Clinical update

Treating breast cancer

Essential facts

Breast cancer is the most common cancer in the UK, with more than 50,000 new cases diagnosed, and almost 12,000 deaths recorded in 2013 (Cancer Research UK). A small proportion of these are diagnosed in the advanced stages when the tumour has spread significantly. About 1 in 8 women will develop breast cancer. People previously treated may subsequently develop either a local recurrence or metastases. 

What’s new

In June, the National Institute for Health and Care Excellence updated its quality standard. It says people who have been diagnosed with a type of early breast cancer and who are at risk of the cancer spreading should be offered an Oncotype DX test. This helps predict how the tumour might develop and identifies which patients would benefit most from chemotherapy after surgery. It also says people with suspected breast cancer who have been referred to a specialist should be offered a full assessment at a single visit to hospital or a specialist unit, involving an examination, breast imaging and, if needed, a biopsy. A single visit will help improve diagnosis rates.

Signs/symptoms

About 30% of women diagnosed with breast cancer report a symptom other than a lump. These include changes to the breast skin, changes in shape or size, and pain.

Causes/risk factors

Breast cancer risk increases with age. Research published in the British Journal of Cancer found women in their 70s and 80s were less likely to survive breast cancer than those in their 50s and 60s. Among the reasons for this was late diagnosis in older women. More than half of those aged 51 to 69 receive an early diagnosis, compared with a quarter of those aged over 80. 

Helping your patient

Promote best practice and inform patients of treatment options, developments in care, risks of recurrence once treated and stages of assessment if referring them to a specialist.

 

Find out more

NICE guidance: 

Breast cancer quality standard 

Metastatic spinal cord compression in adults 

British Journal of Cancer:
Patient and tumour characteristics, management, and age-specific survival in women with breast cancer in the East of England (2011)

RCNi articles:

Why women ignore first signs of cancer 

 

Expert comment

‘This updated quality standard is aimed specifically at streamlining services, with the primary focus on the expectation of triple assessment in a single visit, which has been part of our ongoing service. 

It also emphasises the benefits of using Oncotype DX and clarifies the usefulness of pre-surgery MRI in invasive cancer and ductal carcinoma in situ.  

The use of Oncotype DX has been the most noted improvement and has helped address issues with the over-treatment of patients. Historically, the use of chemotherapy has been dependent not just on the pathology, size and nodal status, but the patient’s age.  Oncotype DX has given a more detailed analysis and helps identify the potential benefits of the chemotherapy to be offered.

Not only is establishing the appropriate use of pre-operative MRI a safety issue for the patient, but it can also be a significant cost saving.

All of these are valid improvements to the service, and I am in favour of all relevant national drives towards a cohesive and equitable service for patients.’ 

Jill Hardman-Smith is advanced nurse practitioner in breast care, University Hospitals of Leicester NHS Trust

 

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