Cancer test gives early all-clear

By Jane Elliott
Health reporter, BBC News

Melloney felt reassured

When Melloney Poole awoke from her breast cancer operation, doctors delivered the good news that her cancer had not spread.

Her lymph nodes were clear. She had no need for further surgery and could start immediately on her radiotherapy treatment.

"To say to me quite categorically that it had not spread was the most tremendous relief, because the worry stopped there," she said.

"Yes, I had to have radiotherapy as a cautionary measure, but I did not have to have chemotherapy or any further surgery and it was a question of being able to move on in myself very quickly from that time."

Speedy test

In most hospitals, women like Melloney have to wait an anxious two to three weeks to get the news.

But she was lucky enough to try a new test designed to get results to the surgeons while the patient is still in the operating theatre.

As soon as I woke up they were able to tell me it had not spread Melloney Poole

This means that those whose cancer has spread will not need a second operation, as affected lymph nodes can be removed fairly quickly while the patient is still in surgery.

Melloney's hospital, the Royal Surrey County Hospital, is one of the first in the country to offer the new procedure known as OSNA - One Step Nucleic Acid Amplification.

Test diagnosis

It is a method of detecting breast cancer cells in lymph nodes using a molecular, biological testing method.

Lymph glands are important in breast cancer treatment because any cancer cells that have broken away from a tumour can be carried to the nearest lymph glands

Previously the sentinel (first) lymph node was assessed in the laboratory under a microscope, with the results being available in a few weeks.

Under the new system, results can be ready while the patient is having their operation.

Mark Kissin, breast surgeon at the Royal Surrey, said the new test was very accurate.

"What happens in a routine case is we usually take two or three slices of a lymph node," he said.

"So if you can imagine a lymph node being like a bean, if you only had a small bit of cancer your slices might miss it.

Melloney's problems came up in a routine scan

"The advantage with this is it analyses the whole of the lymph gland so you don't miss anything.

"So it should be more accurate than what was available before.

"Our findings were that it was just as good as the gold standard."

So far 150 women at the hospital have had the test and another four hospitals are to start using the system.

Emma Pennery, clinical director at Breast Cancer Care, said that while speedier tests were to be welcomed, it was vital that hospitals were equipped to deal with them.

"This kind of technology is very much a developing area and has the potential to result in faster, more accurate results for a range of cancer tests, not just in determining the spread of cancer to the lymph nodes," she said.

"We know that women can feel extremely anxious when waiting for biopsy results that could determine whether other treatments or further surgery is needed, so anything that can remove this anxiety would be welcomed.

"If this new OSNA test is approved for wider use it is essential that the necessary infrastructure is in place to ensure that it is available to patients across the UK."

Lengthy lists

Mr Kissin agreed adding that their year-long trial of OSNA had shown that, while excellent for patients, there could be a number of logistical problems for medical staff, who would be unsure how long an operation might take as it could depend on the OSNA results.

"It speeds up the whole process and takes away anxiety, but we don't know how long lists will take though," he said.

Melloney, now the acting chairman of the hospital trust, said she had been delighted by the treatment received at her hospital.

"I had not appreciated fully at the time the enormous benefits I had being one of the first to have this particular technique."

She said she had been particularly lucky to get such an early diagnosis as she had thought twice about even being screened.

"The routine screen was completely unexpected - right out of the blue, one of the usual letters.

"I was almost in two minds whether to go or not because there is no family history and there was no reason to suspect that there were any problems.

"But I did go and I assumed it would say I was all clear, but when the brown envelope did arrive it was a couple of sheets and had a suggestion that I contact the clinic urgently and go back for a further scan to check.

"I went back assuming it was a mistake but the re-scan showed there was a tumour and having been told I had cancer I was very fortunate because things happened quickly and I had surgery, a lumpectomy, within weeks."