Is Cryoablation Right for You?

The decision to undergo cryoablation is a very personal choice that factors in your unique feelings about mastectomy or lumpectomy as well as your individual tumor characteristics (tumor size, location, stage, and tumor biology).  Some women are inclined to avoid surgery if it can be avoided, whereas others choose to undergo lumpectomy or mastectomy even if surgery might not improve chances of survival.  
 

Many women are motivated to receive cryoablation because of the ease of treatment, while others are more inclined to undergo lumpectomy, mastectomy and/or breast reconstruction.  Overall health status might influence a woman's decision.  For example, women with multiple health conditions may prefer cryoablation to avoid surgery and general anesthesia   However, healthy women with smaller breasts may simply option for cryoablation to void the cosmetic impact of cancer removal.

 

A fundamental requirement of cryoablation is that you have a limited area of disease that can be easily seen by an imaging study, preferable ultrasound, since most breast cryoablation procedures are performed under ultrasound-guidance. Women with invasive breast cancers under 1.5 cm appear to be the best candidates for cryoablation, but larger tumors may qualify for cryoablation on a case-by-case basis. 

 

It is important to understand that cryoablation is only intended to be a substitute for breast surgery. It does not eliminate the need for radiation or anti-cancer medications that might be recommended for your cancer. Although successful cryoablation eliminates the need for breast surgery, lymph node surgery might also be required.  However, lymph node surgery can sometimes be avoided for low risk tumors. Lastly, some patients are motivated to undergo cryoablation based on the view that it might have beneficial effects on the immune system. This is an appealing concept, but it has yet to be proven with certainty in humans that cryoablation-induced immune system stimulation results in actual improvement in cancer control and survival.

 

With the above factors in mind, cryoablation might be right for you if:

 

  1. You qualify for an open clinical trial evaluating cryoablation.  You can find a list of open, currently-enrolling clinical trials by selecting this link: ongoing clinical trials.  Clinical trial treatments are usually provided at no cost to the patient. Most (but not all) clinical trials limit enrollment to tumors under 2 cm diameter. (Figure A) 
     

  2. You qualify for cryoablation “OFF-PROTOCOL”, meaning outside of a clinical trials.  Patients that do not quality for an open clinical trial and those who may be unwilling to adhere to the requirements of an open clinical trial might be offered cryoablation on a case-by-case basis. Off-protocol cryoablation for breast cancer is generally NOT covered by health insurance or Medicare. As a result, you might be required to pay out-of-pocket for the procedure.  You should discuss with the treating physician’s office the cost related to off-protocol cryoablation.  

    www.carecredit.com might provide a means to pay for the cryoablation procedure.
     

  3. Although cryoablation is best suited for tumors smaller than 2 cm, patients with tumors greater than 2 cm sometimes refuse lumpectomy or mastectomy. On a case-by-case basis, these patients may undergo cryoablation using the "multiple cryoprobe technique" that creates multiple overlapping cryoablation zones that merge together to freeze a much larger area than can be cryoablated with a single cryoprobe (Figures B & C). 
     

  4. Most of the data supporting cryoablation are derived from patients with infiltrative or invasive ductal carcinoma. However, other breast cancer subtypes (e.g., infiltrating lobular carcinoma and ductal carcinoma in situ) may to treated with cryoablation on a case-by-case basis if the patient refuses lumpectomy or mastectomy and it pre-treatment imaging shows a well-defined area of disease that can be accurately targeted with cryoablation.  Since there are few studies reporting the outcome of cryoablation for infiltrating lobular carcinoma and ductal carcinoma in situ, it is not possible to predict the long-term outcome of cryoablation of these cancer types. 

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