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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

Two medical studies out today are sure to bring big changes in the treatment of breast cancer and spina bifida.

For many women with early stage breast cancer, researchers found that extensive surgery to remove lymph nodes is not necessary. In a moment, we'll talk about those findings with a breast surgeon.

SIEGEL: First, we're going to hear the latest on an amazing surgical procedure for spina bifida. It's performed on fetuses while they are still in the womb.

As NPR's Richard Knox reports, the surgery can reduce or even eliminate paralysis and brain damage.

RICHARD KNOX: Researchers have shown that the incredibly delicate and risky operation done before birth often spares children the worst effects of severe spina bifida. Children who had the fetal surgery were more likely to walk by themselves later, twice as likely.

The researchers looked at 183 pregnancies. Even more important, the fetal surgery can prevent buildup of fluid in the brain. That can cause devastating lifelong brain damage.

Dr. Diana Farmer helped lead the study.

Dr. DIANA FARMER (Pediatric Surgeon): This is the first time that fetal surgery has ever been attempted and validated for what we think of as a nonfatal birth defect.

KNOX: Farmer is chief of pediatric surgery at the University of California, San Francisco. She says there's been a lot of debate about the ethics of fetal surgery.

Dr. FARMER: Prior to this, because of the risk to the mother, we only considered fetal surgery in a circumstance where either the fetus would not survive pregnancy or whether the baby would be likely to die soon after birth.

KNOX: The surgery has to be done before the 26th week of pregnancy. At that point, the fetus is only about four inches long.

Dr. FARMER: It's important to remember that this is not a walk in the park.

KNOX: Surgeons make a three-inch incision to the mother's uterus, exposing the fetus. They position the fetus so they can see the spinal defect. It's a small hole through which a loop of the naked spinal cord protrudes.

Dr. FARMER: I'd say it's maybe the size between a raisin and an almond.

KNOX: They carefully put the tiny spinal cord back where it's supposed to be, cover it with layers of membranes and muscle and hope for the best.

One of the drawbacks is that mothers who had the operation often deliver their baby several weeks early, posing additional risks. But the study found no more babies died after they got prenatal surgery than those who got the operation as usual, after birth. Two infants died in each group.

Many of the infants who had the prenatal operation still had problems but significantly fewer than the babies who got surgery after they were born.

Dr. FARMER: Spina bifida is not cured by this procedure. Not every patient was helped. What it does is give a chance at improving the outcome.

KNOX: Tara Hallman, of Pennsburg, Pennsylvania, knows what that means. She had the fetal operation at Children's Hospital of Philadelphia. She recalls the day when she and her husband, Jake, saw the ultrasound picture that revealed spina bifida in their son Brett.

Ms. TARA HALLMAN: It was immediately obvious, even to my husband and I, there was a gaping hole in the back of Brett's back.

KNOX: A few days later, surgeons were telling them about the risks and potential benefits of fetal surgery.

Ms. HALLMAN: We had to sign paperwork, and it basically said we might lose the baby in the surgery and we might lose the mom.

KNOX: The gamble paid off when Brett smiled, sat up and crawled on schedule.

Ms. HALLMAN: When he walked at 17 months without any braces, without anything, it just took my breath away. I'll never forget the day that I saw him taking his steps. It was really exciting.

KNOX: Surgeon Scott Adzick says today Brett Hallman is a lively first grader who enjoys swimming and other sports.

Dr. SCOTT ADZICK (Surgeon): He's doing very, very well, although he's not completely normal. He does have some bowel and bladder issues.

KNOX: But nothing that can't be managed. For instance, he can't urinate normally so the 7-year-old has learned to insert a catheter every few hours.

His mom says he has to work harder to keep up physically, but he hasn't let it get him down.

Ms. HALLMAN: Everybody has their challenges in life, and everyone has their battle scars, as we call them. And this is his, and it's something that he's actually very proud of. He loves to show people his scar.

KNOX: She says Brett just sees spina bifida as part of his identity.

Richard Knox, NPR News.

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