MAMI Offers Breast Cancer Cryoablation as an Alternative to Surgery

Most women know Melrose Arch Mammography, or MAMI, as the place they go for their yearly screening. Fewer know that the same Johannesburg practice also treats some breast cancers in its rooms, using a technique that freezes a tumour rather than cutting it out. With Breast Cancer Awareness Month now behind it, MAMI is using November to explain cryoablation, a procedure it describes as an alternative to surgery for selected breast cancers.

MAMI is the new face of the Parklane Women's Imaging Centre, with the same staff, radiologists and equipment in a spacious new department in Melrose Arch. The practice states that it is the only practice offering breast cancer cryoablation. Diagnostic radiologist and managing director Dr Peter Schoub introduced cryoablation for breast cancers into the unit in 2020.

What cryoablation is

Ablation means destroying tissue, and cryo means cold. In cryoablation, liquid nitrogen flows through a thin probe, or needle, which is inserted into the tumour under ultrasound guidance. Ultrasound allows the radiologist to position the probe precisely so that the tumour sits at the centre of the freezing zone. The liquid nitrogen never leaves the needle, but it freezes the tissue around the tip quickly, creating a ball of ice that engulfs the tumour. Alternating freeze and thaw cycles destroy the cancer cells, and the growth of the ice ball is monitored throughout for safety.

What the patient experiences

The procedure is performed under local anaesthetic, with the skin and deeper tissue fully numbed before the probe is introduced. According to MAMI, it is a painless procedure. A 2 mm incision is made in a cosmetically and technically suitable position. Treatment takes 30 to 40 minutes and is done in the practice's rooms, so there is no hospital admission and no general anaesthetic. Patients can go home soon afterwards.

Afterwards, bruising of the breast usually lasts one to two weeks, and any pain is usually mild and controlled with anti-inflammatories and paracetamol. A palpable lump remains where the tumour was. This is scar tissue that forms after the tumour is destroyed, and it resolves within six to 12 months. Follow-up imaging with mammography, ultrasound and MRI is used to confirm that no cancer remains.

Where it fits in treatment

MAMI is clear that cryoablation replaces a lumpectomy but not the other treatments an oncologist may prescribe. Most patients will still need long-term endocrine treatment after the procedure to help prevent recurrence, and some may also need radiotherapy, as they would after a lumpectomy. The practice notes that cryoablation was developed as a treatment for breast cancer around 15 years ago, and that published results from three large clinical trials, two of them ongoing, and several smaller studies show successful ablation in more than 95% of tumours smaller than 1.5 cm. The most significant complication reported is frostbite of the skin over the ice ball.

Because the procedure avoids hospital admission, MAMI points to reduced costs, less exposure to infection and a quicker return to normal life, along with a good cosmetic outcome without breast disfigurement.

Why early detection makes it possible

Cryoablation is best suited to small tumours, which is why it is closely linked to screening. A yearly Mammogram is designed to find cancers at their earliest stage, when they are smallest and easiest to treat. MAMI's guidance is that annual mammography from the age of 40 saves the most lives, and that intervals longer than a year are not optimal because most breast cancers grow from microscopic cells into a detectable lump within 18 to 24 months. The practice also notes that most breast cancers today are found when they are under 2 cm, largely thanks to mammography and ultrasound.

MAMI uses advanced 3D mammogram machines that rely on tomosynthesis to produce a detailed scan with minimal compression and a very low radiation dose, alongside ultra-high resolution ultrasound. Even on a basic hospital plan, most medical aids pay for Mammograms from screening benefits rather than medical savings, and the practice will confirm cover or give a cash price over the phone.

A regular Breast Examination at home is still worth doing between appointments, and any change in the breast should be imaged promptly rather than left until the next annual screening.

Part of a wider team

MAMI works within a multidisciplinary breast cancer team made up of breast surgeons, reconstructive surgeons, oncologists, pathologists and radiologists. A patient diagnosed at the practice is referred directly to these doctors, who evaluate the case and recommend treatment, with MAMI assisting in staging, localisation, monitoring chemotherapy and follow-up. Whether cryoablation is appropriate is decided as part of that process.

Dr Schoub works with several multidisciplinary breast cancer teams around Johannesburg, the largest being the Netcare Breast Care Centre of Excellence at Netcare Milpark Hospital, which is accredited by the National Accreditation Program for Breast Centers. Within these teams he works closely with surgeons and oncologists on diagnosis, staging, monitoring tumour response and presurgical localisation. The practice also performs breast biopsies, so a suspicious finding can be investigated within the same unit.

Accreditation behind the service

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

More information on cryoablation, screening and bookings is available at https://mammogram.co.za/.

About MAMI (Melrose Arch Mammography)

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

Media Contact
MAMI (Melrose Arch Mammography)
Email: info@melrosemammo.co.za
Phone: +27 11 484 3149
Website: https://mammogram.co.za/