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Overview: Breast Cancer- Surgical Treatment

Overview: Breast Cancer- Surgical Treatment. Ms S Tormey Consultant Breast Surgeon MWRH Dooradoyle Limerick Slainte an Chlair Meeting, Ennis June 2011. Statistics . 1 in 9 women Rising incidence 2010 > 2,500 cancers diagnosed in Ireland Outcome from breast cancer has improved.

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Overview: Breast Cancer- Surgical Treatment

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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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