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Sat, 15 Jun 2019 08:23:22 GMT

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Breast Cancer Recurrence

Mon, 21 Aug 2017 16:00:00 GMT

“Research has revealed that 69% of patients are worried that their cancer may recur.”

This is a very high percentage of people who may be experiencing anxiety and fear of recurrence of breast cancer.

Following a diagnosis of cancer it is important to have resources available which help to maintain a good quality of life. The following article from BCNA outlines and provides links to resources designed to provide strategies to deal with these fears. This includes discussions from health professionals and information on ongoing care.

If you feel that fear or anxiety is having a negative impact on your life, it is important to talk to your treating doctor or GP.

Creating a More Comfortable Breast Prosthesis

Tue, 15 Aug 2017 16:00:00 GMT

“Breast Research Australia (BRA) at UOW is aiming to improve the quality of life of women after breast cancer surgery.”

Breast prosthesis can help to restore self image and femininity. This is why BRA are conducting much needed research into the design and comfort level of breast prosthesis. A breast prosthesis can sometimes feel uncomfortable for some women, depending on many factors. Research involving women who have used or are currently using a prosthesis will ensure it continues to improve the quality of life of women after breast cancer surgery.

To read the full article and access contact information to be apart of this research please click here .

Combat Cancer with Your Community this Daffodil Day

Sun, 30 Jul 2017 16:00:00 GMT

Daffodil Day Friday 25th August

Cancer Council Victoria is reminding people how important community participation on Daffodil Day is to raise funds for cancer research, prevention programs and support services.

"We want to beat cancer through more research, through educating the public on ways to prevent cancer and by helping people who have cancer get the best treatment and care."

For more information on getting involved this Daffodil Day, click here .

Lessons Learned the Hard Way

Tue, 06 Sep 2016 16:00:00 GMT

"How I fought displacement and redundancy to keep my job post Breast Cancer."

Several of our patients have been subjected to workplace discrimination after their breast cancer diagnosis. Either in the form of unfair dismissal whilst on treatment, or simply a lack of understanding while trying to arrange a return to work post-treatment. We see widespread misunderstanding in the workplace that the end of chemotherapy or radiotherapy signals the end to any need for work flexibility or compassion. Many patients still struggle emotionally after the treatment for a breast cancer diagnosis and the workplace will not always instinctively be so supportive.

This personal story is truly illustrative of the problem. If you find yourself in need of the legal or workplace resources mentioned in this personal account, you’ll find some suggested avenues at the end of the article.

Suzanne Neil

Breast Surgeon

Lessons Learned the Hard Way

I nearly punched the air in triumph when I returned to work five weeks after my mastectomy to resume the corporate role I’d held for several years. I was then bewildered and disappointed when my phone stayed silent. Naively, I supposed that the management and peers who’d sent flowers to the hospital and encouraging messages as I recuperated at home would promptly welcome me back and I’d slot seamlessly into my ‘pre BC’ (Breast Cancer) routine. After a week or two, I had a nagging sense that the emails and meeting invites I’d typically receive were also passing me by.

During the ensuing weeks of mounting unease and stultifying neglect, I realised I’d been shafted in my absence - by the colleague appointed to cover my role while I was off work.

He did not copy me in on emails while I was away, then inevitably found last-minute reasons to cancel debriefs to discuss activity in my absence. With astounding gall, he simply shut me out so I couldn’t even find out what meetings or travel he continued to undertake ‘on my behalf’. I believe he ‘misinformed’ my internal clients that chemo meant that I couldn’t fly for several months. So, of course, they ‘spared me this pressure’ and didn’t check.

My misfortune was his ticket out of the reserves and he wasn’t going to relinquish the gig.

My boss underestimated the depth of ‘white-anting’ and thought the situation would resolve itself. I confronted my boss’ boss, but he had a deep disdain for any conflict so did not do the obvious thing which was to send a blunt email saying ‘thanks for your assistance, now butt out of her role’. Instead, it was eventually suggested that there was probably enough work for both of us going forward, so we could work it out. I then drafted a role description indicating how responsibilities would be split – we all met and shook hands – and it was never enforced.

In retrospect, I should have protected my patch by requesting I was copied in on all emails. Not that I intended to work or check email while recovering, but it would have ensured transparency when I returned. The most important lesson was probably from one small omission - no one emailed management and colleagues to inform them that I was back on deck feeling fine, it was business as usual and I now resumed all responsibilities (although an email had been sent with my permission when I was diagnosed). I just don’t think it occurred to my boss. I assume he thought word would rapidly get around the organisation as I once again responded to emails and phone calls. But of course, my nemesis ensured I didn’t receive these. About a fortnight after my return, I considered sending out my own email, but figured it might sound a bit lame and plaintive (a touch “ look at moy ”?) so did nothing.

