The Strathfield Breast Centre

Comprehensive care through an integrated team approach

A/Prof David Gillett and A/Prof Hugh Carmalt, both of whom are breast surgery specialists, established The Strathfield Breast Centre in 1989.

The Centre centralizes the expertise of surgeons, a breast physician, radiology, pathology, radiation and medical oncology, specialist breast nurses, plastic surgery, palliative care for optimal patient care. A research and data manager supports a strong Centre commitment to research.

Weekly multidisciplinary meetings provide a forum for discussion and consensus on optimal patient management on a case-by-case basis. Teaching opportunities for junior staff are also a feature of these meetings. Monthly clinical meetings examine new innovations in the management of breast disease as well as allowing the team members to review current research projects.

One Stop Shopping

We appreciate that women with a lump or an abnormal mammogram will be frightened and anxious which is why we provide rapid and accurate investigations to ensure that a diagnosis and where necessary a treatment plan is available on the day of consultation.

Multidisciplinary Cancer Care

Every year, The Strathfield Breast Centre diagnoses and treats more than 300 cases of breast cancer. We provide the most advanced, comprehensive breast cancer treatment available, making every effort to preserve the breast, which we achieve in the majority of cases. In cooperation with Strathfield Private Hospital and selected public hospitals, The Strathfield Breast Centre provides the most advanced on-site care.

Second Opinion Service

If you’ve been told you have breast cancer, or if you’re worried about a breast lump or abnormal mammogram, you’re undoubtedly anxious and perhaps confused by the increasingly complex diagnostic and treatment options available to you. The Strathfield Breast Centre can help. We’ll explain your choices and assist you in making the important decisions that lie ahead.

With our Second Opinion Service (SOS) you’ll be seen as an urgent consult. At the conclusion of your consultation you will have a clear idea about your treatment options and your general practitioner will receive a letter within 48 hours explaining our recommendations.

Breast surgery

Surgery remains the first line treatment for early breast cancer. Surgical therapy has two components:

  • The breast 
  • Draining lymph nodes (in the arm pit) 
The Breast

In our unit, 60% of cases undergo breast-conserving surgery. The principle is to remove the tumour with a surrounding rim of normal breast tissue, while at the same time, achieving an acceptable cosmetic result. Sometimes, a second small operation is required to obtain a clear surgical margin. Postoperative radiotherapy is almost always required after breast conserving surgery.

Some women still require a complete mastectomy because of the pathological nature of the tumour or because the size of the tumour in relationship to the size of the breast would result in an unacceptable cosmetic outcome. A number of women elect to have a mastectomy, most commonly because radiotherapy can often be avoided after total removal of the breast. All women who have mastectomy are offered breast reconstruction by one of our plastic surgeons.

Draining Lymph Nodes

Invasive breast cancer will spread to the lymph glands in 40% of cases. It is therefore very important to know if this has happened in order to plan optimal further management such as chemotherapy or hormonal therapy.

The lymph node status is assessed by removing the Sentinel Lymph Node (SLN). The SLN is the first lymph node that a breast cancer will spread to (if it spreads). It is usually situated in the Axilla (armpit), and is occasionally found in other places such as the lymph nodes behind the sternum (breast bone).

The SLN is identified by pre-operative mapping of the draining lymph nodes by lymphoscintigraphy or the use of blue dye at the time of operation. A radioactive substance, blue dye, or both is injected near the tumour to locate the position of the sentinel lymph node. The surgeon then uses a device (gamma probe) that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incision (about 3-4 cm) in the overlying skin and removes the node.

If the SLN has significant tumour involvement, removal of more lymph nodes (axillary dissection) may be necessary.

Axillary dissection may lead to shoulder stiffness and restriction of movement. It may also cause numbness down the inside of the upper arm and in 10-15% of cases, it may result in long term swelling of the arm known as lymphoedema. These side effects are very uncommon following SLN biopsy.

Most breast cancer surgery requires a short hospital stay (Day Only or “24 hour” admission).  Patients who have a mastectomy or axillary dissection will usually have a drain left in after surgery which may need to remain in place for a week or more. A specialist breast nurse will help with its management at home.

If you have a question, e-mail us at: info@tsbc.com.au

Breast medicine
Role of Specialist Breast Physician

Breast Physicians are skilled in clinical breast examination, mammographic interpretation, the performance and interpretation of breast ultrasound, and the performance and interpretation of fine needle and core breast biopsies. Most importantly, a breast physician correlates all these test results and can explain the outcome to the patient and her referring practitioner.

