Breast Cancer
A lump in the breast
is this cancer? By Miss Joanna Franks and Ms Jennifer Gattuso
Most women who are referred to the Breast Care Unit will present with an innocent lump or benign breast changes. Around one in eight women in the UK will be diagnosed with breast cancer during their lifetime. However, our knowledge of breast cancer has changed dramatically over the last decade. We now have a variety of medical and surgical treatment options which means we can offer individualised patient care. The NHS Breast Screening Programme, high profile celebrities sharing their personal stories and breast cancer campaigns, has raised the public profile of breast cancer. We hope that this will encourage patients to seek prompt medical attention, enabling an earlier diagnosis with an even greater improvement in prognosis.
The majority of biopsies are now achieved under imaging guidance-stereo-tactic core biopsy or ultrasound
Diagnostics In our clinics, patients with new symptoms are seen in a ‘one-stop’ diagnostic clinic. A detailed history and clinical examination is undertaken with any necessary imaging offered on the same day. The current guidelines state that mammography should be carried out from the age of 40, supported by ultrasound where necessary. In the under 40s, the first line of investigation is through ultrasound. Any discrete abnormality presented will require a biopsy, which is usually performed by either a fine needle aspiration cytology or core biopsy. The majority of biopsies are now achieved under imaging guidance-stereo-tactic core biopsy or ultrasound. These stages of diagnostics form a ‘triple assessment’. If a woman is found to have a cancer it is essential to obtain as much information as possible. Many patients will require MRI scans
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12 • PRACTICE MATTERs Summer 2014
and further ultrasound assessment, potentially with more biopsies, before a personalised management plan can be finalised. Factors such as tumour type and receptor status, as well as the patient’s own views, must all be considered.
Surgical options Oncoplastic surgery prioritises excellent cancer management. These techniques can enable more women to keep their breasts, achieving greater rates of breast conserving surgery. For example, a cancer in a suitably large and ptotic breast may be best tackled via a breast reduction; a therapeutic mammoplasty. This can have the advantage of allowing a wider excision whilst reducing the overall breast volume, making post-operative radiotherapy easier to plan. However, it will often require symmetrisation of the contra-lateral side, either simultaneously or as a delayed procedure. If it is not possible to approach the cancer with breast conserving surgery or if the woman prefers a mastectomy, this can be combined with a breast reconstruction. This can be achieved either at the time of the cancer surgery or at a later date. The advantage of an immediate reconstruction (from the surgical point of view) is that much more of the skin envelope can be retained, improving the aesthetics. From the patient’s perspective, they are already on