That was a big mistake as it enabled the continuation of his subterfuge.

Several months passed (during which I had chemo, then daily radiation) and I sensed that while there was sympathy for my humiliating position, everything would be solved if I graciously capitulated and disappeared. I’d had a successful and long-standing career with the company, so while I realised I was pushing against the odds, I resolved to fight on rather than risk finding a new job (and walk out on a large accumulation of sick leave I might need if the cancer returned).

So I quietly consulted a lawyer specialising in labour and employment law who stepped me through my options. I decided it would be more remunerative to stay with the company for several more years if possible, rather than pocket the maximum I’d receive if I successfully forced the company’s hand for a settlement through legal teams, or if necessary, a court case. And of course, there’s the financial risk of mounting a case you might lose. (I didn’t qualify for legal aid or seek pro bono legal assistance). Engaging a lawyer was worth every penny. All up, it cost me around $2,000, which I was told could probably be claimed as a tax deduction for work-related expenses. However, the key benefit of engaging my lawyer was psychological.

The stress of those months was horrendous.

She called frequently, had a knack for anticipating the tactics used to undermine me, and let me vent my dismay and disgust in a safe and private environment.

At her suggestion, I kept detailed notes of relevant conversations with my boss, his boss, the interloper and other involved parties, in case we did decide to press hard. I was also quite deliberate in my choice of lawyer; if work Googled the firm, they’d realise I was not mucking around and that if a case ensued, unwelcome publicity might arise. But playing that card was always going to be a last resort as they would, of course, counter-attack. In the end, I never disclosed that I’d hired a lawyer, as we both felt it would antagonise the situation. (A tip – Don’t call your lawyer on a work mobile).

Eventually, I was offered a redundancy. Thanks to helpful coaching from my lawyer, I conducted myself in this meeting with a calm but steely resolve and rejected their offer. More meetings followed around ‘what did I intend to do’, with the subtext being that I might roll-over and take the redundancy. I kept batting the ball right back into their court, saying it was up to them to find a solution, not up to me. I think they then probably sensed that I’d ‘take the matter external’ if it dragged on. So they created a new job for me, on the same pay and conditions. I accepted it and I’m still with the company.

I share my story in the hope that it may help prevent you from being in this predicament. Or at least negotiate from a position of strength if you do. As they say, forewarned is forearmed.

I had a great relationship with my boss and good performance reviews. It never occurred to me that this could happen to me.

I didn’t bother going to HR – they are essentially there to support management. Just remember that sometimes the threats can come from of left-field and be so underhanded that it’s difficult to recognise them until the damage has been done. Take some simple steps upfront to protect your turf, such as:

Maintain regular contact with the company while you recuperate so they sense your keenness and determination to return;
Ensure you see something in writing that clearly states the duration that someone will fulfil your role in an acting capacity, plus a hand-over process;
Agree a ‘return to work’ plan in advance (even if this simply states that a communique will be sent out to specified parties announcing your return to full duties and clarifying how your work will be handled when you take time off for chemo or radiation).

Good luck – and remember that cancer can unleash an inner strength you never knew you had!

WHERE TO GO FOR HELP

Contact Cancer Council Victoria- 131120 . Speak to one of the cancer nurses about a referral to the Pro Bono Workplace Advisory Services. This service is not means tested and they can advise on disclosure requirements and HR issues. They can also refer on if legal assistance is recommended but this is means tested.
Contact the Fair Work Ombudsman if you feel you are being unfairly treated for advice and possible investigation of the complaint. Phone 131394 or www.fairwork.gov.au
Australian Human Right Commission also attends to complaints about bullying and discrimination in the workplace and promotes fairness. Phone 1300 656 419 or www.humanrights.gov.au

Role of MRI in Screening, Diagnosis and Management of Breast Cancer

Tue, 23 Feb 2016 16:00:00 GMT

Mammography and ultrasound has an established role in breast cancer screening and detection. Most cancer(s) can be detected, sized and staged with conventional mammograms and thorough ultrasound evaluation. However the advent of MRI and its role in management of breast disease is ever increasing.

In Australia facilities performing and reporting breast cases are not widespread, unlike general radiology. Specialist Radiologists who perform and report the studies are limited. It is therefore important to send a patient to a centre where Breast MRI is routinely performed.

MRI serves in the role of screening, diagnosis and management of breast cancer primarily as an adjunct to conventional methods of mammogram and ultrasound.