Breast physicians can provide information to the patient concerning their investigations and provide a plan of management for their breast problem. They can organise appropriate referral to other members of the multidisciplinary team and are skilled in counselling.

A specialist breast physician is particularly interested in the diagnosis and management of benign breast disease, and in the care of women with a personal or family history or other high risk factors for the development of breast cancer.

Most women presenting to a breast physician will have a favourable outcome at the end of their assessment. Most women will have normal breasts and their symptoms will be due to benign breast disease, hormonal changes, muscular skeletal effects or a combination of these.

Breast physicians see women with a variety of breast concerns: lumps, minor hormonal changes, breast pain, skin changes, lactation problems, family history of breast cancer, anxiety due to a friend having breast cancer or as part of their general health check.

Yes, we see men as well.

Some women will have had tests performed elsewhere and require a second opinion on these results or simply an explanation of their breast problem. Breast physicians are happy to discuss any breast problem, however minor you may think your concern is.

Specialist breast nurses
  • The diagnosis of breast cancer can be a traumatic and emotionally distressing time for every individual and their family. We understand breast cancer can have an impact on your personal and professional life and leave you feeling confused and overwhelmed.

Breast Care Nurses are specially trained to identify and meet your needs after the diagnosis of breast cancer and during the course of treatment. Breast Care Nurses work as part of the multidisciplinary team involved in your care and aim to provide you with optimal health care and services. We also provide you information (verbal & written) that you may need relating to your disease or treatment.

Our aim is to make your experience of breast cancer a little easier by being available and supportive to you and your family each step of the way.

Col Deguchi - specialist breast nurse at Concord Repatriation General Hospital. 

 

We recognize that you may have many concerns and questions about the impact breast cancer and treatments may have on your life. These may include such issues as:

  • Clarifying information
  • Impact on family and friends
  • Treatment side effects and benefits of treatments
  • Dealing with your emotions such as sadness, grief, anger, and anxiety
  • Access to temporary and permanent breast prostheses
  • Sexuality and body image
  • Cultural and Spiritual needs
  • Communication to your loved ones
  • Relaxation methods
  • Community Supports available to you and your family
  • Exercises

Your Breast Care Nurse is a vital link to ensure that you will receive the right service assisting you on the recovery road from breast cancer. If you have any concerns or questions, please feel free to contact us at: info@tsbc.com.au

Radiation oncology

Adjuvant (supplemental) radiation therapy uses high-energy rays (such as X-rays) to kill cancer cells or shrink tumours. Most commonly, radiation therapy is used to kill any cancer cells that remain in the breast, chest wall or underarm area after surgery. It is also used to treat the healthy breast tissue that remains after a lumpectomy – not to kill cancer cells that have remained, but to radiate the tissue to prevent it from creating breast cancer cells again.

The Strathfield Breast Centre has three radiation oncologists as part of its multidisciplinary team. Advice is provided concerning the role of radiotherapy in breast conservation both for breast cancer and for ductal carcinoma in-situ (DCIS). The role of radiotherapy following mastectomy is discussed as well as its role in the metastatic setting. 

Dr Susan Carroll MB BS FRANZCR

Susan Carroll is a Senior Staff specialist in Radiation Oncology at the Chris O’Brien Lifehouse situated at Royal Prince Alfred Hospital Campus in Camperdown and the Concord Cancer Centre located at Concord Repatriation General Hospital. Susan consults at Lifehouse, Strathfield Private Hospital and Concord Cancer Centre. She subspecialises in Breast cancer and actively participates in translational and clinical research in collaboration with the Garvin Institute, and the Trans-Tasman Radiation Oncology Group.

The treatment machines are situated in the Radiation Oncology Department at Lifehouse in Camperdown on the Royal Prince Alfred Campus and are equipped with state of the art technology. Here Susan works with a wonderful team of dedicated and experienced professionals. The department has free, on-site dedicated parking for patients on treatment.

Dr Rebecca Chin MB BS (Hons) FRANZCR

Rebecca Chin is an experienced Radiation Oncologist with the Multi-Disciplinary Breast Team here at The Strathfield Breast Centre. She has been delivering comprehensive breast treatment for the last twenty years in her role as a consultant Radiation Oncologist. Rebecca regularly attends national and international meetings to keep abreast of recent advances in treatment, new technology and the evolving role of radiotherapy in various cancers. Such meetings provide radiation oncologists with the scientific basis for current therapeutic managements as well as providing the opportunity for personal networking between peers in this speciality field.

