Introduction

It must be remembered that early breast cancer is a curable disease. In patients with tumours less than 1cm there is a greater that 90% 100 year disease free survival.

Even in patients with large breast cancers, chemotherapy and hormone therapy (as well as new target therapies) can result in a relatively long period of palliation (in some instances longer than 10 years).

Why do 10% of Stage I die within five years? The reason is that metastatic spread may take place even in Stage I breast cancer. These metastases may remain silent, so that the doctor cannot find them with the usual tests they use to detect metastases (x-ray chest, ultrasound of the liver, enzyme tests of liver function such as the alkaline phosphatase, x-ray long bones and spine, bone scan, etc). These silent metastases remain hidden for many months and we call them micrometastases. It is these micrometastases that eventually cause the demise of 10 - 15% of Stage I breast cancer. The other 90%, who do not have these silent metastases, will survive for five years and longer, after appropriate treatment. It is because of these established statistics in terms of breast cancer survival, that there is a growing trend to be more aggressive with the use of chemotherapy and hormone therapy (oncology).

Breast cancer treatment guidelines

Instead of looking at treatment of breast cancer stage for stage, it is important to remember that each patient presents as an individual and the specialist must tailor the treatment to each individual patient. There are certain fundamental treatment principles that should be adhered to, such as who should receive chemotherapy, who should receive radiation therapy and what different surgical options are available for each patient.

In other words, the size of the tumour, the type of cancer, the size of the breast, the position of the tumour, the state of general health and the psychological make-up of the patient help determine which treatment options are utilized and in what order they are employed. Once a cancer has been diagnosed, there is no harm in taking a few days to discuss the different treatment options. Waiting a day or two, participating in the discussions and understanding what the different treatment options are, will help ensure ultimate psychological, cosmetic and cancer management that is optimal. It is for this reason that principles of treatment have been devised. 2 big collaborative groups responsible for these treatment consensus statements are the American NIH and the St Gallen consensus.

The treatment of breast cancer is a multimodal approach involving three lines of attack:

• surgery

• radiotherapy (DXT)

• oncology (chemotherapy and hormone manipulation)

Again to stress once the diagnosis is made, there is no need to jump into a decision. Breast cancer is not flu - patients need to explore their options and find out what treatment is available to them. The average doubling time of breast cancer cells is 40 days; the cancer did not arrive yesterday and will not be gone tomorrow. So go for a second opinion, speak to other patients who have been treated by the doctor you have chosen.