Understanding How Cryoablation Works

Cryoablation represents a paradigm shift in the treatment of breast cancer, a beacon of hope for those seeking an alternative to the rigors of traditional surgery. At its core, cryoablation is a process that leverages the lethal effects of extreme cold to precisely target and annihilate cancer cells, sparing the patient the physical and emotional scars often associated with conventional treatments. This innovative technique is not just about removing cancer; it's about preserving the essence of the patient's well-being and dignity.

The site is marked on your skin, and local anesthesia is injected into the skin and the area around the tumor.

Liquid nitrogen will cycle through the probe to allow freezing of the adjacent tissue. The tumor itself and an additional margin of tissue around it is treated. This cycle takes up to 10 minutes. The cryoprobe is taken through a thaw cycle, and another freeze cycle is done.

At the end of the procedure, the probe is warmed to be removed from the breast. The cancer cells are dead at the end of the procedure.

The Science Behind Cryoablation

The principle behind cryoablation is deceptively simple yet profoundly effective: cancer cells, like all living tissue, are vulnerable to extreme temperatures. By applying intense cold directly to the tumor, cryoablation induces a series of cellular reactions leading to the cancer's destruction. The procedure employs a cryoprobe, a slender instrument guided by ultrasound imaging, to deliver liquid nitrogen or argon gas directly into the heart of the tumor, creating an ice ball that envelops and kills the cancerous cells.

The cryoablation process unfolds in meticulously controlled stages, beginning with the careful insertion of the cryoprobe into the tumor under local anesthesia, ensuring the patient's comfort and minimizing pain. As the probe activates, it rapidly lowers the temperature of the targeted tissue, freezing the cancer cells to a critical threshold where cellular structures are irreversibly damaged. This freezing is not uniform; it's a carefully calibrated assault on the cancer, designed to maximize cell death while preserving surrounding healthy tissue.

Images © IceCure LTD

Diagnosis

In the United States, Breast Cryoablation has been FDA approved for the treatment of benign breast conditions (e.g., fibroadenoma). Breast Cryoablation for cancer tumors is currently in the process of obtaining FDA approval. Many doctors who perform Breast Cryoablation will stay within the current FDA guidelines; however, if you have a diagnosis of breast cancer or DCIS, you may still seek treatment with Cryoablation.

Tumor Visible Under Ultrasound

Being able to identify the tumor under ultrasound is a prerequisite for the Cryoablation procedure. If the tumor cannot be seen under ultrasound (e.g., DCIS), patients can be eligible for Breast Cryoablation if a marker has been placed and that marker is visible on ultrasound.

During a biopsy, a marker can be placed to identify the affected area. In this scenario, the Cryoablation specialist can locate the marker and cryoablate the surrounding area. It is important to share all relevant information with your Cryoablation specialist so that you can be presented you with all your options.

Tumor Size

Breast cryoablation is typically recommended for small tumors or lesions. The size of the tumor should be within the acceptable range for cryoablation, as determined by medical guidelines. However, a skillful, experienced breast surgeon is capable of performing multiple placements of the Cryoprobe, which allows for the treatment of larger tumors.

Tumor Location

The tumor's location within the breast is essential. Cryoablation may not be suitable for tumors located too close to the skin, chest wall, or other critical structures, as it could lead to complications. Depending on the level of experience of your breast surgeon, they can employ different techniques to safely treat tumors that may be in these more complicated sites.

Surgical History

A woman's previous breast surgeries or interventions should be discussed as they may impact the feasibility and safety of cryoablation. Your surgical history is not a disqualifying factor, however it is something that your Cryoablation specialist will have to consider when assessing your eligibility for this procedure.

Lymph Node Involvement

The presence of lymph node involvement in breast cancer can impact eligibility for breast cryoablation, particularly if it indicates a more advanced stage of cancer or a higher risk of metastasis. Patients should have open discussions with their healthcare providers to understand their treatment options and make informed decisions.

Comprehensive Evaluation

Breast cancer is a family of diseases. This means that the cancer diagnosis of one patient may be different from another patient, even if they are related. The comprehensive treatment of breast cancer extends beyond the Cryoablation procedure itself. Your breast surgeon will treat not just the tumor but also consider your medical history, family history, genetics, tumor characteristics, the latest medical advancements, and alternative therapies. All of these factors are crucial for presenting patients with an individualized treatment plan.