Rebecca treats patients at the Sydney Adventist Hospital, Wahroonga. The Practice has 2 linear accelerators with special equipment for accurate planning of treatment, with 3 dimensional conformal radiotherapy and intensity modulated radiation therapy (IMRT). During 2014 a new department became functional, with a state of the art tomotherapy unit being available for treatments as well as 2 new linear accelerators. At the Practice a dedicated radiotherapy, physics and nursing staff supports Dr Chin in providing external beam therapy and brachytherapy.

Dr Verity Ahearn MB BS FRANZCR

Verity was appointed a staff specialist at Westmead, now the Crown Princess Mary Cancer Centre(CPMC), in 1996. Following specialty training at Westmead, Verity undertook a Fellowship in paediatric radiation oncology in Toronto, Canada, and then worked for three years at Guy’s and St Thomas’ Hospitals in London in a busy breast cancer practice as a Fellow and locum consultant. Verity is now the Director of the Sydney West Radiation Oncology Network (Westmead, Nepean, and Blacktown). She has been involved in the development of patient and clinician guidelines for breast cancer through the National Breast and Ovarian Cancer Centre as well as the Cancer Institute NSW.

Verity has been the principal investigator of several national and international breast cancer clinical trials in which women from Westmead have participated. She is the Trial Chairperson of the Trans-Tasman Radiation Oncology Group trial “PET scans for locally advanced breast cancer and diagnostic MRI to determine the extent of operation and radiotherapy (PET LABRADOR).

CPMCC has four linear accelerators and all patients are managed with the best available technologies, while remaining focussed on the care of the individual with a dedicated team of radiation therapists, nurses and physicists.

 

Medical oncology and cancer genetics

You may be referred to a medical oncologist at The Strathfield Breast Centre for advice regarding systemic treatment. Referral may occur before or after your operation or for advice at any time during your follow-up.

Hormonal therapy and chemotherapy are systemic treatments for breast cancer. One or both of these treatments may be recommended after surgery for breast cancer.

Chemotherapy treatment uses drugs to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. Chemotherapy, often shortened to just "chemo," is a systemic therapy, which means it affects the whole body by going through the bloodstream.

There are many chemotherapeutic drugs which are improving and evolving continuously... In many cases, a combination of two or more drugs will be used as chemotherapy treatment for breast cancer.

Both hormonal therapy and chemotherapy are used to treat:

  • early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back
  • advanced-stage breast cancer to destroy or damage the cancer cells as much as possible

In addition to chemotherapy and hormonal therapy, there is Herceptin (trastuzumab) which is a monoclonal antibody and has been around for a number of years but its use was restricted to patients with advanced breast cancer. That all changed on 1st October 2006 when it was listed on the PBS and made available as adjuvant therapy to prevent the cancer returning.

Read more

 

Plastic and reconstructive surgery

When a patient needs to undergo some form of tumour excision, which will alter the appearance of the breast, she may wish to consider surgery to restore breast symmetry, or to fully reconstruct her breast in the case of mastectomy.

There are an array of procedures, which are available to work towards this ultimate aim of achieving symmetry of good breast shape with a desired breast volume:

  • Breast Reconstruction
  • Breast Reduction
  • Breast Augmentation
  • Mastopexy (breast lift)
  • Nipple/areola reconstruction

Within each of these groups of procedures there are a number of alternative techniques which a Plastic surgeon would discuss with you, bearing in mind other factors such as your health, age, work, lifestyle, sporting/recreational activities, to help select an appropriate surgical plan. This may provide the opportunity to alter the final size and shape of your breast to suit changes previously considered but not acted upon. For example, the reconstruction of a smaller breast after mastectomy, with reduction of the other breast for symmetry.

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Advanced breast cancer

"Advanced breast cancer" includes both locally advanced and metastatic breast cancers.

Patients with locally advanced disease encompass a wide range of clinical scenarios including advanced primary tumors (stage T4), advanced nodal disease (fixed axillary nodes or involvement of ipsilateral supraclavicular (nodes under the collar bone on the same side as the breast cancer), or internal mammary nodes), and inflammatory carcinomas. This is often referred to as Stage III breast cancer.

Metastatic breast cancer, also referred to as metastases, secondaries or Stage IV breast cancer is a stage of breast cancer where the disease has spread to distant sites beyond the axillary lymph nodes.

Advanced breast cancer is usually treated with systemic therapy (drugs that travel through the bloodstream, reaching and affecting cells in the body). Systemic therapy includes hormonal treatment, chemotherapy, and targeted therapy.  Radiation therapy also has a part to play especially if bones are affected.  Palliative Care often forms part of the management plan for patients with life-threatening advanced breast cancer.

