Sydney Breast Cancer FoundationSydney Breast Cancer FoundationThe Department of Breast Surgery Royal Prince Alfred Hospital provides state-of-the-art treatment for all patients which is in accordance with the national guidelines published by the National Breast and Ovarian Cancer Centre. The breast surgeons offer breast conserving surgery (55%) and mastectomy (45%) to breast cancer patients which is consistent with national and international practice.
Triple assessment (clinical exam, imaging - mammogram +/- ultrasound, biopsy) is the basis of management of all breast cancer patients who attend the Breast Clinic at Royal Prince Alfred Hospital. Patients managed through the Breast Clinics undergo triple assessment resulting in over 95% of patients having a definitive diagnosis prior to surgery.
Our surgeons, A/Prof Richard West, A/Prof Hugh Carmalt, Dr Cindy Mac and Dr George Fleischer, provide the latest in surgical techniques such as sentinel node biopsy - a new technique of axillary surgery performed in conjunction with breast surgery in patients who have early breast cancer. The department recently acquired a Faxitron Radiography machine which x-rays tissue specimens during the surgery.
A multidisciplinary case meeting is held weekly to discuss imaging and pathology results and plan optimal management for all patients. For patients with breast cancer, the breast surgeons, medical oncologists and radiation oncologists work in conjunction with the breast care nurses to plan patient management.
The department also works closely with the NSW breast screening program's (BreastScreen) Sydney South West Area Health Service located in the same premises as the Rachael Foster Breast clinic. The surgeons provide services such as surgical consultation to patients seen the BreastScreen Assessment Clinics. Our surgeons also see ladies referred to the department through BreastScreen in the Rachael Foster Clinics.
At the Institute, we have a team of medical oncologists with expertise in the management breast cancer. Dr Jane Beith and Prof Martin Tattersall form the core of the breast medical oncology team.
As well as delivering state-of-the-art treatment on-site, our medical oncologists work closely with their rural colleagues to coordinate care for patients who come from outside the metropolitan area.
Breast cancer patients are referred to a medical oncologist to discuss the role of appropriate systemic therapy in relation to the management of their breast cancer. The types of systemic treatment that may be discussed with you are hormonal therapy, chemotherapy and Herceptin® - a monoclonal antibody.
Our medical oncologists have a strong commitment to ongoing clinical research. The aim of the clinical trials undertaken is to test the latest innovative cancer treatments for the management of breast cancer. Clinical trials are not suitable for everyone and the oncologists will assess the suitability of all patients before offering them participation in current clinical trials.
There are three specialist Radiation Oncologists in our multidisciplinary team, Dr Susan Carroll, Dr Regina Tse and Dr Joanne Toohey.
Patients who are referred to see a radiation oncologist will receive advice regarding the role of radiotherapy in the management of their breast cancer. Patients receiving radiotherapy are treated in accordance with national guidelines published by the National Breast Cancer Centre. The radiation oncologists actively participate and are involved in breast clinical trials through the Australian New Zealand Breast Cancer Trials Group (ANZBCTG) and Trans-Tasman Radiation Oncology Group (TROG).
Patients are seen in clinics at Royal Prince Alfred Hospital and Concord Hospital. In addition, a radiation oncologist also attends the oncology clinic at Dubbo Base Hospital twice a month to cater for patients in the Greater Western Area Health Service. All radiotherapy treatment is delivered on-site at Royal Prince Alfred Hospital and accommodation services can be organised for all non-Sydney patients.
Breast reconstruction is an option taken under consideration by many women who have undergone a mastectomy for the treatment of breast cancer. The aim of reconstructive surgery is to restore balance and breast shape that is symmetrical with your remaining natural breast. We provide immediate breast reconstruction when indicated.
Plastic and Reconstructive surgeons, Dr Harvey Stern and Dr David Pennington, work closely with the multidisciplinary team to optimize the planning of reconstructive surgery. At your consultation, your breast surgeon and/or specialist Plastic and Reconstructive surgeon will discuss with you the type of procedure that best suits your case and the timing of the reconstructive surgery.
The diagnosis of breast cancer can be a traumatic and emotionally distressing time for every individual and their family. Breast Care Nurses are specially trained to identify and meet the needs of women after a diagnosis of breast cancer and during the course of treatment.
Our Breast Care Nurses, Ann and Ruth work as part of the multidisciplinary team involved in patient care and aim to provide women with optimal health care and services. They provide women with information (verbal & written) that women may need in relation to their disease, treatment or ongoing care.
Breast physicians are dedicated to a holistic approach to the care of patients with breast diseases. Breast physicians see women with a variety of breast concerns including cysts, lumps, minor hormonal changes, breast pain, skin changes or family history of breast cancer.
At the Sydney Breast Cancer Institute, the breast physicians work in consultation with the multidisciplinary team in the diagnosis and management of breast disease.
Dr Bronwyn Kennedy and Dr Wendy Vincent attend the Breast Clinic each Tuesday on Level 4, Gloucester House which is dedicated to the assessment of patients with new symptoms that are more than likely to be benign and the routine review of previous symptomatic patients.
