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Evolution of Breast Cancer Treatment: From Ancient Times to Modern Practices

Explore the historical perspective, anatomy, oncology development, modern surgical practices, and multidisciplinary approach in breast cancer treatment. Learn about the evolving surgical techniques, services in Ireland, and the importance of tailored therapies. Discover the significance of neoadjuvant chemotherapy, reconstruction options, and the role of the multidisciplinary team in achieving optimal outcomes. Stay informed about innovations in diagnostics, including triple assessment and same-day services, contributing to improved prognosis and patient care.

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Evolution of Breast Cancer Treatment: From Ancient Times to Modern Practices

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  1. Overview: Breast Cancer- Surgical Treatment Ms S Tormey Consultant Breast Surgeon MWRH Dooradoyle Limerick Slainte an Chlair Meeting, Ennis June 2011

  2. Statistics • 1 in 9 women • Rising incidence • 2010 > 2,500 cancers diagnosed in Ireland • Outcome from breast cancer has improved

  3. HISTORICAL PERSPECTIVE • Ancient Eygptians 3,500 • Hippocrates 460 BC- humoral disease • Breast Cancer considered systemic- surgery did not cure because this was a disease involving the entire body • (Humoral Theory)

  4. Move to Localised Theory • 17th Century- Localised disease potentially curable with surgery • 19th Century-Halstead-Era of Radical Mastectomy

  5. Anatomy Halstedian theory Cancer spread anatomically Breast- Lymphatics/ direct invasion of surrounding tissues

  6. Oncology Development • 1895 Beatson- oopherectomy • 1896 Emile Grubb- radiotherapy • Chemotherapy- 20th century

  7. Influential Clinical Trials • NSABP • Milan • Breast Conservation and radiotherapy • Chemotherapy development and trials

  8. Modern Surgical Practice Less invasive surgery More attention to cosmetic outcomes Improved prognosis

  9. Oncological Approach • Combining treatments: • Surgery/Chemotherapy/Radiotherapy/Biological treatments • Multidisciplinary • “Tailored” approach

  10. Breast Cancer Services in Ireland Specialist Cancer Centres • Population of 250,000-300,000 per centre • 100 -150 new cancers p.a. per centre • High volume of cancer cases leads to experienced personnel National Quality Assurance Standards for Symptomatic Breast Disease Services (Ireland 2000)

  11. National Cancer Control Programme • Established 2006 • Cancer Strategy • 8 Cancer Centres West: GUH and Limerick South:CUH and Waterford East:Mater/Vincents, Beaumont and James’

  12. Minimally invasive surgery 1970 Breast conservation 1990’s Sentinel node biopsy

  13. Breast Conservation/Oncoplastic Surgery • Volume reduction • Scars • Symmetry .

  14. Oncoplastic/Reconstructive Surgery In past decade- evolving speciality Preservation of the breast with a cosmetic appearance, after oncological resection (oncoplastic resection) or reconstruction after mastectomy- either immediate or delayed

  15. Neoadjuvant Chemotherapy Pre-opChemotherapy Negative Margins Negative Margins Positive Margins

  16. Reconstruction • Skin sparing immediate • Nipple sparing- immediate

  17. Who? Multidiciplinary discussion Factors influencing: Breast size Tumour size Pathology Age Prerequisite before decisions: Triple assessment and diagnosis

  18. Triple Assessment • Triple assessment- gold standard • Clinical, Radiology, Pathology

  19. Clinical Assessment • History and Examination • Clinical diagnosis Accuracy- clinical breast examination is reported to have sensitivity of 68-80%

  20. Radiological Assessment • Mammography • Ultrasound- focal palpable area on clinical assessment/focal area of pain

  21. Mammography • Standard screening tool for breast • Sensitivity increases with age • Overall sensitivity 75%, but 54-58% < 40years, and 81-94%> 65 yrs YOUNG WOMAN POST MENOPAUSAL WOMAN

  22. Ultrasound • Used to evaluate focal areas in breast- palpable lumps/painful areas, or an area seen on mammography • Low sensitivity and specificity when used for screening

  23. Ultrasound Guided core biopsy • Increases accuracy • Current standard for performing breast biopsy in lesions graded U3 or above

  24. Same Day Service • TAC visit takes 2-3 hours to complete • Results from imaging available at the end of the visit • Re visit the primary clinician for results • Second visit necessary for biopsy results

  25. Multidisciplinary Meeting • Consists of symptomatic breast unit core personnel ie surgeons, radiologist, pathologist, medical oncologist, radiation oncologist, breast care nurses, radiographers • Held weekly • All imaging, and clinical assessment re visited, and biopsy results • Consensual decision re outcome • All surgically excised breast cancer discussed- decisions son treatment

  26. Summary • Last 25 years- many large trials have led to better outcomes • Current research- focus on understanding cancer genes and cancer cell growth to achieve potentially more targeted “individualised” treatment

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