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Histopathology

Specialist Pathologists from Concord Hospital Pathology Department, Healthscope Pathology and Douglass Hanly Pathology provide a comprehensive pathology and cytology service for patients attending the Strathfield Breast Centre. This service is provided by means of written reports and also by attendance at weekly Multidisciplinary Team Meetings. The aim of the Pathologist is to provide information to the Multidisciplinary Team that will assist in providing treatment that is tailored specifically to the individual patient.

An important step in the evaluation of patients with a breast lesion is fine needle aspiration biopsy (FNAB) or core needle biopsy (CNB). These techniques may be used to diagnose both benign and cancerous lesions in the breast. A sample of breast tissue is provided to the Pathologist so that any abnormality can be diagnosed and if necessary a treatment plan discussed with the Surgeon. If the diagnosis is breast cancer then it is likely that wide local excision or mastectomy will be performed with or without lymph node sampling, so that all the features of the cancer can be assessed by the Pathologist. There are many subtypes of breast cancer and it is not just one disease. Correctly categorizing the cancer of each patient is important so that the best treatment can be given. The Pathologist will examine the cancer microscopically to evaluate features that are of ‘prognostic’ importance such as the size and grade of the cancer as well as information concerning possible spread of the cancer cells to local lymph nodes in the armpit. In addition there are features of the cancer that the Pathologist assesses and that are used to determine any further treatment. These ‘predictive’ factors include the presence of oestrogen and progesterone receptors (ER and PR)on the cancer cells. When these are present there is likelihood that the growth of any remaining cancer cells in the patient may be controlled by endocrine therapy. Some breast cancer cells may overexpress HER2 a receptor that is on the surface of the cells and that is associated with a poor prognosis. Patients with this form of cancer would be considered for specific anti-HER2 therapy.

Newer classifications of the different subtypes of breast cancer have been proposed that employ analysis of the genes that control the growth of individual cancer cells. The main breast cancer subtypes identified in this way are called luminal A, luminal B, HER2-enriched and basal-like. These subtypes have been shown to be prognostically significant and their use may also help us to provide more specific treatment targeted to the individual patient; so called “targeted therapy”. Other tests examining the genes that are found in breast cancer cells are also available. Two of these are Mammaprint and Oncotype DX and they can be used to divide patients into various prognostic groups thereby assisting in making an informed decision on chemotherapy choices. So far the gene tests providing this information are available only in specialist laboratories and breast cancer samples may have to be sent to specific laboratories in centres most of which are in the USA. However the Pathologist reporting on any breast cancer can apply a “surrogate” set of tests to the cancer sample that simulates the gene testing and using the combination of the 4 markers ER,PR, HER2 and Ki-67. The latter is a measure of the growth of the cancer cells.

Radiology

Healthcare Imaging Services (Strathfield Imaging Centre) is collocated with The Strathfield Breast Centre in Strathfield Private Hospital. It is equipped with modern technology, and the specialized experience of the radiologists, radiographers and ultrasonographers make this unit a centre of excellence in breast radiology. Approximately 5,000 mammogram examinations are performed each year using dedicated mammography machines. Diagnostic techniques include high resolution breast ultrasound, stereotactic- and ultrasound-guided core biopsies, fine needle aspirations, preoperative localization procedures and galactograms. The hospital department is also equipped as expected in a teaching hospital, so x-ray examinations and CT scanning can usually be done without prior booking at the time you visit your breast specialist. Particular attention is paid to maintaining optimal quality of mammograms through daily testing of equipment.

Mammography is still our best diagnostic tool in the early detection of breast cancer. In some instances, however, a mammogram may be inconclusive and breast ultrasound can be performed on the spot all within the same visit. Mammography and ultrasound complement one another, allowing the doctor to differentiate between common benign cysts and solid lesions requiring still further tests.

A fine needle aspiration biopsy may be offered, guided by ultrasound or a mammogram machine. The passage of a very thin needle into the area of concern allows collection of cellular material to be examined by a pathologist. Within one working day, and often the same day, the result will be available to your breast specialist. A core biopsy of the breast is just as commonly required and is guided by the same methods; it has the benefit of allowing a more specific diagnosis from the pathologist, which in days gone by would have required a surgical operation.

A galactogram is another specialized procedure available at our centre. By introducing an x-ray dye the radiologist is able to obtain an accurate picture of the ducts in cases of a nipple discharge.

These examinations are carried out in a private environment. The common experience elsewhere of waiting days for results is eliminated as your breast health concerns are addressed at the time of your visit.

Staff at Strathfield Imaging Centre are trained to understand how you may feel when a mammogram or biopsy is needed and to welcome you warmly. A radiologist is always present to address your unique needs. You are not alone.