We’re at the cutting edge of research
Research, teaching and education form a very important part of activities at The Strathfield Breast Centre. Our commitment is to a broad spectrum of research, which has relevance for prevention, early detection, diagnosis, treatment, rehabilitation and palliation for people impacted by breast cancer.
Critical to these goals is the comprehensive prospective data collection of patient information including demographics, together with data describing diagnosis, surgical management and adjuvant therapies. Outcome, which is the determinate of survival, is monitored by regular update of patient status. Where appropriate, patients have been encouraged to return for regular review of alternatively, contact has been maintained through the patients’ general practitioners. Therefore we are able to benchmark our outcomes with those published in the national and international literature.
To ensure “best practice” is maintained and that our standards are in keeping with the NHMRC Clinical Practice Guidelines for the Management of Early Breast Cancer, we are continually evaluating what we are doing and looking at avenues for quality improvement.
Surgery remains the cornerstone of breast cancer treatment. Dr William Halstead, in the late nineteenth century, described what was considered optimal surgical treatment for breast cancer which remained the bench mark for more than a hundred years. Since that time, surgical management for breast cancer it has been refined by disciplined surgical studies and scientific trials. The cosmetic and functional damage has been minimised without compromising survival. Survival has increased from 40% five year survival in Halstead’s time to 87% five year survival at The Strathfield Breast Centre.
Evolution of Breast Cancer Surgery and the Concomitant Improvement in Survival
Cancer of the breast has been described for centuries; the recognition of the “bulging tumours of the breast” is recorded in the valuable Edwin Smith Papyrus of 1600 B.C. found at Thebes in Egypt in 1862 and translated by Breasted.1 Treatment was limited to two methods – either burn the lesion with fire, or remove it with a sharpened instrument.
Leonides, a Greek physician of the first century A.D. working in the great medical school at Alexandria, is believed to have been the first to carry out a surgical removal of the breast.2 His technique was to cut into normal breast tissue wide of the tumour. Leonides employed cautery to control bleeding, and to destroy residual tumour. He also advised that surgery was not indicated if the whole breast was hardened, or if the tumour was fixed to the chest wall. It is probable that Leonides was the first to recognise that breast cancers spread to the axilla. Nearly two millennia were to pass before any innovation would develop in the battle against breast cancer.
The staff at The Strathfield Breast Centre has a strong commitment to developing new knowledge and understanding of breast cancer and its treatments. Complimenting this is the desire to communicate new and novel findings to others. This may be done through professional society journals, national and international conferences, and less formal means such as this web site or even social networking tools.
Measuring outcomes is a five step process:
- Identify outcomes and develop performance measures.
- Create and implement a data collection plan: valid and reliable data is the backbone of programme analysis.
- Analyse the data.
- Communicate the results.
- Reflect, learn, and do it again.
These principals have been rigorously applied in the outcome measurement at The Strathfield Breast Centre.
The American Joint Committee on Cancer (AJCC) and the International Union for Cancer Control (UICC) maintain the TNM classification system as a tool to describe the extent of the cancer in the body. It is based on whether the cancer is invasive or non-invasive, the size of the tumor, how many lymph nodes are involved, and if it has spread to other parts of the body. It’s updated every 6 to 8 years to include advances in our understanding of cancer.
Staging Breast Cancer
To further define our patient population, all patients with a diagnosis of breast cancer are staged according to the TNM system.
The stage of a breast cancer can be based either on the results of physical exam, biopsy, and imaging tests (called the clinical stage), or on the results of these tests plus the results of surgery (called the pathologic stage). The staging described here is the pathologic stage, which includes the findings after surgery, when the pathologist has examined at the breast mass and nearby lymph nodes. Pathologic staging is likely to be more accurate than clinical staging, as it allows the doctor to get a firsthand impression of the extent of the cancer.
The Strathfield Breast Centre holds regular continuing education sessions, which focus on the investigation, diagnosis and management of breast pathology.
Every Friday Morning at 7.00 am the weeks work is reviewed in the Conference Room at Strathfield Private Hospital. The meeting begins with a radiology session to review mammograms and breast ultrasounds. This is a multidisciplinary meeting involving surgeons, radiologists, medical and radiation oncologists. Participants also bring private films for review and we would be pleased to discuss any films you may wish to bring. Following this, there is a review of the weeks interesting histopathology presented by pathologists using the latest video-microscope technology. The meeting concludes with case presentations of newly diagnosed patients with breast cancer. This provides the opportunity to discuss treatment options and plan optimal management in the multidisciplinary setting. All medical practitioners are encouraged to attend these meetings. Breakfast is provided.