Breast cancer surgeon Ian Campbell delights in giving his patients the good news stories.One is that most will have a positive outcome.
“Most of my patients can be very confident about their long-term outcomes. The death rate from breast cancer has halved in New Zealand in the past 30 years. In the future, we will have more effective treatments, less toxic treatments and better targeted therapy.”
Another good news story is that the work of breast cancer surgeons will diminish over time. Breast cancer rates have levelled off in the developed world and are expected to decline. While New Zealand rates are still rising, they are also expected to plateau and then fall. “Environmental factors led to the increase of breast cancer but with greater education and improved detection and treatment, we can expect the rates will reduce.”
Prof Campbell, who is a general surgeon at Braemar Hospital, has seen extraordinary breakthroughs in breast surgery since he began specialising in the field in 1988. “Thirty-plus years ago, radical mastectomies were mutilating operations. Today they are far less radical and we can offer breast conserving operations, which retain the breast’s form and shape.”
“Early patients could expect to spend weeks in hospital. Now they rarely spend more than two or three days.”
He says the ultimate aim would be for patients to take a tablet that would cure the cancer or stop it in its tracks. “That may be the result in the future. But we are now making incremental gains and through that are improving outcomes all the time.”
Prof Campbell, who is Associate Professor in Surgery at Auckland University’s School of Medicine and recognised internationally for his clinical research, is leading projects that will produce further breakthroughs.
One is a trial to find better ways to check if cancer has spread to the lymph nodes (sentinel node biopsy). When breast cancer spreads it can travel to other parts of the body through the blood and lymph systems. In standard breast cancer treatment for women with breast cancer larger than 3cm or with multiple cancers, the surgical team will perform an axillary clearance to remove and examine the lymph nodes in the armpit. Yet two out of three women may not have cancer in their lymph nodes. In a sentinel node biopsy, a smaller number of lymph nodes (most likely to contain cancer cells) are identified and removed. This minimises the surgery and the risk of side effects such as lymphedema (arm swelling) and sensory nerve damage.
He is also involved in other studies to prevent cancer and in endocrine (hormonal) therapy.
Prof Campbell says Braemar Hospital offers “state of the art” facilities for his work and a “marvellous team of supportive people and stable staff.” He said he chose to return to work in the Waikato after working in Britain and Australia, because – in the early 1990s – it was one of two regions with a pilot breast cancer screening programme.
Prof Campbell also does a range of general surgical procedures at Braemar such as hernia repairs, gall bladder removals and endoscopy. He also does breast reductions. He says he particularly enjoys that work because it makes such a difference to women. “For many women large breasts are a handicap socially and physically. This operation literally changes their lives. “
In his spare time, he likes to ski in winter and dive and fish at the family’s holiday home at Opito on the Coromandel Peninsula. His wife Marie-Francoise Jean-Louise is an ear, nose and throat surgeon at Braemar Hospital, who specialises in paediatric and general otolaryngology. The couple has three children aged between 15 and 20.
Footnote: Prof Campbell is the chair of Waikato Breast Cancer Trust, which celebrates 10 years this month (October). As part of the celebration, the trust has produced a New Zealand Women’s Health Diary. Copies can be obtained from the trust (www.wbct.co.nz)
5 Commonly Asked Questions
1) What causes breast cancer?
The main risk factors for breast cancer are being a woman and getting older. Reproductive factors such as earlier age of onset of menstruation (possibly related to increased dietary fat intake), later age at first child birth, exposure to more hormonal medication (eg the oral contraceptive pill and hormone replacement therapy) and later age at menopause, probable account for about half the increased incidence in breast cancer seen in the latter half of last century.
Environmental factors, which are extremely hard to prove, such as saturated fat intake, obesity, alcohol, possibly pesticides and some plastics and unknown other factors – account for the rest.
A small proportion of women, carry an inherited gene mutation which may cause breast cancer. Such mutations likely account for only 5% of all breast cancer cases
2) How do I reduce my risk?
- Regular exercise (at least 4 hours a week – for example brisk walking)
- Healthy diet: low fat, lots of fresh fruit and vegetables (same as for heart disease)
- Healthy weight: especially after the menopause
- Keep alcohol intake to less than 10 drinks per week
- Breast feeding
- Breast awareness and regular screening mammograms from age 40 for as long as you remain in good health.
3) What research into breast cancer is happening in the Waikato?
- We have a trial of breast cancer prevention for high risk postmenopausal women (IBIS II);
- a trial of endocrine therapy for women with ductal carcinoma in situ (DCIS);
- a trial of sentinel node biopsy vs axillary dissection for women with larger or multifocal tumours (SNAC2)
- trials of endocrine therapy 5 years of more after diagnosis (SOLE and LATER);
- a trial of postmastectomy radiotherapy for intermediate risk women (SUPREMO – about to start);
- and trials of new drug agents in advanced breast cancer; plus ongoing analyses from the Waikato Breast Cancer Register.
We have set up the Waikato Breast Cancer Trust to fund this work.
For more information on these studies, information on breast cancer and events that will be happening for breast awareness month, see the Trust website, www.wbct.org.nz
4) What are the benefits and side effects of breast reduction?
Many women have significant problems due to their breast size. Besides the social stigma and self esteem issues, breast weight can lead to neck and back problems, physical discomfort from cutting in of bra straps and fitting of clothes, and difficulty with exercise sometimes leading to weight gain and further increase in breast size. For these women, a breast reduction can be a life changing experience.
The down side to surgery is that it involves time out for an operation – 2-3 days in hospital and several weeks recovery; there are scars where tissue is removed and the nipple and areola repositioned; women may not be able to breast feed afterwards and sensation in the breast is reduced or altered. Complications such as bleeding, wound infection and healing issues, and some asymmetry may occur, and rarely there may be loss of the nipple and areola.
In spite of this somewhat daunting list, most women who undergo breast reduction are very glad they did so and comprise some of our most appreciative patients.
5)Do I need to see a surgeon about my goitre or enlarged thyroid?
Most goitres are due to benign multinodular changes in the thyroid gland and need no treatment unless they get large enough to cause compression symptoms. Compression symptoms are: difficulty swallowing (especially a lump of meat), airway compression affecting breathing or voice change (huskiness, limited range and power). Compression symptoms need treatment, usually surgery.
The other important condition to rule out is a thyroid cancer. These most often present as a solitary lump or a dominant or enlarging lump in a multinodular gland. Most thyroid lumps are not cancer and do not need surgery, but if suspicion is there, removal is indicated. The large majority of thyroid cancers are particularly good outlook, so are well worth diagnosing promptly and getting treated.