As a breast surgeon, I am involved in the whole process of diagnosing and treating women with breast problems. This means I am a part of every aspect of the patient journey, from initial consultation, to tests leading to a diagnosis, and then working in a multidisciplinary team to coordinate treatment.
After training in general surgery, I specialised in oncoplastic surgery, which involves combining cancer removal with techniques in plastic surgery to minimise the impact of surgery on quality of life.
The Royal Marsden ﬁ rst opened its doors at Cavendish Square in April 2021, and the breast unit is set up as a one-stop clinic. This means that women with a breast concern can have a clinical examination and the necessary tests in the same visit (mammography, ultrasound, CT and X-ray). The majority will have changes that occur as part of normal life, or benign problems that do not require treatment. However, should they be diagnosed with breast cancer, patients can access most of their treatment in one place, as the clinic has a minor procedure suite, and a medical day unit for patients to receive chemotherapy.
The breast unit is run very much in the same way as The Royal Marsden’s Chelsea site and shares its expertise and culture of treating each patient as an individual. The emphasis is on approaching patients in a holistic way and providing a positive and personalised experience with all the comfort of first-class private care.
We have an excellent multidisciplinary team, so every patient gets the input of experts in all the areas relevant to them, and this also ensures a seamless transition from one element of treatment to the next. So far, the breast care unit has scored incredibly well in patient satisfaction surveys, and I believe this is due to a combination of the state-of-the-art care on offer and the compassion and dedication of the nurses. Although this is predominantly a cancer hospital, it is not a place for doom and gloom. In fact, patients often describe feeling ‘safe’ here, and there is an optimistic and upbeat feel to the place.
Aside from the outstanding treatment, another advantage of being a patient at Cavendish Square is that you not only benefit from the research focus of The Royal Marsden, but also from its cutting-edge clinical trials. If there is a trial available, we will invite the patient to participate in that, allowing them to access the most up-to-date treatments, which is not only good for them personally, but helps us build knowledge that will be beneficial for future patients.
One of my key passions as a breast cancer specialist is improving cosmetic outcomes for my patients. Of course, as a clinician, disease control is always my absolute priority, but the psychological recovery of the patient is important too, and maintaining or improving the cosmetic outcome is key to this, because it has a significant impact on a woman’s confidence, and helps her to get back to a near normal life.
Over the past seven years, I have been working on research to develop 3D surface imaging of women’s breasts, using either infrared scanners or multiple, simultaneous cameras producing images to be ‘knitted’ together. One of our recent research studies revealed that women are much more confident going into a lumpectomy operation if they have seen a simulation of how they might look after surgery, rather than being guided by photographs of other women who have had a similar operation. We are now developing these techniques into the reconstructive arena and, ideally, we will be able to show women simulations of different reconstruction techniques to help them decide whether they want reconstructive surgery after mastectomy and, if so, what type.
My other main research interest is in breast cancer prevention. There are some risk factors for breast cancer that we can control, such as weight, alcohol intake and limited physical activity. I am leading a pilot study that empowers women to change their lifestyle, not only by informing them of their own future breast cancer risk, but also by supporting them to identify a relevant health goal they might want to reach. Over time, we hope to scale this up to a much larger study that can make a real difference to women’s lives.
Going through breast cancer treatment is undoubtedly a challenging process, but I am optimistic about the huge advances being made in diminishing the side effects of treatment. Lots of breast cancers are now diagnosed on imaging before a lump can be felt in the breast. New techniques enabling us to pinpoint the location of tumours at the time of surgery mean we can be more precise, removing the area of abnormality while preserving normal breast tissue. This minimises the change in shape resulting from surgery to the breast.
In the future, some women will be able to avoid surgery altogether because the drugs being used are now more tailored and effective at eradicating disease.
One of our areas of focus at The Royal Marsden is identifying women who don't need surgery at all. Over the past quarter of a century, there has been a marked decrease in invasive surgery for breast cancer patients, thanks to improvements in imaging techniques and medical oncology. So, 20 or 30 years ago, most women were having radical mastectomies and their armpit lymph nodes were removed to protect them against the disease, but today less surgery is just as safe in many situations.
There are ongoing parallel developments in diagnostic, surgical and radiotherapy techniques that, together, make for a far better outlook and experience than in the past. Overall, I am very positive, because most patients with breast cancer can expect to be cured. That’s a wonderful message that hasn’t been widely heard yet.