They also consult at the Multidisciplinary Breast Clinic on Level 5, Gloucester House each Thursday afternoon and the High Risk clinic on the first Thursday of each month, along with Dr Helen Zorbas and Dr Charon Western.
The monthly Breast and Ovarian Cancer Risk Management Clinic is a multidisciplinary clinic that caters for women who are at high risk of breast and ovarian cancer. The clinic provides regular surveillance, genetic counseling and genetic testing to the women referred to the clinic.
For all enquiries regarding genetic testing, genetic counseling or attending the Breast and Ovarian Cancer Risk Management Clinic, please contact Georgina Fenton, Genetic Counselor, on 9515 6999
An essential component of the Breast Clinic is the on-site diagnostic services. The radiologists and radiographers who provide this service have specialist experience in breast imaging and breast diseases. Dr Deborah Stephens, Dr Nigel Hunter, Dr Alison Green and Dr Ken Ho form the core of specialist radiologists who provide their expertise to the twice weekly Breast Clinics.
The service provides digital mammography, breast ultrasound, fine needle aspiration biopsy, ultrasound-guided and mammotome core biopsy and pre-operative localisation procedures. These services are provided on Tuesdays and Thursdays with same-day results provided to the doctors in the Breast Clinic all mammography and ultrasound investigations. All other test results are provided in the next appointment in the following week.
Breast MRI (Magnetic Resonance Imaging), a new diagnostic technique for the detection of breast cancer, has been added to the arsenal of diagnostic techniques available at the Breast Clinic. Breast MRI's are performed by Dr Kevin Ho-Shon at the Specialist MRI Practice located in the RPA Medical Centre. Dr Winnie Sum provides the services at Concord Hospital.
Breast MRI is currently indicated for young women who are at increased risk of breast cancer with very dense breast tissue on regular mammograms or who have questionable findings on routine imaging. We have recently bought a new MRI coil to further assist us in diagnosing and biopsying young women with a high risk of breast cancer which is housed at the radiology department at the Concord Repartition General Hospital.
Pathologists, Dr Paul McKenzie, A/Prof Sandra O'Toole and Dr Caroline Cooper, are an integral part of our multidisciplinary team. They provide specialist expertise in the analysis of breast cytology / biopsy specimens, frozen section specimens during surgery and tissue specimens following surgery.
The pathology services are provided on-site, allowing the pathologists to work closely with clinicians in the management of patients diagnosed with breast cancer or other breast conditions. Breast tissue specimens are tested for oestrogen receptors, progesterone receptors and HER-2 receptors which enable us to individualize treatment for patients diagnosed with breast cancer. The pathologists also collaborate in the clinical trials undertaken by the Institute.
Royal Prince Alfred Hospital has recently established the Breast Cancer Tissue Bank. The Tissue Bank collects samples of breast cancer and normal breast tissue as well as blood from women diagnosed with breast cancer. The aim of the Tissue Bank is to build up a large collection of breast cancer specimens and information about women with breast cancer that can be used for future research.
Breast Lymphoscintigraphy is done prior to a sentinel node biopsy (PDF) at the Nuclear Medicine and Diagnostic Ultrasound clinic at the Royal Prince Alfred Hospital Medical Centre. A sentinel node biopsy is a surgery to detect cancerous lymph nodes in the armpit without removing all lymph nodes in the armpit. The Centre, run by nuclear physicians, A/Prof Uren, A/Prof Howman-Giles and Dr Chung, provides a vital service to the surgeons by providing with one of the two detection techniques used in detecting cancerous lymph nodes without a need for a major surgery for the patients.
The Psycho-Oncology Service is a newly established service aimed at improving the quality of life of cancer patients and their significant others by providing counseling and other therapeutic interventions for patients who are having difficulties in coping with the social, emotional and physical consequences associated with having a cancer diagnosis.
Social workers provide emotional support through counseling and can also help with practical issues like accommodation, transport, legal and financial matters, accessing community and government support.
Clinical psychologists provide psychological treatment for patients and their families who may be experiencing distress from anxiety, panic, phobias, depression and other adjustment issues related to living with breast cancer.
Breast cancer patients are referred to a physiotherapist to improve their physical well-being and quality of life by identifying and treating concerns such as muscle pain, joint stiffness and restricted arm movement.
Lymphoedema is a problem that can affect breast cancer patients following surgery to the axilla (the armpit). This condition involves swelling of the soft tissues of the arm or hand. The swelling may be accompanied by numbness, discomfort, and sometimes infection. Occupational therapists provide treatment for and advice on the management of lymphoedema.
Copyright © 2012 Sydney Breast Cancer Institute
Dr Ken&Ho
Dr Bronwyn Kennedy
Dr Deborah Stephens
Dr Nigel Hunter
Dr Regina Tse
Dr Duncan McLeod
Dr Helen Zorbas
Harriett and Margo-Lynne
Dr Sue Carroll
Dr Wendy Vincent
Dr Anne Hamilton
Dr Kevin Ho-Shon and Kate O'Donohue (Radiographer)