By Dr Anitha Karunairajah, Breast Surgeon, Joondalup
Breast cancer remains one of the most prevalent cancers worldwide, affecting around one in seven women and ranking as the second most common cause of cancer-related death among females.
However, the landscape of breast cancer treatment is evolving rapidly, bringing improved survival rates and better quality of life for patients.
One of the most significant advancements in breast cancer care is the move towards personalised treatment. Tumour profiling and precision medicine now allow for therapies tailored to the individual patient’s tumour biology, reducing treatment toxicity while improving efficacy, leading to prolonged survival and better quality of life.
Innovations in breast surgery
Surgical techniques have progressed significantly, offering patients more aesthetically favourable and functionally beneficial options.
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Oncoplastic breast surgery techniques combine plastic surgery principles with breast-conserving surgery, allowing for better cosmetic outcomes. These techniques involve:
Volume displacement: Repositioning breast tissue during tumour removal to maintain a natural shape.
Volume replacement: Using perforator flaps (fatty tissue with its own blood supply) to fill defects without requiring complex microvascular reconstruction.
Therapeutic mammoplasty: A technique where tumour removal is integrated with breast reduction, particularly beneficial for patients with larger breasts.
Skin and nipple sparing mastectomy: These advanced mastectomy techniques preserve the breast skin and, when appropriate, the nipple-areola complex, enabling immediate reconstruction with superior cosmetic and psychological outcomes.
Advancements in radiation therapy
Radiotherapy has also seen significant improvements, focusing on reducing treatment duration and side effects:
Partial breast radiation therapy: A technique delivering targeted radiation to the tumour bed rather than the entire breast – particularly useful for selected early-stage breast cancer patients, reducing radiation exposure and treatment duration while maintaining efficacy.
Hypofractionated radiation therapy: Delivers higher doses over fewer sessions, maintaining effectiveness while minimising patient burden.
Intraoperative radiation therapy: Administered during surgery, this technique reduces the need for postoperative radiation, particularly in elderly patients with early-stage cancer.
Systemic treatments and targeted therapies
HER2-positive breast cancer: Breakthrough therapies such as Trastuzumab, Pertuzumab, and Trastuzumab Deruxtecan have drastically improved patient outcomes.
CDK4/6 inhibitors: Drugs like Palbociclib, Ribociclib, and Abemaciclib are enhancing survival rates in hormone receptor-positive breast cancer.
PARP inhibitors: Used in BRCA-mutated cancers, these drugs, such as Olaparib, exploit defective DNA repair mechanisms to kill cancer cells.
Immunotherapy and neoadjuvant therapy
Emerging as a promising option for triple-negative breast cancer, immunotherapy drugs like pembrolizumab (Keytruda) are offering new hope in an area historically associated with poorer prognoses.
Preoperative treatments, including chemotherapy and targeted therapies, are increasingly being used to shrink tumours before surgery especially in HER-2 positive and triple negative breast cancers.
This approach allows for more conservative procedures and facilitates response-guided surgical decisions.
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Genomic tests such as Oncotype-DX is used to assess the risk of recurrence in certain types of early-stage breast cancer and helps avoid unnecessary chemotherapy for low-risk patients while ensuring high-risk patients receive appropriate treatment.
Genomic profiling is a cutting-edge approach in cancer treatment that analyses a tumour’s genetic mutations to guide personalised therapy by identifying specific alterations in DNA, such as mutations in BRCA1/2, and is particularly valuable in metastatic breast cancer.
Key messages
- Breast cancer treatment is evolving rapidly
- GPs play a vital role in early detection, screening, and lifestyle modification for breast cancer patients.
- They are essential in supporting and coordinating ongoing care, and a crucial member of the patient’s multidisciplinary team.
Multidisciplinary approach and the GP’s role
Breast cancer management requires a collaborative effort involving surgeons, oncologists, radiologists, pathologists, and other healthcare professionals. The GP plays an integral role in this multidisciplinary team.
- During pre-diagnosis, screening and early detection, through clinical examination and imaging referrals. Identifying high-risk individuals and referring them for genetic counselling.
- Post diagnosis and during treatment, by monitoring treatment side effects, including chemotherapy or radiation induced toxicities. Providing emotional and psychological support, with referrals to mental health services when necessary. Direct patients to resources such as Cancer Council, Breast Cancer Care WA and Breast Cancer Network Australia for ongoing information and support.
- Post-Treatment and Survivorship Care, through annual mammography and clinical exams for long term surveillance. Managing side effects of hormonal therapies, including osteoporosis monitoring for patients on aromatase inhibitors. Addressing lifestyle modifications to reduce recurrence risk.
When referring patients to breast surgeons, it is helpful to include relevant medical information or a summary, mammogram and ultrasound report of both breasts, core biopsy ± FNA report and, where applicable, full histopathology report including receptor status (ER/PR) and HER2 DISH.
Author competing interests – nil
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