Dr Newson reports on the recent conference: Breast Cancer Treatment - Doctor's Dilemma or Patient's Choice?

Published: 7th November 2018

Held at The Royal Society on 31 October, during Breast Cancer Awareness Month, this groundbreaking women’s health conference looked at how women are often denied the information they need to make a shared decision with their doctors regarding their own health needs.

Too many of the women I speak to tell me they are never given any choice over their healthcare treatment, which is so wrong. And this is not just about menopause care; we should all have a choice in how we choose to live our lives – how much exercise we decide to do, and what we eat, for example. As a doctor, I feel strongly that we should also have a choice regarding what treatment we receive, once we know all the potential benefits and risks. It is essential that these are informed choices – but too often women are being denied the information they need.

This conference provided a really stimulating and interesting debate on the benefits and harms of breast screening. Professor Tony Howell, a Professor of Medical Oncology at the University of Manchester, started this debate giving us evidence to support the use of breast screening. Screening, he explained, has been shown to diagnose smaller tumours, reduce the extent of treatment, and reduce deaths from breast cancer.

Professor Michael Baum, Professor Emeritus of Surgery at UCL in London, responded with facts addressing the potential harms of breast screening – which can lead to some women being over-diagnosed, and treated for a lesion that may never lead to harm.

Both of these experts talked about the need for more targeted breast screening, which involves assessing the future risk of breast cancer, including genetic testing. Clearly more work needs to be done in this area to assess risk in women before they opt for screening.

Dr Renee Hoenderkamp, a GP with a special interest in women’s health, spoke about the fact that GPs are not involved in the breast screening process in the same way they are with cervical screening. This means many women undergo breast screening without it being a properly informed choice. She suggested this should change, as GPs are often well-placed to discuss the implications of breast screening with their patients. All women also need to be encouraged to undertake regular self-examination.

The next speaker was Avrum Bluming, a Clinical Professor of Oncology in Southern California, USA. He has recently co-authored a book, Oestrogen Matters: why taking hormones and menopausecan improve women’s well-being and lengthen their lives – without raising the risk of breast cancer – written to enlighten us with detailed information about oestrogen and its effects. His book also goes into detail on the history of various large studies, which were wrongly reported to the media.

Dr Bluming also presented in detail numerous studies supporting the benefits of taking hormone replacement therapy (HRT), including reducing future risk of osteoporosis, heart disease and dementia. In addition, women taking HRT have been shown to have lower death rates from all causes, including cancer, compared to women who have never taken HRT.

I followed his very inspirational talk by presenting two women who I have seen in my menopause clinic, both of whom have previously been denied HRT by their GPs. Both women were having significant symptoms, which were having a very negative impact on their lives; one of them had even given up her job because of the effects of the menopause on her memory and cognition. She had been treated for breast cancer in the past, and had tried numerous alternative solutions for her menopausal symptoms.

However, she ultimately elected to take HRT. Her life has been transformed, and her quality of life is now considerably better. She understands that there may be an increased risk of developing a recurrence of her breast cancer, but she feels this has been offset by the other benefits taking HRT gives her.

Diane Danzebrink then followed, talking about the role of the menopause counsellor. She discussed her frustrations at the inadequate support and advice for menopausal women in the UK. There is already a lack of menopause specialists, and this is especially concerning as many NHS menopause clinics have been closed in recent months.

The afternoon was chaired by Dr Margaret Spittle OBE, and involved a discussion regarding intraoperative radiotherapy (IORT). This treatment is not widely offered despite there being excellent evidence to support its use.

For co-organiser Katie Taylor, founder of The Latte Lounge, this was “the most outrageous thing to come out of the conference.” TARGET IORT, she explains: “is a revolutionary new treatment for early stage breast cancer patients. It was approved by NICE almost a year ago and yet is still not being used in this country, where it was pioneered. Yet it is being used in 60 centres across Germany. It is a one stop shot of radiation during a lumpectomy operation saving the woman 6 weeks of radiation after.”

Marcel Benstein, a patient who had received this treatment, gave a very emotive talk about the importance of being given a choice regarding her treatment for breast cancer.

As a healthcare professional, I strongly feel that my patients should be given informed choices. We have a duty to help them with their decision-making, but should respect their choices – even if we do not always totally agree with them!

This article was first published at https://hystericalwomen.co.uk/2018/11/06/breast-cancer-treatment-doctors-dilemma-patients-choice/