MRI is useful in:

Screening of high risk individuals with or without BRC1 or BRC2 mutations;
Patients who had childhood cancers such as chest Lymphoma and mediastinal radiation (these patients are at a higher risk of developing breast cancer);
Patients with extremely dense breasts where there is high index of concern but are mammographically and sonographically occult for disease;
Pre-operative planning and staging of extensive or multifocal disease;
Evaluation for residual disease in cases of positive margins or early disease recurrence in scar;
Staging and assessing the response to chemotherapy; and
MRI guided techniques (vacuum assisted core biopsies for lesions not visible on mammogram or ultrasound).

Benefits of MRI:

Does not involve ionizing radiation, therefore can be a screening tool used in young women with high risk and dense breasts;
Ability to show abnormality is not lessened by dense breast tissue (as may be the case for some mammograms in dense breasts); and
MRI is the best method to evaluate the breasts of women with implants (and the integrity of the implant) as implants can obscure breast tissue. Although, it is important to note that not all microcalcifications can be seen with MRI, in these cases performing a mammogram is also required.

Limitations of MRI:

Cannot be used in pregnant patients as the contrast agent (Gadolinium) cannot be given;
Patients who have renal failure due to inability to give contrast (possible contra- indication);
Patients who suffer from claustrophobia; and
Cost considerations as patients must meet the pre-requisites to attract the Medicare rebate.

MRI in Diagnosis and Staging:

Some studies show that MRI may be better at identifying multifocal and multicentric disease, particularly for some DCIS and lobular cancers.

MRI is useful in patients with axillary lymphadenopathy due to occult disease. It is also useful in detecting cancer or early changes in the contralateral breast.

MRI is more sensitive than ultrasound or CT scan to assess the lymph node involvement in the mediastinum and axilla- thus helping staging.

Silicone implant rupture can have detection rates of 99% with MRI. It is a challenge to detect early cancer in an augmented breast, particularly with rupture, because carcinomatous change may be misinterpreted as silicone mastopathy or nodularity, skin retraction or nipple inversion.

MRI allows objective assessment of response to chemotherapy and assessment of reduction or residual tumour size and restaging of the axilla.

MRI is now an established tool in our armament for diagnosis and management of breast cancer.

Its limitations of high sensitivity and cost mean in Australia we only use it for select cases.

The judicious use of MRI leads to better management of screening high risk patients, better outcomes in the work up of disease and reduced morbidity and mortality to provide the patient with the best surgical and medical option the first time.

Radiation Oncology Update - Dr Andrew See

Sun, 14 Feb 2016 16:00:00 GMT

Breast Radiotherapy

Radiotherapy is typically delivered via a course of painless daily visits on a Monday to Friday basis spanning between three and 6 ½ weeks.

Splitting the treatment up into small sessions delivered daily over many weeks is called ‘fractionation’. Fractionation ensures that the radiotherapy treatment will be safe as the normal body tissues cope very well with radiation when delivered in this manner.

Traditional Fractionation – 6 weeks

Traditionally, radiotherapy has been administered over 6 to 6 ½ weeks comprising between 30 and 33 daily treatments. This is delivered in two phases. The first phase, which spans 5 weeks, is termed ‘whole breast radiotherapy’. During this phase, the whole breast is treated through a technique called opposed tangents. The second phase of treatment, also called the ‘boost’, is delivered in the final 1 to 1.5 weeks. During this component of therapy, just the immediate breast tissue surrounding the original primary tumour is irradiated. Not all women require a ‘boost’ dose however in those who do, it is considered to further improve local tumour control.

Shortening the Radiotherapy Course - 3 weeks

Over the last two decades, a number of clinical trials have explored the merits as to whether it is possible to shorten the duration of whole breast radiotherapy from the traditional 6 ½ weeks to anywhere between three and 3.5 weeks. These studies were conducted in countries where radiotherapy machines were scarce and as a result the waiting times for treatment unacceptably long. Three trials, accruing over 5000 women have now been published and peer reviewed. They appear to show that a select group of women can be safely treated with a shortened 3.5 week course of therapy yet still enjoy equivalent long term cure rates and acceptable cosmetic outcome.

In some groups of women, it is still preferential to extend the treatment over 6 ½ weeks. This is particularly so for women who are large breasted, as the very same trials did show that shortening the treatment in large breasted women can lead to an increase in the risk of long term breast fibrosis and shrinkage, which may lead to dissatisfaction with the overall cosmetic outcome. Furthermore, women who are intending to undergo breast reconstruction of any type and women who also require treatment of the supraclavicular fossa (glands above the collarbone as well as the breast) will generally be managed on a standard six week course.

