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Dr. David Krag: Reducing Complications for Breast Cancer Patients

By Alison Davis

December 21, 2009

David Krag, M.D., Professor of Surgery, University of Vermont

Photo of Dr. David Krag

Personalized medicine means knowing precisely what drug or procedure is best based on an individual's specific health status. Can new methods serve as predictors of breast cancer survival and thus help doctors personalize treatment decisions? Cancer surgeon Dr. David Krag is on the case.

The Problem: According to the National Cancer Institute, nearly 195,000 new cases of breast cancer will be diagnosed in 2009. Thankfully, four out of five of the newly diagnosed women and men will survive the disease due to early detection and treatment. The downside is that side effects from some common cancer treatment procedures can cause long-term complications and impair quality of life for cancer survivors. In one procedure, for example, doctors remove lymph nodes to prevent cancer from spreading because lymph nodes, the small sacs that collect and drain fluid from body organs, are the first place cancer appears when it spreads. Removing lymph nodes can lead to numbness and painful swelling of the arm, a troublesome condition known as lymphedema.

Finding a Solution: One example of an individually tailored approach to breast cancer treatment is a "radiotracer" technique that Dr. Krag developed to determine which lymph nodes are cancerous, potentially significantly reducing side effects for the patient and avoiding unnecessary treatment. The technique works like this: A cancer surgeon injects a small amount of a harmless radioactive tracer into a patient's breast. Then, using painless imaging methods, the surgeon tracks the movement of cancer cells to their lymph node destinations. The surgeon can then remove only the lymph nodes that are affected by the cancer, leaving the rest in place to perform their normal function of managing fluid balance and providing immune defense.

At the forefront of translational research, Dr. Krag has spent his career looking for new treatment options by intertwining cancer research and therapy. Funded by an ongoing NIH research grant, Dr. Krag has been tracking the success of his radiotracer procedure through a university-based clinical trial involving more than 5,000 breast cancer patients. He wants to know whether removing only a few lymph nodes has the same clinical outcomes as removing most or all of them. Although the selective lymph node procedure intuitively seems to be better, Dr. Krag says, the technique needs to be put to a formal test to see whether patients do better over time.

How This Funding Helps: Earlier this year, all of this promising work in progress nearly came to a screeching halt when the economy slowed and Dr. Krag's grant funding dried up. Then came the American Reinvestment and Recovery Act of 2009: Dr. Krag got a letter in the mail from NIH, telling him he had been selected to receive Recovery Act funds to restart his breast cancer research.

"Before the Recovery Act funds, support for this large, randomized surgical trial for breast cancer patients was about to end," says Dr. Krag. "Now this project is fully back on track, which is phenomenal for the thousands of women who participated in this trial as well as for all future breast cancer patients."

After Two Years ... The outcome of Dr. Krag's radiotracer study is still unknown, yet previous studies suggest that his work will help physicians identify only a few lymph nodes for removal in the large majority of their breast cancer patients.

The ability to use lymph nodes as "sentinels" of a spreading cancer will spare certain patients with less advanced disease complications like lymphedema, chronic numbness and potentially serious infections.

Recovery Act Investment: "Sentinel Node Versus Axillary Dissection in Breast Cancer," $751,060 for FY 2009 (National Cancer Institute)

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