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Major changes in breast cancer surgery to meet quality-of-life outcomes

Breast cancer is the most common malignancy in Australian females; however, as the 5-year survival rate has increased to 90%, the quality-of-life outcomes are increasingly important when considering surgical management.

A Clinical Focus published in Medical Journal of Australia outlines the ways cancer specialists are looking toward the future when determining the best outcomes for their patients. Professor Andrew Spillane from the University of Sydney and President of Breast Surgeons of Australia and New Zealand explained that the focus of surgical management has undergone a major evolution.

“If the best treatment for breast cancer is thought of as a package of care, rather than a series of independent therapies, then understanding the multifaceted implications of each component allows for increased flexibility in delivery of care and a range of benefits for the patient,” he wrote.

Improvements to surgical management and prevention include:

  • An increasingly common recommendation for chemotherapy before surgical treatment, with studies having shown this results in lower mastectomy rates, broader surgical options and less surgical morbidity.
  • The use of oncoplastic breast surgery, which combines the principles of breast oncological surgery with aesthetic techniques borrowed from plastic surgery.
  • The recommendation that women be offered immediate breast reconstruction when appropriate, which has been seen to improve quality of life and help women recover from the psychological trauma of surgery; however, uptake rates have remained low in Australia compared to other countries.
  • Increased information available to patients and their doctors about breast cancer risks from lifestyle choices, family history and previous hormonal exposures. This information gives women an opportunity to reduce risk factors, be monitored appropriately for their level of risk, and for those with a high level of familial risk, other preventive options can be discussed.
  • The recommendation that breast cancer patients should be managed by a multidisciplinary team, made up of representatives from the relevant medical, nursing and supportive care specialities, minimising the chance of any bias from individual specialists.

Article: What is new in the surgical management and prevention of breast cancer? Andrew J Spillane, Medical Journal of Australia, doi: 10.5694/mja16.00002, published 2 May 2016.