A multidisciplinary team approach to breast cancer treatment
Breast cancer is a complex and serious disease, and during the course of treatment the patient will encounter many different individuals with different specializations and assets. A patient is likely to either work with or be evaluated by: a radiologist, a surgeon, nurse, a radiation oncologist, general practitioner, pathologist, psychologist, social worker, clinical oncologist, hemato-oncologist, medical technologists, and possibly a gynecologist. Some breast cancer treatment centers also include consultation with a specialized ‘geneticist‘. In some cases a woman might be working with a reconstructive-plastic surgeon as well.
This page is getting somewhat kind of old, but don’t get me wrong, it still has fantastic material and I would still put it to use. However, I have created a newer version of this page with more up-to-date information on The Multidisciplinary Team to Breast Cancer Treatment.
Breast cancer treatment requires a solid support network
Supportive care is also an integral part of breast cancer treatment and recovery, as breast cancer treatment places huge stresses on individual and family resources. Consultation and counselling by a psychologist and social working is often highly beneficial. Breast cancer treatment might also involve consultations with a pharmacist, a dietitian, and a physical therapist. A gynecologist might not seem like an obvious member of a breast cancer treatment team. Often a gynecologist will perform a breast mammogram as part of a general visit or screening for other cancers. A gynecologist can also frequently offer a valued ‘objective second opinion‘, especially with regards to the choice of mastectomy vs. breast conserving surgery.
Multi-disciplinary team approach for breast cancer ensures the best options and results
Depending on the unique characteristics of a particular breast cancer, a woman may encounter greater or lessor numbers of medical personnel. Sometimes the size of the hospital or town in which a patient resides and is getting treatment can also have a bearing on the number and range of professionals on the team. However, geographical remoteness in this day and age should not be an impediment to quality multidisciplinary care. And, with the advantage of having a treatment team from a variety of specialties, it is more likely that these professionals will be knowledgeable on the latest clinical trials and multi-modal treatment options.
With breast cancer treatment, there are many decisions
It should also be remembered that there is a balanced role between the choices that a patient should make herself, and choices that should best be left to the considered opinion of the medical team. Where possible, treatment decisions should only be made when all the available diagnostic results and experts opinions have been gathered. The patient generally has as much input into their treatment plan as they wish, and should be informed about their treatment choices.
However, there are also hard costs to medical diagnosis and treatment and at a certain point a realistic decision must be made based on available resources, known diagnostic features of the breast cancer, and prudent treatment measures based on known and effective results. Women with early-stage breast cancer tend to have access to the most beneficial adjuvant treatment therapies when a multidisciplinary-team approach is utilized.
The breast cancer ‘core’ treatment team involves the surgeon, pathologist, radiologist, and oncologist
The role of the radiologist in breast cancer management will vary during the diagnostic and treatment phases. A radiologist plays the primary role in the initial diagnosis of breast cancer in the identification of suspicious lesions on screening X-rays, ultrasounds, and MRI’s. Subsequently, a radiologist also performs pre-biopsy wire localization, pre-surgical planning, and evaluation of post-operative breast cancer success.
Breast cancer is diagnosed by the pathologist
The pathologist plays a pivotal role in the differential diagnosis and confirmation of breast cancer. The pathologist will exam cell samples taken from the tumor and through a variety of tests, either confirm of exclude the diagnosis of breast cancer. A pathologist also helps determine the aggressiveness of the cancer and the extent of any spreading or ‘metastasis‘, helps in suggesting treatment, and also helps in the evaluation of successful breast cancer treatments.
Most breast cancer treatments involve surgery
The primary treatment modality for breast cancer is through surgery. Therefore, the central role in breast cancer treatment truly falls upon the surgeon. However, surgeons will not act without a clear treatment plan, established in consultation with the all members of the team, and especially the radiologist and pathologist, and also with the women herself. Surgery is often required in the excision of small tissue samples for biopsy analysis, usually from the suspected tumor but often from the lymph nodes as well. And of course, the surgeons performs the lumpectomy or mastectomy, as required.
The true breast cancer expert is the oncologist
The oncologist is a specialist in all kinds of cancer, including breast cancer. Usually, the breast cancer treatment team counts on the input of the oncologist for an opinion on the best treatment approach for a particular type of breast cancer, and to keep up on the very latest treatment studies and trials. In fact, it is the oncologist who typically determines and administers chemotherapy treatments. A hemato-oncologist is a specialist in diagnostic elements of cancer as found in the blood. They play a pivotal role in finding specific breast cancer ‘markers‘, suggesting chemo therapies, and monitoring treatment success.
Good communication is vital for breast cancer treatment
It is important to recognize a patient’s needs, to respect each other, and to maintain good communication in a climate of respect among all team members. Breast cancer treatment can be very stressful, and through good communication and informed involvement from all team members, patient motivation remains high.
For further reading, I suggest you visit this page with information on breast cancer staging vs. screening, and go to this page that has information on the hormone receptor status of breast cancers.
References
- Marsh, CJ., Boult, M., Wang, JX., Madeem, GJ., Roder, DM., Kollias, J. National Breast Cancer Audit: the use of multidisciplinary care teams by breast surgeons in Australia and New Zealand Med J Aust 2008; 188 (7): 385-388.
- Gillis CR, Hole DJ. Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ 1996; 312: 145-148.
- Frost MH, Arvizu RD, Jayakumar S, et al. A multidisciplinary healthcare delivery model for women with breast cancer: patient satisfaction and physical and psychosocial adjustment. Oncol Nurs Forum 1999; 26: 1673-1680.
- Luxford K, Rainbird K. Multidisciplinary care for women with breast cancer: a national demonstration program. NSW Public Health Bulletin 2001; 12: 277-279.
- Tulloh BR, Goldsworthy ME. Breast cancer management: a rural perspective. Med J Aust 1997; 166: 26-29.
- Houssami N, Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer, 2006, 42, 2480-2491
- Ruhstaller T, Roe H, Thurlimann B, Nicoll JJ. The multidisciplinary meeting: an indispensable aid to communication between different specialities. Eur J Cancer, 2006, 42, 2459-2462.
- Pruthi, S., Brandt, KR., Degnim, AC., Goetz, MT., Perez, EA., Reynolds, CA., Schomberg, PJ., Dy, GK., Ingle, JN.A Multidisciplinary Approach to the Management of Breast Cancer, Part 1: Prevention and Diagnosis Mayo Clinic Proceedings August 2007 vol. 82 no. 8 999-1012
- Sarah Lewis, Craig A. White, Liam Dorris, (2005) "Psychosocial care within a multidisciplinary breast cancer team", Clinical Governance: An International Journal, Vol. 10 Iss: 4, pp.304 – 307
- Kane B, Luz S, O’Briain DS, McDermott R. Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments. BMC Med. 2007 Jun 13;5:15.
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