Breast cancer is the most common cancer in New Zealand. On average 1 in 9 women will develop it at some stage in their lives. It may present as a mass, change in shape of the breast or nipple, skin dimpling or puckering and bloody nipple discharge. Many breast cancers are diagnosed at the Breast Screening before women develop any symptoms. Men can develop breast cancer, approximately 1 of 100 new breast cancer diagnosis are found in men.
Breast cancer develops when breast cancer cells develop abnormally, grow out of control and start invading into surrounding tissue.
Different types of breast cancer
They behave differently and have different molecular biology. Treatment options depend on cancer behaviour and biology as well as stage at presentation. The stage of breast cancer depends on the size of the cancer, number of lymph nodes involved and whether the cancer has spread (metastasized) to any other tissue apart from lymph nodes.
The treatment of breast cancer
It usually involves surgery and may also involve radiation and chemotherapy. Depending on the cancer there are different treatment options available to women and this can at times lead to confusion. There should be no rush to make decision or start treatment straight away. With most breast cancers, there is time to think about the options and gather all the information (sometimes may include different imaging or other testing). There is time to get more then one opinion if needed and you can always talk to other women so you can carefully consider all your options.
Surgical treatment
Options can be lumpectomy (or wide local excision) or mastectomy (with or without reconstruction). If the lump is not palpable then Hookwire may be used to localize the lesion and guide the surgeon to the area that needs to be removed.
Radiotherapy
It is most often used after lumpectomy (wide local excision or breast conserving surgery). It may also be recommended after mastectomy. Standard radiation therapy is given over 4 weeks (20 treatments), but sometimes other radiation options are available as well. It is always performed after surgical treatment.
Chemotherapy
It can be given in some cases before surgery (neoadjuvant chemotherapy) or mostly after surgery (adjuvant chemotherapy). It is usually given to tumours that show more aggressive behavior and may have already spread to the lymph node.
If cancer is oestrogen and/or progesterone positive, then endocrine treatment is also recommended. This may consist of tamoxifen or aromatise inhibitors (anastrazole, exemestane or letrozole) medication.
As said before “One size fits all” does NOT apply to treatment recommendations of invasive breast cancer.
In Wellington region, all cases of DCIS and invasive breast cancer are discussed at the Breast multidisciplinary meeting following surgery. Members of this meeting include: breast surgeons, breast radiologist, medical oncologist (chemotherapy specialists), radiation oncologists (radiotherapy specialists), breast pathologists and may include breast physicians. Recommendations of any further treatment are made at this meeting. If radiation treatment or chemotherapy or both are recommended, then patients are referred to be seen by the Radiation Oncologist for discussion of risks and benefits of radiation treatment and to Medical Oncologist for discussion of risks and benefits of chemotherapy.