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New Diagnosis What Now?

The diagnosis of breast cancer is associated with many feelings, most commonly shock and denial at the diagnosis. Usually patients with breast cancer do not feel unwell. Most breast cancers are asymptomatic and fortunately the majority of breast cancers will be early breast cancers which will have excellent outcomes.

Early detection and improvements in breast cancer treatment have led to a 30% reduction in breast cancer mortality in all age groups over the last 20 years. Regardless of the tumour type or grade, a smaller breast cancer at the time of diagnosis is more likely to have not spread beyond the breast and therefore the current strategy for reducing breast cancer mortality is for patients to seek diagnosis and treatment as soon as possible. Tumour size and lymph node stage are diagnosis are the best predictors of outcome.

Once the diagnosis is made patients will usually be referred to a surgeon. Surgery has been the cornerstone for the treatment of patients with breast cancer for over a 100 years. This can be a difficult time associated with uncertainty and fear as patients will often not know which surgeon to choose.

In the early 1990’s, the trend in general surgery towards subspecialisation started to appear. Traditionally, surgeons who trained in general surgery treated a patient with a wide range of cancers. While this provided a good standard of care for many years, it is now known that subspecialisation and multidisciplinary care of specific cancer types improves survival and allows an exceptional level of care.

Specialisation has also allowed initiatives such as fast tracking appointments to reduce the delay in assessment and diagnosing of patients with malignancy.

There is also data to support the evidence that an increased case load ( operating on more patients with breast cancer) improves surgical outcomes. For example, breast specialist seeing more than 50 cancer patients per year achieved a 10% better survival compared to non-breast specialist. This may be contributed not only to the surgery but also to the use of adjuvant treatment which is recommended by the multidisciplinary breast cancer team.

Therefore it is strongly recommended that patients be referred to a Specialist Breast Cancer Surgeon. There is good evidence to indicate that patients that are treated for breast cancer in a specialist breast cancer centre with a specialist multidisciplinary team have a better outcome than those who are treated in a non-breast specialist breast cancer centre.

It is important that women particularly from rural locations are well supported and have the ability to access specialist tertiary breast cancer care. Most surgery for breast cancer (approximately 70% of all breast cancer surgery will be breast conserving surgery) will be performed with an overnight hospital stay only and therefore, country patients will not be isolated from their families or hospitalised for a prolonged period of time.

Adjuvant treatment such as radiotherapy and chemotherapy that require more intensive and frequent visits to the hospital may also be delivered in rural areas closer to home.

Dr Thornton herself grew up in a rural community and therefore, it is her strong belief that all women in Australia regardless of where they live have access to a specialist breast cancer surgeon, who can facilitate multi disciplinary breast cancer care. All patients in Australia should have the ability to receive first class surgical and medical treatment for their breast cancer.

When choosing a breast surgeon, it is important that not only is the surgeon technically competent (and can offer a wide variety of oncoplastic procedures) but is also supported by a multidisciplinary breast cancer team. The patient must also feel comfortable and have rapport with the treating surgeon. It is extremely important that an honest and open relationship can be developed between the patient and the treating surgeon.

The surgeon will form an integral part of the patient’s breast cancer management and a long-term relationship will be formed. The surgeon will be responsible for caring for the patient many years after the operation. Thus it is important that the patient is able to freely communicate with the surgeon their fears and concerns. The patient must also feel that they are respected, listened to and genuinely cared for by the surgeon and the surgeon’s team.

Australian surgeons can demonstrate their commitment to improving and maintaining the highest standards of care for their patients by participating in clinical audit. The BreastSurgANZ Quality Audit (BQA) is a clinical audit directed by the Breast Surgeons of Australia and New Zealand (BreastSurgANZ), a specialty society for surgeons treating breast cancer.

To locate a surgeon who is a member of BreastSurgANZ in your area use the 'Find a surgeon' section of the BreastSurgANZ website.

Listed below are some questions that may be helpful when talking about surgery for breast cancer:

  • Do you specialise in breast cancer surgery?

  • Could you refer me to a specialist breast cancer surgeon?

  • What will the surgery involve that is recommended for me?

  • Where will the scars be placed and how will the breast look post operativley?

  • How long will I be in hospital?

  • What is the expected recovery time?

  • What are the risks of surgery and side effects of breast cancer treatment?

Once the diagnosis is made, further investigations may be required. There may be further investigations to give more information regarding the primary tumour or the contralateral (opposite breast) and this can include an MRI.

Patients who present with large tumours (greater than 5 cm) or patients with known axillary lymph node metastasis will be asked to undergo preoperative CT staging in the form of CT scan of the chest, abdomen, pelvis, and a bone scan.

All patients before surgery will undergo a full set of blood investigations and a chest x-ray if they have not had CT scan imaging of the chest. Some patients may be required to see an anaethatist preoperatively or undergo a preoperative ECG or further investigations depending on their other medical comorbidities.

While the diagnosis of breast cancer is a psychological emergency, it is not a surgical emergency. Patients need to be aware that they have time to adequately discuss all of their available treatment options and that there is no urgency for them to go directly to the operating theatre without having a significant discussion regarding the potential treatments available to them. Patients at Specialist Breast Cancer Surgery will be supported by a breast care nurse during this difficult time.

In general, the patient will attend an annual visit with the surgeon for the first 5 years post diagnosis, however, this may be extended to the lifetime of the patient. Therefore is crucial that patients who are considering a long-term relationship with a surgeon consider the surgeon’s age as well as their experience/ clinical expertise.

The doctor-patient relationship has evolved significantly over the last few years. Patients are extremely knowledgeable, but also can feel quite vulnerable when they are diagnosed with breast cancer. Patients need to feel involved in the decision making regarding their treatment but must also be supported and guided by the professional opinion of the breast cancer surgeon. The patient should feel comfortable at all times with their surgeon as the surgeon will be guiding them and their families through times when they have to make difficult decisions.

It is our aim at Specialist Breast Cancer Surgery to provide exceptional care for our patients in a comfortable and warm environment. We aim to provide understanding and empathy to our patients and their families. We appreciate the significant difficulties that patients are facing with a new diagnosis of breast cancer. We understand the pressures and challenges that our patients face particularly with employment and family commitments. We endeavour to streamline your appointments and make the breast cancer journey from an administration perspective as easy as it can be, while maintaining the highest possible standard of surgical care.