It’s not appropriate for women with breast cancer to undergo a mastectomy if their doctor hasn’t first discussed breast reconstructive surgery.

Discussing the option of breast reconstruction is just one of the evidence-based practices that ‘ought to be done’ to provide the best care possible to women with breast cancer, says Cancer Australia CEO professor Helen Zorbas.

Every year, 1 in 8 Australian women are diagnosed with breast cancer before their 85th birthday. While the survival of women with breast cancer is among the highest in the world, evidence shows some women are still not receiving the most appropriate care.

To remedy this, Cancer Australia has released a best practice statement to iron out the variations in treatment.

Zorbas says they want to be able to empower health professionals and patients with the evidence to ensure the best care possible for each individual.

“This unwarranted variation in practice has the potential to have an impact on patient outcomes and experience,” she said.

Launched on Pink Ribbon Day, the Influencing Best Practice in Breast Cancer statement identifies 12 key appropriate and inappropriate practices, from diagnosis to palliative care.

It was developed by a group of experts in the fields of oncology, pathology, radiology and surgery.

The evidence shows that breast reconstruction surgery at any time following a mastectomy has no negative impact on the chances of the cancer returning, or overall survival.

It’s for this reason that Cancer Australia states that it’s not appropriate to perform a mastectomy without first discussing the option.

What is appropriate, is the offer to undergo genetic counselling to women with high family risk factors and discussing fertility and family planning with women of child-bearing age prior to treatment.

What ought to be done in breast cancer

Appropriate Care:

• Offer of genetic counselling if high familial risk.
• Optimal fixation, or preservation, of breast cancer specimens for accurate pathological examination.
• Discuss fertility and family planning with premenopausal women before treatment.
• Offer choice of either breast conserving surgery followed by radiotherapy, or a mastectomy.
• Offer of shorter, more intense course of radiotherapy as an alternative to conventional radiotherapy if aged over 50 years and/or have undergone surgery with clear surgical margins.
• Offer choice of shared care between physician and specialist if have early stage cancer.
• Offer of palliative care to those with symptomatic, metastatic breast cancer.
• Consider preoperative use of chemotherapy or hormonal therapy if clinically indicated.

Inappropriate Care:

• Diagnoses confirmed or excluded without undertaking the triple test: patient history and clinical examination, mammogram and/or ultrasound and biopsy.
• The offer of sentinel node biopsy to patients with ductal carcinoma in situ (DCIS) having breast cancer surgery.
• Undergoing a mastectomy without discussing breast reconstruction.
• Performing intensive testing (full blood count, biochemistry or tumour markers) or imaging for patients who have been treated for early breast cancer and who don’t have symptoms.

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