The New Breast Cancer Treatment Protocol in Singapore
Singapore, 28 October 2015 - Surgeons treating breast cancer patients who seek treatment at the SingHealth Duke-NUS Breast Centre (SDBC) may now refer them to participate in the Preoperative Breast Cancer Programme (PBCP) for chemotherapy treatment before performing definitive surgery.
This new approach to breast cancer treatment offers patients the multi-disciplinary care where they will be jointly cared for by mainly a team comprising of the surgeon and the oncologist. The process means the patient, particularly those with high-risk early-stage breast cancer or locally advanced breast cancer, will now be given chemotherapy as the first line of treatment before going for surgery.
The benefits of neo-adjuvant therapy (administer chemotherapy before surgery) for high-risk early-stage breast cancer or locally advanced breast cancer patients are significant. Treatment such as chemotherapy is given to patients for a period of time before they undergo surgery. It stops cancer cells from growing and reproducing themselves, and helps to reduce the tumour size so that it can be surgically removed with an improved cosmetic result.
Alternatively, it may also mean only a smaller area of the breast needs to be removed. A further advantage is that it allows the clinicians to observe the treatment effects. This is important as it enables the team to tailor a more personalised therapy for the patient.
Dr Veronique Tan, a Consultant Breast Surgeon with the SDBC, said, "If chemotherapy is able to shrink the tumour significantly, a smaller area of the breast may be removed. This may mean the patient becomes suitable for breast conservation, instead of needing a mastectomy. Essentially, patients who respond well to preoperative chemotherapy will have more surgical options." Dr Tan is also a consultant at NCCS, specialising in oncoplastic breast surgery.
'We are seeing more young patients diagnosed for breast cancer, 20% of the patients are under 44 years of age,' said Dr Tan.
The introduction of PBCP makes SingHealth Duke-NUS Breast Centre the first centre to provide a structured preoperative breast cancer programme in Singapore.
The PBCP, which was launched in October 2014, has as of September 2015, treated 67 patients. All the 67 patients had responded positively to chemotherapy. Treated breast cancer patients were mostly in the cancer stage IIb and the tumours were hormone negative.
Explaining the process, Dr Lee Guek Eng, Associate Consultant, at the Division of Medical Oncology, NCCS said,
"The patient will be seen by a multi-disciplinary team of specialists where a structured plan will be developed for the patient. It is confusing for a patient to see various doctors before a surgery. Having a structured plan in place will provide clarity and assurance to the patient and hence make them feel less anxious about their condition. Multi-disciplinary care is also important for a breast cancer patient.
"A national centre like NCCS will have the capacity and manpower to integrate the various services to provide a personalised and coordinated care for patient", said Dr Lee.
A dedicated nurse clinician such as the Breast Care Nurse (BCN) and an Advanced Practice Nurse (APN) will also participate in this programme to coordinate the patient's care journey and provide quality care to the complex needs of the patient.
This co-ordinated care process will ensure that relevant investigations and treatments are carried out in a timely manner.
Ms Hashimah Bachok, 46 a breast cancer patient whom benefitted from the preoperative breast cancer programme commented that the programme allowed for good access to the health care team. Ms Mabel Tan, an Advanced Practice Nurse who coordinates the multidisciplinary inputs was there to answer her questions about the different treatment options, and the personalised attention and care provided much appreciated support during this challenging period.
- The new Preoperative Breast Cancer Programme provides coordinated, seamless, high quality, multi-disciplinary care for women who have breast cancers that may benefit from chemotherapy before surgery.
- The breast tumours that benefit from preoperative chemotherapy include cancers that are large or grow fast, and those that have spread to the lymph nodes. Special subtypes like 'Triple negative' and 'HER2 positive' cancers also benefit.
- Even with positive results from the chemotherapy, i.e. shrinkage of the tumours, surgery to remove the footprint of the original tumour site is still essential. This is because live tumour cells that may not be detected on breast imaging often still remain.
The multi-disciplinary team of healthcare professionals who are involved in this programme include:
||Dr Ong Kong Wee, Head & Senior Consultant
Dr Benita Tan, Senior Consultant
Dr Preetha Madhukumar, Senior Consultant
Dr Yong Wei Sean, Senior Consultant
Dr Wong Chow Yin, Senior Consultant
Dr Veronique Tan, Consultant
||Dr Rebecca Dent, Senior Consultant
Dr Lee Guek Eng, Associate Consultant
Dr Elaine Lim, Senior Consultant
Dr Yap Yoon Sim, Senior Consultant
||Dr Jill Wong Su Lin, Senior Consultant
||Prof Tan Puay Hoon, Head and Senior Consultant
||Ms Mabel Tan May Leng, Advanced Practice Nurse
||Ms Tan Yee Pin, Head
||Cancer Genetic Service
||Dr Joanne Ngeow, Head, Cancer Genetics Services
||Dr Wong Fuh Yong, Consultant
Dr Chua Eu Tiong, Senior Consultant
Dr Richard Yeo, Senior Consultant
Dr Sethi Vijay Kumar, Emeritus Consultant
Dr Faye Lim, Consultant
Source: NCCS, Singapore
Flow chart to show the treatment path for patient under the PBCP.