BREAST C ANCER AWARENESS MONTH
A shining light for breast cancer M
any things have changed since Miss Walters was appointed as a consultant breast surgeon in 1996. • Mammograms are now performed by tomosynthesis and are three-dimensional, increasing accuracy and decreasing false positive, abnormal results caused by overlapping of the breast tissue. • Contrast enhanced mammograms, which will be as accurate as MRI will soon be available in London. Improved digital analysis of the images has resulted in less compression of the breast tissue during the procedure and therefore much less discomfort for the patient. • Microscopic areas of calcification can now be targeted and biopsied under mammographic control with stereotactic vacuum biopsy and X-rayed immediately with a device called a faxitron to ensure that the correct tissue has been sampled. • Biopsy of lesions no more than a few millimetres in size can be undertaken under ultrasound control and are now commonplace. • Immuno-histochemistry of the specimens provides greater accuracy of diagnosis and therefore prognosis and treatment can be tailored to fit both the nature of the disease and the needs of the patient. • Genomic tests of the tissue of breast cancer tumours is now able to improve selection of patients needing chemotherapy and that chemotherapy is better tolerated and more effective in preventing the spread of the disease to more vital organs where it can cause decreased function. • In the past all of the lymph glands were surgically removed in patients with breast cancer, but now with radioactive isotope and a gamma probe only the Sentinel or’ the guardian’ lymph node needs to be removed and this can be analyzed for abnormal cells while the patient is still under anaesthetic and with the identification of smaller earlier tumours by screening often the tumour needs to be marked with a wire before surgery
2 0 2 O C TO B E R 2 0 1 8
and the surgeon would be unable to see or feel it. This can then be examined by X-ray in a faxitron machine, again while the patient is still asleep. • Keeping patients warm during surgery has reduced the risk of bleeding post-operatively and improvements in anaesthetic agents her meant less nausea is experienced. • Radiotherapy is now more focused on the treatment area, which has reduced the side effects from this treatment. • There are now several drugs available to treat hormonally sensitive breast cancers, although Tamoxifen remains a powerful anti-hormonal therapy. Problems with decrease in bone density, post chemotherapy and hormonal therapy are now better monitored and treated and bone strengthening drugs also reduce the risk of breast cancer spreading to the bones. With more women surviving breast cancer for longer periods, therapy is also better directed at supporting their needs post therapy and the mental health sequelae of a diagnosis of cancer. Some of the genes causing breast cancer have been identified and it is possible to detect these genes in embryos, pre-implantation genetic diagnosis means that genes carriers do not need to pass these genes onto their children and grandchildren. So why do we still read in the newspapers of 40 year old women dying from the disease? It is still the most common cancer. At the age of 40 the risk of breast cancer is 1/250 women and at the age of 47 it is 1/50. Many other countries screen at an earlier age than the NHS BSP and more frequently. It’s Breast Cancer Awareness Month, so BE AWARE! For appointments please call 01622 873058. For more details call Tena’s PA Helen on 07982 249612. Or email tenakerrywalters@gmail.com
“Biopsy of lesions no more than a few millimetres in size can be undertaken under ultrasound control and are now commonplace”