Download Breast Cancer - Professor Mohammed Keshtgar

Breast Cancer - Professor Mohammed
Keshtgar
Speaker key
IV
MK
Interviewer
Prof Mohammed Keshtgar
MK My name is Professor Mohammed Keshtgar and my talk was about breast
cancer diagnosis, treatment and also the recent advances that we have made in this
field.
IV
How common are breast cancers and which age groups do they affect?
MK Breast cancer is an extremely common disease. It is actually the commonest
female cancer worldwide and within our country in the United Kingdom one in eight
women during their lifetime they can get breast cancer. It’s usually the disease of
post-menopausal but we are actually seeing younger and younger women.
IV
What are the differential or benign diagnoses?
MK The majority of the patients who come to our clinic they are referred by our
general practitioners and the majority have got symptoms. Most symptoms are lumps
and also we see quite a lot of patients with breast pain and, of course, in my practice
for every 30 to 40 women that I see in my clinic I diagnose one cancer. So it can give
you an idea how many what we call worried well we actually see in our practice.
So the majority have got either no significant disease in their breast or they have got
benign conditions in the breast. However, every single woman who comes to the
clinic is extremely worried about their disease so that’s why we see a lot of worried
well.
IV
Are there any common pitfalls either in diagnosis or treatment to try and
avoid?
MK Yes. I mean, of course, one of the pitfalls is that we are seeing younger and
younger women and the assumption is that if the woman is a young woman then the
disease is benign. However, I think we should have a high level of suspicion and if
you find the lump in even a young woman, it requires being referred and being
assessed and confirmed or refuted the nature of the disease.
IV
What happens once a patient is referred to a breast clinic?
MK So all symptomatic breast patients are regarded as a two week target referral
anyway. As I outlined, we see them, we take history, examine them, and then
depending on the age of the patient we decide on the appropriate imagining,
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mammography, ultrasound, sometimes MRI scan, and if we find an abnormality we
can do a guided needle biopsy of this to get the diagnosis.
All of these patients get what we call the triple assessment in the same visit so that we
can expedite the diagnosis of their disease.
IV
What is the prognosis?
MK We have made a huge amount of progress in treating breast cancer to a degree
that the majority of our cancers, because of the increased awareness and also to an
extent because of the screening programme, we are seeing earlier and earlier stage
breast cancer. Taking that, coupled with the advances that we have done in multimodality treatment in breast cancer, the prognoses are extremely good, to an extent
that most of them, the majority of breast cancer patients, are sort of regarded, and
early breast cancer can be regarded, as a type of a chronic disease.
That’s why we also emphasise not only on the oncological treatment but also on the
aesthetic outcome of these patients to make sure that because they are going to live
very long with the outcome of the surgery and the treatment, we not only would like
to give them a best oncological treatment but also best aesthetic outcome from their
operations.
IV
Are there going to be any advances in diagnosis and treatment in the future?
MK I am glad to say that we have actually got the first dedicated Breast PET at the
Royal Free Hospital. It’s the first in the country and third in the world. We are now
entering in the era of functional imaging of the breast to diagnose the disease at the
very early stage and also hopefully be able to, in a young woman, diagnose the
disease and also to monitor response to treatment. We need as clinicians to take
advantage of the period that women are in as they are diagnosed to give them not only
advice regarding their treatment but also give them lifestyle advice and dietary advice.
And also, as I mentioned, we are moving away from radical mutilating type surgery to
minimally invasive surgery and my line of research is hopefully to go into noninvasive treatment of breast cancer and that’s the next challenge for us.
And also there has been a significant improvement in the radiotherapy with the new
innovations in radiation and also a lot of advances in the multi-modality
chemotherapy and endocrine treatment in breast cancer. So we have got a way to go
but we have made quite significant advances.
IV
Where can GPs find out more?
MK So there is a huge amount of information on the web and various recognised
charities have got quite comprehensive information for the patients. However, I will
be more than happy to be contacted at the Breast Unit at the Royal Free Hospital and
my email address is [email protected].
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