A Gentler Way to Treat Breast Cancer
An Interview with Kenneth Tomkovich, MD
By Christie Henschel, staff writer
“Today, the way we often treat breast cancer is like using a sledgehammer to crush a pea,” proclaims Kenneth Tomkovich, MD, director of imaging and breast intervention at the Women’s Center at CentraState Medical Center and a practicing radiologist at Freehold Radiology (Freehold, NJ). “With advanced diagnostic technologies, cancer is being found at an earlier stage than ever before. While some highly aggressive tumors warrant that level of intervention, many others simply do not. There has to be a better way.”
As lead author of a major cryoablation clinical trial, Dr. Tomkovich is helping to create that better way for women with certain low-risk forms of breast cancer. The trial explores treatment of diseased breast tissue with extreme cold (cryo) to destroy (ablate) it from the inside out. Liquid nitrogen circulating through a special probe causes a rapid temperature drop and forms an ice ball at the tip of the probe, which is applied to the tumor.
A dedicated breast cancer specialist with a longtime interest in treatment innovation, Dr. Tomkovich helped to develop the protocols for a landmark multi-center cryoablation trial, which involves women over age 65 with certain small, non-aggressive tumors.
“For these patients, cryoablation dramatically changes the nature of cancer therapy. We can deliver effective treatment in as little as 20 minutes without general anesthesia in an office setting,” he explains. “Patients experience minimal discomfort and recovery time and have excellent cosmetic results. They typically leave the office with just a band-aid on their breast and can return to normal activity quickly without post-procedure prescription pain medicine.”
“By contrast, with traditional lumpectomy, these women would be hospitalized and endure significant pain, disfigurement and recovery time,” he notes. “ It’s easy to understand why they are extremely enthusiastic about the cryoablation. The difference is night and day.”
Dr. Tomkovich’s involvement with the trial is the outgrowth of a longtime interest in the benefits of treating breast cancer with non-surgical ablation. He is convinced many cancer patients are over-treated today and experience unnecessary detrimental side effects. This is especially true because advances in medical science mean that cancers can be better staged, graded and characterized at a cellular level. As a result, physicians can more appropriately tailor treatment to a patient’s individual disease.
As an interventional radiologist, Dr. Tomkovich had seen various forms of ablation—involving both extreme heat and cold—achieve success with prostate, cervical, kidney and other cancers. “I wanted to understand what was unique about the breast and why image-guided ablation was not being used to treat breast disease,” he explains.
A survey of the literature revealed that few studies had been conducted focusing on radiofrequency, microwave, cryoablation or other ablative techniques to treat breast cancer. For the studies he did find, Dr. Tomkovich analyzed the protocols involved – including patient age, tumor size and disease characteristics. He hoped to use this information to help launch a trial for ablation as an effective alternative treatment for breast cancer.
His next step was to search for the appropriate ablation technology. “I identified specific criteria that I was convinced would enhance effectiveness of the treatment,” he says. An important consideration was that the technology involved needed to create extremely low and stable temperatures.”
Dr. Tomkovich began writing the trial’s protocols and identified an experimental cryoablation device, which initially he began using to treat fibroadenomas. “Cryoablation is a quick, effective, minimally invasive treatment for benign breast disease that leaves little scarring,” he notes. “However, when it comes to cancer, the device provides the ultimate benefit. When the probe is precisely placed and treatment guidelines are followed, cryoblation kills cancer. But, training and proper technique are key.”
Noting that caution is important in employing any new therapy, Dr. Tomkovich emphasizes that the trial is restricted to women with relatively benign, typically slow-growing forms of cancer. However, he believes that as more data is acquired, the technology eventually will be used with larger, potentially more aggressive tumors as well as in younger women. “The probe and ice ball are placed under ultrasound guidance,” he notes. “This helps ensure ablation of the entire tumor along with an appropriate margin of healthy tissue, similar to the results of lumpectomy surgery.”
After treating patients for several years, Dr. Tomkovich notes that only once did a patient voice a complaint—an unexpected one, at that. “A woman met her friends for dinner several hours post-treatment,” he says. “’They told me I looked great, but I was hoping for a little more sympathy.’ After all she had just been treated for breast cancer. ”