Quality care and treatment
Any cancer diagnosis is a shock and it naturally takes time to come to terms with your condition. At the initial consultation I believe it important to emphasise the positive aspect of your diagnosis: your illness has been identified and appropriate action can now be recommended to treat it.
It is also the best time to address some common misconceptions about treatment side effects. Most importantly, you should understand that the management of your illness is defined by the specific nature of your breast cancer, so you can rest assured that you will receive treatment best suited to your needs as an individual.
To maintain the best standards of patient care, I work closely with a number of specialist breast surgeons practising in Buckinghamshire, Hertfordshire, Bedfordshire and North London. A specialist oncology opinion may be required prior to surgical treatment although the majority of patients are seen following initial surgical treatment.
The treatments available for breast cancer continue to improve. Today 73% of patients diagnosed with breast cancer are alive ten years later – compared with 41% in the 1970s – and the most recent data suggests 64% of patients are alive twenty years after their initial diagnosis.
The firm foundation for successfully treating breast cancer relies on initial expert surgery. Not only does this procedure remove the tumour in this entirety, but also helps obtain valuable information about the nature of each patient's breast cancer, so that subsequent treatment may be tailored accordingly. As expert surgery is critical, I work only with specialist breast surgeons, all of whom are consultants within NHS breast clinics. Following surgery, I recommend that patients should be evaluated for precautionary (adjuvant) treatment designed to reduce the risk of a recurrence of their breast cancer.
Adjuvant treatments fall into two main categories - local and systemic - while other treatments are also available. These are outlined as follows:
- Local Treatment
Innovations in radiotherapy over the past two decades have enabled this technology to become a highly sophisticated and focused treatment for breast cancer. As a consequence, I recommend radiotherapy should be considered for all patients following surgery, although only a proportion of those who have undergone a mastectomy would require treatment.
I plan patient treatment using CT scanning, while the radiotherapy treatment itself is targeted in an extremely accurate way using the latest generation of highly sophisticated equipment. Patients can be treated either at the Mount Vernon Cancer Centre or privately at Elstree Cancer Centre run by Cancer Partners UK.
Patients frequently have concerns about radiotherapy techniques, based on the reputation for side-effects caused by early and outdated forms of treatment. The great strides made in radiotherapy treatment means you should be reassured about the overwhelming benefits of these advanced techniques.
- Systemic (Generalised) Treatment
Systemic treatment entails using drugs which are able to reduce the risk of a cancer returning either within breast tissue or elsewhere in the body.
All cancers are now tested to assess their hormone sensitivity, with the results often determined by a patient's age. In older patients most tumours are hormone sensitive, but in younger pre-menopausal patients hormone sensitivity is less common. By determining sensitivity the most appropriate and effective hormone treatment can then be selected for your needs.
Historically Tamoxifen has been a mainstay of treatment and routinely administered to the majority of patients. However, new hormone treatments are now available for post-menopausal patients, which offers an increased benefit in comparison to Tamoxifen. Treatments normally continue for some years and while a proportion of patients experience side effects, these may frequently be addressed in an effective manner. If your cancer profile indicates suitability for this new treatment, I will discuss this with you.
Of all the various forms of cancer treatment, chemotherapy is most closely associated with preconceptions of debilitating side-effects. However, as with radiotherapy, the modern techniques used to administer chemotherapy are more refined and the difficult side effects of nausea and vomiting have, to a large extent, been overcome.
Precautionary chemotherapy should be considered for all patients diagnosed with breast cancer, although for many patients the additional benefits may be marginal and treatment not necessarily recommended. To decide suitability for chemotherapy, I assess the benefits of treatment on a case-by-case basis, ensuring you will only receive chemotherapy treatment if it is judged to be of likely benefit to you.
Cancer treatment has entered a new era where drugs - commonly referred to as biological agents - are developed to exploit specific differences between cancer and normal cells at a molecular level. For breast cancer, this approach was based on assessing a protein found on the surface of cancer cells to determine the "Herceptin status" of individual tumours.
On average, Herceptin positivity is seen in 20-25% of breast cancers and this information is used to guide subsequent treatments using a combination of Herceptin, chemotherapy and hormone treatments. This aspect of care continues to expand with new drugs being developed to target specific characteristics of tumour cells.
A Positive Future For Cancer Treatment
Recognising that breast cancer has become a chronic medical condition for many patients, the future holds the prospect of even more effective, innovative and potentially less invasive treatments. For instance, the growing understanding of genetics - not only for breast cancer but in many unconnected medical conditions - enables the identification of genetic aberrations and the means of correcting these offers great promise for the future. When added to the very effective treatments currently used, I am increasingly encouraged and optimistic that we will continue to see ongoing improvements in how this disease is effectively treated and managed.