Abstract
Introduction
Treatment of breast cancer has become more complex and sophisticated in recent years, and a multidisciplinary team approach to management is now recommended worldwide. The present study reviews the applicability of the multidisciplinary approach to the management of patients with breast cancer in a private hospital.
Methods
Between September 2003 and April 2005, a total of 579 consecutive patients undergoing breast cancer surgery were studied. Patients receiving neoadjuvant chemotherapy or who had metastatic disease at presentation were excluded. Demographic and operative details, pathology, and recommended adjuvant therapy were discussed in the weekly multidisciplinary breast conference involving breast surgeons, pathologists, and radiation and medical oncologists.
Results
The mean age was 48.6 years. A self-discovered breast lump (80%) was the most common presentation, whereas screening mammography accounted for only 12.2%. The accuracy of preoperative mammography, ultrasonography, fine-needle aspiration cytology, and core biopsy were 66.5%, 80.7%, 89.4%, and 98.9%, respectively. Mastectomy was performed in 49.3% of patients, of whom 22.0% underwent immediate reconstruction. Eighty-five percent of patients underwent concomitant axillary surgery, comprising either sentinel node biopsy (49.9%), sentinel node biopsy followed by axillary dissection (38.7%), or axillary dissection alone (11.4%). The mean size of invasive tumors was 2.3 cm, and lymph node metastases were detected in 40% of patients; stage 0, I, II, and III disease was present in 14.2%, 34%, 44.5%, and 7.2% of patients, respectively. Adjuvant hormonal therapy, chemotherapy and radiotherapy were recommended in 62.4%, 51.2%, and 64.9% of patients, respectively.
Conclusions
Breast cancer in Hong Kong most often presents as a breast lump discovered by self-examination. The role of screening mammogram has to be reevaluated. Multidisciplinary teamwork is essential for optimizing decision-making about adjuvant treatment interventions in such patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hong Kong Cancer Registry. Hospital Authority. 2002
Grunfeld E, Mant D, Yudkin P, et al. Routine follow-up of breast cancer in primary care: randomized trial. BMJ 1996;313:665–669
Sainsbury R, Haward B, Rider L, et al. Influence of clinician workload and patterns of treatment on survival form breast cancer. Lancet 1995;345:1265–1270
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
Wong TT, Cheung PSY, Ma MKK, et al. Experience of stereotactic breast biopsy using the vacuum-assisted core needle biopsy device and the advanced breast biopsy instrumentation system in Hong Kong women. Asian J Surg 2005;28:18–23
Bonadonna G, Valagussa P, Rossie A, et al. Ten-year experience with CMF-based adjuvant chemotherapy in respectable breast cancer. Breast Cancer Res Treat 1985;5:95–115
Fisher B, Fisher ER, Redmond C. Ten-year results form the NSABP clinical trial evaluating the use of l-phenylalanine mustard (L-PAM) in the management of primary breast cancer. J Clin Oncol 1986;4:929–941
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–1232
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–1241
van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomised trial comparing breast-conserving therapy with mastectomy: European Organisation for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143–1150
National Institutes of Health (NIH). NIH Consensus Conference: treatment of early stage breast cancer. JAMA 1991;265:391–395
Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast carcinoma: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997;15:2483–2493
Fisher ER, Wang J, Bryant J, et al. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer 2002;95:681–695
Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from the National Surgical Adjuvant Breast and Bowel Project B-18. N Natl Cancer Inst Monogr 2001;30:96–102
van der Hage JA, Cornelis JH, van de Velde CJ, et al. Preoperative chemotherapy in primary operable breast cancer: results form the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 2001;19:4224–4237
Link JS. History and overview of comprehensive interdisciplinary breast centers. Surg Oncol Clin N Am 2000;9:147–157
Leung GM, Lam TH, Thach TQ, et al. Will screening mammography in the East do more harm than good? Am J Public Health 2002;92:1841–1846
Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005;353:1784–1792
Bonadonna G, Molitemi A, Zambetti M, et al. 30 Years’ follow up of randomized studies of adjuvant CMF in operable breast cancer: cohort study. BMJ 2005;330:217–222
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chan, WF., Cheung, P.SY., Epstein, R.J. et al. Multidisciplinary Approach to the Management of Breast Cancer in Hong Kong. World J. Surg. 30, 2095–2100 (2006). https://doi.org/10.1007/s00268-005-0370-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-0370-9