Individualised Treatment
Neoadjuvant chemotherapy (NACT)
Neoadjuvant chemotherapy (NACT) involves administering chemotherapy prior to surgery for locally advanced breast cancer, especially in triple-negative breast cancer and HER2-positive breast cancer. This approach has the potential to downstage disease which may allow less extensive surgery to the breast and/or axilla. It can also provide valuable information regarding treatment effectiveness and response. The degree of residual invasive cancer after neoadjuvant therapy is a strong prognostic factor for risk of disease recurrence.
Targeted therapy
CDK4/6 inhibitors for hormone receptor-positive breast cancer, Monoclonal antibodies for HER2-positive breast cancer and PARP inhibitors for breast cancer in BRCA1 or BRCA2 genetic mutation carriers are all examples of targeted breast cancer therapy.
Oncoplastic surgical techniques
Oncoplastic breast surgery involves combining removal of the breast cancer with the use of techniques to achieve optimal cosmetic outcome. This approach aims to minimise the degree of potential breast deformity and asymmetry. In some instances, depending on the breast shape, size and extent of disease, a therapeutic mammoplasty may be appropriate. This involves performing wide excision of the cancer with a lift & reduction procedure. A similar lift & reduction can be done for the unaffected breast to maintain symmetry.
Reconstruction/Symmetrisation
Breast reconstruction restores the appearance of one (or both) breasts after mastectomy to allow maintenance of breast shape, size and symmetry. The timing of reconstruction depends on consideration several factors for each individual case.
Risk management
Women with a family history of multiple breast (+/-ovarian) cancers are likely to be at increased risk of developing breast cancer. The precise level of risk is often difficult to determine. An individual assessment and discussion are required to recommend an appropriate screening and risk management strategy.
Five years of preventative medication with an anti-oestrogen tablet have been shown to reduce the risk of breast cancer in women that are known to be at increased risk.
Bilateral risk reducing mastectomy surgery can reduce the absolute breast cancer risk to below 2%.