Ablation or Excision? (Guest Editorial).

Growing interest in nonsurgical ablation of small breast cancers reflects a triumph of marketing over substance.

All of these nonsurgical ablation methods--cryotherapy, laser, radiofrequency ablation, high-frequency focused ultrasound--are clearly in their infancy as breast cancer therapies.

What's less clear is whether ablative therapies will ever offer any meaningful advantages over standard surgical excision.

There are good animal data and limited clinical data showing that all of the ablative therapies can destroy breast cancer. But there is no suggestion that they improve survival or reduce the morbidity of the disease itself. And it's doubtful that nonsurgical ablation reduces the morbidity of therapy.

Surgical excision of small breast cancers--the procedure that nonsurgical ablative techniques seek to replace--is an outpatient therapy done under local anesthesia with or without intravenous sedation. It results in local control of the malignancy in 95% of cases. Ninety percent of treated women in most series rate their cosmetic outcome following conventional breast-conserving surgery as good to excellent.

That's a record not easily surpassed. The limited data available to date suggest that nonsurgical ablation offers no advantages over surgical excision in terms of treatment time, anesthetic requirements, or complication rates.

One major advantage with these ablative techniques is that they allow you to make a smaller incision; also there's a certain marketing appeal to saying you're doing nonsurgical treatment because everybody hates surgery.