TOP SURGEON REVEALS MODERN BREAST CANCER TREATMENTS
Former model Elle McPherson's refusal to receive conventional treatment for breast cancer has caused a media storm. Here, world-leading breast cancer surgeon Associate Professor Sanjay Warrier explains why modern treatments remain the gold standard for managing breast cancer, particularly for those with high-risk forms of the disease.
Breast cancer treatment varies based on two important factors: what it is and where it is. We effectively break down breast cancer into three types: hormone-positive, HER2-positive, and triple-negative cancer.
For HER2-positive and triple-negative cancers, we generally give chemotherapy with targeted therapies first and then operate. For HER2-positive breast cancers, we tend to utilise dual HER2-blocking therapies, whereas for triple-negative breast cancers, we are using immunotherapies.
In HER2-positive disease, utilising dual treatments has led to six to seven out of 10 patients not having cancer on post-surgical excision. In the immunotherapy group for triple-negative, this is coming up to the five out of 10 mark, which is an incredible outcome.
For hormone-positive breast cancers, we tend to operate first for the lower-grade or slower-growing cancers, whereas the higher-grade cancer may be considered for chemotherapy first.
A big breakthrough with hormone-based cancers has been our increased utility of CDK 4/6 inhibitors in the post-surgical setting for higher-risk tumours.
I guess the point is we have a lot of effective therapies personalised to different breast cancer subtypes and are getting improved outcomes for patients who present early.
I respect Elle’s personal journey. She has sought opinions and made her choice. Going through a diagnosis is incredibly tough, and she is at peace with her decision-making. I don’t know enough about the specifics of her case as it is only through media outlets we get the information.
One thing with going through a diagnosis of cancer is that it is like going through stages of grief and shock. Suddenly, you have to make life-altering decisions in a space of a few weeks.
All I would say is that, depending on the clinical vignette, it is important to remember that your medical colleagues are part of your team to work out the best treatments for you.
A concern for me is more around the ramifications of what has happened and how that plays out for future patients with high-risk diseases where there are treatments that we know work so well.
I think it's really important that they can work with their medical professionals to ensure they are getting the best possible treatments, weighing up the risks and benefits of treatments.
Are there any alternative therapies that have proven to be effective?
Any alternative therapies must work hand in hand with traditional therapies. Synergy is important rather than picking one or the other.
It is important to understand that we have moved from an era of paternal medicine to an era of mutualistic medicine, where patients are involved in and aware of their choices, and they are included in the decision-making around their treatments.
Medicine has progressed significantly, not only in advancements in diagnosis and treatment but also in the way the medical-patient relationship is managed and supported.
Medicine now puts the patient front and centre of all aspects of the health journey. We have experienced incredible advances in medical treatments and are trying to be proportionate in our treatments relative to the patient's circumstances.
The critical issue to understand in breast cancer medicine today is that most treatment pathways are performed in an ecosystem involving a team rather than a decision made by one medical practitioner.
There should be at least two early consultations to ensure the patient is supported and is able to move through the pathway informed and involved.
Patients are able to choose options inside this net with support. I feel it is important to continue to encourage people to understand the benefits of modern medicine despite them not always being the most comfortable. They do offer the best outcomes.
When it comes to the idea of alternative solutions, it is important for them to be considered in partnership with conventional medicine because conventional treatments are incredibly effective.
Associate Professor Sanjay Warrier is a world-leading breast cancer surgeon known for his expertise in Breast Surgical Oncology and Oncoplastic Surgery. He practices at prominent institutions, including Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, and the Mater Hospital in Sydney. He pioneered robotic mastectomies in the Southern Hemisphere and was the first in Australia to use Spy technology in breast reconstruction.