New Radiotherapy Techniques - Improving Safety & Minimising Risk

In the modern era, radiotherapy is considered safe and equitable although there still are some potential long-term side effects that can manifest years after the treatment has been administered. In the case of women who require left-sided breast radiotherapy one of the long-term side effects involves the potential for radiotherapy to damage the heart. This occurs because the radiotherapy beams do come close to the front of the left ventricle (main chamber of the heart that pumps blood around the body) and also the left anterior descending coronary artery (main artery that feeds the left chamber of heart). Although the overall risk is considered to be low, a small increase in ischemic heart disease is observed when treating left sided breast cancer that is not apparent when managing right sided disease. This risk is magnified even further in women requiring left sided breast radiotherapy who also have other cardiac risk factors such as diabetes, active smokers, hypertension or a familial history or predisposition for heart disease.

Deep Inspiratory Breath Hold for Left Sided Breast Cancer

A recent refinement in the management of left-sided breast cancer is a technique called ‘deep respiratory breath hold’ or DIBH.

A single treatment of radiotherapy usually lasts 6-10 minutes. During this time women are asked to take shallow comfortable breaths in and out of an open mouth.

With deep respiratory breath hold, additional coaching occurs prior to radiotherapy planning and women are asked to take a deep purposeful breath inward and then to hold the inspired position for as long as they feel comfortable (20-30seconds). The radiotherapy is only administered while the breath is held in this phase. This manoeuvre pushes the heart back and away from the radiation beam further reducing the dose to the heart. Women are usually required to wear video feedback goggles or watch a computer monitored during their therapy which allows instant feedback as to whether their breathing is maintained in the desired phase. Furthermore, breathing drills similar to which are taught in a Yoga class are practiced in the weeks leading up to the commencement of radiation therapy. Not all radiotherapy departments offer this technique although in the years ahead it is likely to be more widely available.

Dr Andrew See consults out of the unit on Monday mornings.

Melbourne Breast Unit

29 Simpson St,

East Melbourne VIC 3002

Phone: 03 9419 1166

Fax: 03 9419 6416

Hair Loss Prevention During Chemotherapy

Sun, 07 Feb 2016 16:00:00 GMT

Paxman Hair Loss Prevention During Chemotherapy

The Epworth Medical Foundation has recently installed the Paxman Hair Loss Prevention System, a new machine to prevent hair loss during chemotherapy. Epworth are now offering the revolutionary system to patients thanks to generous contributions from donors through the Epworth Medical Foundation.

Hair loss is a major concern for breast cancer patients facing treatment, the thought of losing their hair is a very frightening one. The ability to control this is not only a big step for the industry but for patient comfort too.

Scalp cooling has been available for over 40 years, older versions using crushed ice or frozen gel caps. The previous caps sometimes resulted in temperatures of -25 degrees, causing unbearable patient discomfort. Only through the recent advances technology with Paxman system has it been effective and comfortable for patients. It is widely available in the UK and Europe, today there are currently machines installed in over 1800 centres worldwide. A UK observational study reported an 89% success rate after using the Paxman system, with only 11% having severe hair loss requiring a wig or head covering.

The Paxman Hair Loss Prevention System uses a ‘scalp cooling’ method or ‘cold cap treatment’ system. The Paxman system is a small refrigerated unit which is plugged in next to the patient during chemotherapy treatment. The machine pumps a liquid coolant through a light silicone cap that is attached to the cooling machine, therefore extracting heat from the scalp. The cap is worn before, during and after chemotherapy has been administered, depending on the patients type of treatment this could take up to 2-3 hours.

The scalps reduced temperature causes vasoconstriction of blood vessels in the area, therefore reducing blood flow to the scalp and hair follicles while the drugs are circulating in the body, minimising the damage to the follicles.

A mild discomfort is often felt by patients on first contact but the system otherwise has no side effects and does not interfere with treatment in any way.

The MBU Team Strive to Be World Class!

Tue, 01 Sep 2015 16:00:00 GMT

The highly-specialised and dedicated multidisciplinary team at MBU provide a diagnostic, treatment and support service for women (and men) with breast concerns. Working in conjunction with Breast Imaging Victoria, a private radiology service, breast surgeons Dr Suzanne Neil and Dr Su-Wen Loh provide a comprehensive (inpatient and outpatient) breast care service. Complementing the team is medical oncologist Dr Yen Tran , radiation oncologist Dr Andrew See , together with experienced breast care nurses, radiologists, pathologists and psychologists.

The Clinic is uniquely designed to ensure that all necessary diagnostic procedures can be performed onsite, in one convenient, comfortable and private location. Most patients will have results of their assessments and a treatment plan before they leave the Clinic.

The team at MBU provide a comfortable and professional environment for patients and are committed to ensuring a positive and stress-free experience. They are able to provide a wide array of information including DVDs; connections to support services; answer questions; and refer to other medical professionals, as appropriate.

Our goal is to provide a world-class breast care service and to guide our patients appropriately. Our priority is patient wellbeing.