and recommend treatment, and MAMI helps with staging, localisation, monitoring chemotherapy and follow-up. The decision on whether cryoablation is suitable is made within that process.

Dr Schoub works with several multidisciplinary breast cancer teams across Johannesburg. The largest is the Netcare Breast Care Centre of Excellence at Netcare Milpark Hospital, which holds accreditation from the National Accreditation Program for Breast Centers. In these teams he works closely with surgeons and oncologists on diagnosis, staging, tracking how tumours respond and presurgical localisation. Breast biopsies are also done at the practice, so a suspicious result can be investigated in the same unit.

The accreditation behind it

The breast unit, first at Parklane Radiology and now at Melrose Arch Mammography, was the first department in South Africa to earn the American College of Radiology gold seal. It received this for mammography in 2017, MRI in 2018, stereotactic biopsy in 2020 and breast ultrasound in 2021. The ACR named the department a Breast Imaging Center of Excellence in 2022. Dr Schoub has specialised in breast radiology for 15 years. He holds the European Diploma of Breast Imaging and is an honorary lecturer in radiology at the University of the Witwatersrand.

Details on cryoablation, screening and bookings can be found at https://mammogram.co.za/.

About MAMI (Melrose Arch Mammography)

MAMI (Melrose Arch Mammography Inc.) is a breast imaging practice based at 10 Melrose Boulevard, Melrose Arch, Johannesburg, and is the new home of what was the Parklane Women's Imaging Centre. Its services include 3D mammography, breast ultrasound, breast biopsies, bone density and body composition scans, and breast cancer cryoablation. It is accredited by the American College of Radiology as a Breast Imaging Center of Excellence.