A Focus On: The Breast Multidisciplinary Team
Figure 7.1, Reproduced from Breast Cancer: The Facts, by Christobel Saunders and Sunil Jassal. (© Oxford University Press 2009). ISBN 9780199558698.
Contrary to the message found in some media, breast cancer survival in the UK has improved and has the potential to continue to improve. Two of the factors contributing to this are the development of the breast multidisciplinary team (MDT) and the introduction of breast screening.
The introduction of the breast MDT resulted in the bringing together of all the disciplines–surgery, radiology, pathology, oncology and nursing–involved in managing patients with breast cancer. A good team that meets regularly to discuss the results of patients both in the stages of initial diagnosis and management of breast cancer is essential to ensure that diagnoses are not delayed and management plans are appropriate. Whilst not perfect, this approach, together with the introduction of national guidelines, has done much to remove the so-called ‘postcode lottery’ of cancer treatment. More recently, specialised oncoplastic MDT meetings have been established to discuss individualized breast reconstruction options for breast cancer patients.
The concept of the breast MDT had its origins in the breast screening programme and many early teams only concerned themselves with screening cancers. However, as the benefits of the MDT were realized, it included symptomatic cases, so that now it is considered by many units as a continuum. Despite concerns raised about the benefits of screening, the Marmot report has confirmed that overall breast screening is worthwhile, and the effect shows overall improved survival from breast cancer. As a discipline, screening has driven improvements in surgery, radiology, pathology and oncology. In the future, techniques such as Oncotype DX and OSNA, as well as targeted drugs therapies, may further improve outcomes. The next frontier will be defining which types of ductal carcinoma in situ (DCIS) will progress, thus improving treatment of this condition. In the future, the next member of the MDT may be a new entity–the molecular pathologist.
James Harvey is Consultant Oncoplastic Breast Surgeon, Nightingale Centre, UHSM, Manchester, UK; Sue Down is Consultant Breast Surgeon, James Paget Hospital, Great Yarmouth, UK; Rachel Bright-Thomas is Consultant Breast and Reconstructive Surgeon, Worcestershire Royal Hospital, Worcester, UK; John Winstanley is Consultant Surgeon Emeritus and Hugh Bishop is Consultant Surgeon Emeritus, both at The Royal Bolton Hospital, Farnworth, Bolton, UK.
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