Thursday, January 27

Chemo before surgery better for early stage breast cancers

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Preoperative chemotherapy allows clinicians to directly observe the effects of chemotherapy on a breast cancer so that further treatment can be tailored according to the response.

PATIENTS with locally advanced or some early stage breast cancers can benefit from a new treatment programme

Chemotherapy may form part of the first line of treatment before surgery for patients with locally advanced or some early stage breast cancers, under a new programme at the SingHealth Duke-NUS Breast Centre.

Having a patient undergo chemotherapy as early as possible allows the whole body to be treated and any circulating cancer cells present to be targeted.

Doing this lowers the risk of the cancer spreading, allows doctors to observe how well the tumour is responding to chemotherapy, and helps shrink the breast tumour, facilitating breast cancer surgery.

If chemotherapy is able to shrink the tumour significantly, a smaller area of the breast may need to be removed. For some patients, a mastectomy can be avoided, allowing them to safely opt for breast-conserving or reconstructive surgery instead, said Dr Veronique Tan, Consultant, SingHealth Duke-NUS Breast Centre.

“Surgery remains necessary as residual live tumour cells are often present. Essentially, patients who respond well to preoperative chemotherapy have more surgical options,” said Dr Tan, who specialises in oncoplastic breast surgery.

Because preoperative chemotherapy allows clinicians to directly observe the effects of chemotherapy on a breast cancer, further treatment can be tailored according to the response, said Dr Lee Guek Eng, Associate Consultant, Division of Medical Oncology, National Cancer Centre Singapore (NCCS).

“If the cancer completely resolves after preoperative chemotherapy, this heralds a good sign for the patient. This group of patients tends to have a better outcome. Conversely, for patients with cancers that hardly shrink with chemotherapy, we can then react early by including additional chemotherapy options or expediting surgery,” said Dr Lee, who is part of the team behind the programme.

Another is Dr Rebecca Dent, Senior Consultant, Division of Medical Oncology, NCCS, who said that preoperative treatment is widely practised in the US and the UK. Up to 80 per cent of patients will respond favourably to chemotherapy, with the response rate usually higher for more aggressive breast cancers, underscoring the case for starting chemotherapy early for these patients.

A few patients have been put on the Preoperative Breast Cancer Programme since it started in October 2014. A dedicated nurse clinician coordinates the patient’s care journey, ensuring that her needs, investigations and treatment are efficiently and smoothly carried out, said Dr Benita Tan, Senior Consultant, SingHealth Duke-NUS Breast Centre.

“This expedites patient care as it avoids redundancies and improves waiting times for treatment, and is a huge benefit for our patients,” said Dr Tan. The SingHealth Group is redesigning the way health care is provided, and the set-up of the Breast Centre brings specialists with different expertise together. The Breast Centre functions as a multidisciplinary team where breast surgeons work closely with medical and radiation oncologists, plastic surgeons, radiologists, pathologists, pharmacists, rehabilitation therapists, nurses and medical social workers from Singapore General Hospital and NCCS.

“We are essentially putting the patient in the middle and placing a whole medical team that will adequately address her needs around her,” said Dr Ong Kong Wee, Head and Senior Consultant, SingHealth Duke-NUS Breast Centre.

  • This story was first published in Singapore Health, Jan-Feb 2015.