More Surgical Options for Breast Cancer Patients

Wednesday, 15 May, 2019

While breast cancer remains the most common cancer in women worldwide, it's also true that no other cancer has witnessed such a tremendous improvement in terms of diagnosis and management in the last two decades. Survival rates are increasing annually and the range of treatment options has now become a 'menu' from which patients are invited to make some of their own choices.

Mr Colm Power, Consultant Surgeon and his colleagues are committed to translating these advances into better outcomes for breast patients at Beaumont Hospital. He says, "Back when I started my training, the surgical treatment for every woman with breast cancer was a mastectomy and a full axillary clearance (removal of all the lymph nodes under the arm), regardless of whether a patient had early or advanced breast cancer.

But in the last fifteen years, major medical advances have changed treatment outcomes for the majority of breast cancer patients. Sentinel lymph node biopsy now replaces the need in many cases for a full axillary clearance and the move to only remove the tumour with clear margins around it, rather than the entire breast, offers a more satisfactory outcome particularly for younger women. Earlier detection and more effective treatments have resulted both in an increasing percentage of small breast cancers found at the initial diagnosis and in a decline in mortality".

The landscape is changing for both patient and breast surgeon. At present, seven or eight different types of breast reconstructions are offered to patients - and some of these procedures are uniquely available at Beaumont Hospital. Mr Power is the only surgeon in the country performing laparoscopic omental flap reconstruction - a technique which he studied in Japan.

Using key hole surgery, the procedure takes fat tissue from the inner-abdomen to replace excised breast tissue. Mr Power regards it as being 'not as tough on patients', with little or no scarring and it can be particularly effective for certain patients.

The latest addition to the hospital's breast cancer beating tool box is intra-operative radiation therapy which again is uniquely available at Beaumont Hospital. Ideally adopted as an option to treat smaller breast cancers in older patients, Mr Power says, "Traditional whole-breast external beam radiation therapy aims radiation at the whole breast, often with a boost to the area where the cancer was, and a standard course would be delivered daily over a 3-5 week period.

By contrast,intra-operative radiation therapy is delivered in-theatre, at the time of the patient's operation, and directly targets the site from which the tumour is removed. It offers suitable patients access to a complete radiation course in just 30 minutes, making it more convenient and a less demanding form of radiotherapy.

In the next year we will treat over 400 patients with breast cancer. This growth in patient numbers is testament to the team who established the unit - Prof Hill, Mr Allen and Dr Duke - and results from a growth in our catchment area and its population, the fact that patients are living longer and that people are more aware of the early signs of breast cancer.

Breast cancer survival has improved in Ireland in the last decade which can be linked to the setting up of cancer centres. Family history also plays a role something highlighted by actress, Angelina Jolie, when she took the preventative measure of having a double mastectomy because of a family disposition to the disease. Genetic testing is being used increasingly as an indicator of this predisposition and ideally we will get to a stage where genetic tests will be done pre-operatively to better inform our decision making and ultimately afford patients with more choices", he concluded.

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