On Saturday 2nd October, we held our inaugural Perth Breast Cancer Institute (PBCI) GP Breast Diseases Education Forum at the Pan Pacific Perth. As approved education providers with the RACGP, the event attracted CPD points for RACGP members.
The program was aimed specifically at GPs as a vital part of the clinical team in the care of patients with breast cancer and other breast issues.
The speakers were members of PBCI including our medical oncologists, oncoplastic breast surgeons, genetic counsellor, and breast physician as well as Dr Jo Lazberger from Perth Radiological Clinic who spoke about the role of MRI in the ongoing surveillance of women with dense breasts.
The feedback was uniformly positive with many GPs commenting that the emphasis on multidisciplinary care and protocols for following up benign breast conditions would translate into their daily practice.
During the presentations, attendees were able to send questions via text message. Here are some of the questions and the responses from the speakers:
Should we be avoiding MHT in pts with no hx breast ca but hx of papilloma/multiple fibroadenoma?
(answered by Mr Richard Martin: Yes we should be cautious in giving HRT to women with a diagnosis Papillomas, Papillomatosis etc as they are at higher risk of developing Breast cancer and HRT is known stimulant to breast tissue proliferation particularly Papillomas.)
Our PBCI team at the GP Breast Diseases Educational Forum. (L to R) Mr Bhavya Vora – Associate Genetic Counsellor, Dr Kallyani Ponniah – Oncoplastic Breast and General Surgeon, Dr Jose Cid Fernandez – Oncoplastic Breast Surgeon, Dr Joanne Lazberger – Managing partner Perth Radiological Clinic, Dr Farah Abdulaziz – Oncoplastic Breast and General Surgeon, Professor Arlene Chan – Medical Oncologist, Dr Richard Martin – Specialist Oncoplastic Breast, Endocrine and General Surgeon, Dr Hilary Martin – Medical Oncologist, Dr Pamela Thompson – Breast Physician.
Is there a lot of lymphoedema after SLNB?
(answered by Dr Farah Abdul Aziz: The risk of lymphoedema is 2-5% after sentinel node biopsy, it’s a lifetime risk and patients need to be educated regarding prevention and seeking early management)
Where is fat usually harvested from for grafts?
(answered by Dr Kallyani Ponniah: Fat is usually harvested from the lateral thigh and anterior abdominal wall. It can also be harvested from the flanks and from the back.)
Is there a place for mirena + topical oestrogen for menopausal symptoms?
(answered by Dr Hilary Martin: The safety of this option has not been absolutely established in the breast cancer survivor population.
For patients on tamoxifen circulating oestrogen is blocked and so the effect of any topical oestrogen absorption should be counteracted by this but for those on aromatase inhibitors the mechanism of action differs and so there is still a theoretical risk from circulating oestrogen from the topical oestrogen.
Mirena also is generally not recommended for this population. At an individual level it may be that the patient does decide to go with these options balancing risk against quality of life.)
Premenopausal ladies with menorrhagia/fibroids and wanting contraception Mirena safety?
(answered by Dr Hilary Martin: We recommend removal of Mirena’s for patients with a history of hormone receptor positive breast cancer and avoidance therefore of future Mirena due to the systemic progesterone absorption. Non-hormonal contraception is recommended.
Goserelin may be a suitable option for such patients with ovarian suppression, along with additional non-hormonal contraception. Or potentially for those not planning any future pregnancy hysterectomy could be considered.
At an individual patient level there may be some who opt to continue to use Mirena weighing quality of life against their risk but would recommend avoiding this option if possible)
The presentations were recorded and will be available to view by registered healthcare professionals soon.
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