Cryoablation is not intended to be a standalone procedure. Depending on the specific case, other therapies may be advised to properly treat the patient and reduce the risk of recurrence. It is important that you choose a doctor who will guide you on your breast cancer journey beyond the Cryoablation procedure.

Who Can Do My Cryoablation?

Typically, a cryoablation procedure can be performed by either a Breast Surgeon or an Interventional Radiologist. From a technical standpoint, both professionals are equipped to conduct the procedure, provided they have received the necessary training and experience.

Radiologists will focus primarily on the tumor whereas Breast Surgeons will treat the patient as a whole and provide ongoing care and advise beyond the Cryoablation procedure.

Choosing the right professional is perhaps the most important decision you will make in your breast cryoablation journey. Having a breast surgeon by your side to guide your care moving forward can be invaluable. Unfortunately, radiologists, even those who are quite skilled, will usually see you just for this stand-alone procedure and nothing more.

Breast surgeons can:

• Determine whether lymph node assessment is needed
• Perform sentinel lymph node assessment
• Advise you on surgical options, if cryoablation is not feasible for any reason
• Do any other breast procedures, if needed
• Advise you on follow-up care
• Advise you on further treatment options
• Help to identify and recommend additional team members and coordinate care with them
• Supervise, order, and review future imaging
• Help with risk reduction
• Guide you on genetic testing

If you are researching or considering your options, you want to make sure that you are comfortable with your decision. You should never feel obligated, coerced, or in any way forced to do your cryoablation with a specific provider just because you had a consultation. If you have breast cancer, you are allowed to put yourself first.

Breast cancer is a journey, and you need a doctor that will be with you along the way.

Breast cancer treatment is more than a medical procedure; it's a journey that requires compassionate, holistic care. Ensure your chosen provider aligns with your needs and values, offering not just technical expertise but a partnership in your health and well-being.

What To Expect During Cryoablation?

In Dr. Bednarski's hands, the procedure is… well, different than at other facilities. She believes that having any procedure on your breast is incredibly nerve-wracking, and she tries to minimize this anxiety as much as possible.

I like to perform the procedure with dimmed lights and soft, healing music in the background. I make sure that you are warm and comfortable. I will talk you through the entire process, as this is not a time for surprises. I will tell you exactly what I am doing and what you will feel.

During cryoablation, there is some waiting time – as the iceball forms, as the thawing takes place, and then the second iceball formation. I have a very limited joke supply, which I am happy to share with you, but I will likely chat with you about your pets, garden, or food.

—Dr. Hania B. Bednarski D.O. F.A.C.O.S.

Once the procedure is done, we ensure that your breasts are well supported and that you feel well before saying our goodbyes. We also make sure that you are clear on your instructions after the procedure and schedule any follow-ups that are needed.

TESTIMONIALS 

Learn about the successes of patients who chose breast cryoablation. Read their inspiring stories of hope and healing after breast cryoablation and see how we can help you reclaim your life.

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Price-Benefit

In the United States, cryoablation for treating breast cancer is currently considered an experimental procedure, though it has been FDA-approved for the treatment of breast fibroadenomas since 2002. There is anticipation that FDA approval for its use in breast cancer treatment may occur in the near future. The coverage of the cryoablation procedure by health insurance varies, depending on your policy and the state where you reside, and it may not be covered by most health insurance plans.

It's important to note that the equipment used in cryoablation, including machines and disposable cryoprobes, represents a significant expense. Consequently, the procedure tends to be costly across all providers.

Despite the costs, many patients opt to pay out of pocket, primarily because they consider the benefits of cryoablation—such as a potentially shorter recovery time and less physical impact compared to traditional surgery—to outweigh the financial expense.

When evaluating the cost of cryoablation against traditional surgical methods, it's crucial to consider more than just the financial implications. The non-monetary costs associated with surgery—such as longer recovery periods, the risk of complications, and the emotional impact of a more invasive procedure—should also be taken into account.

These are some of the financial and non-financial factors that you may want to consider when assessing the "actual" price of a Cryoablation procedure. For instance, you pay a monthly premium for your health insurance whether or not you are healthy. When you need coverage for a procedure, your plan may be subject to deductibles, co-insurance, and copays. That means that even if you have good insurance, you may still have financial responsibilities that will be out of pocket.