Dr. Mona Tan work has been cited in an International Conference
Have you offered been a mastectomy (total breast removal) for a diagnosis of breast cancer?
There may be a better option for you!
It was first observed in the year 2007 that women in Western Australia who were diagnosed with breast cancer and underwent Breast Conservation Treatment (BCT) had better survival when compared with total breast removal (mastectomy).1 Since then, several studies have confirmed these findings.
What is Breast Conservation Treatment?
Breast Conservation Treatment is the removal of the cancerous cells with a rim of uninvolved tissue around the cancer. The rest of the normal breast tissue is retained. The resultant defect in the retained breast tissue is restored immediately after to create a close-to normal-looking breast. This requires specific surgical training and techniques to achieve. Thereafter, radiotherapy to the breast is often required for complete treatment. The important thing to remember is that the majority (about 85%) of patients with breast cancer do not have to lose their breasts!
Over the years since 2007, there have been many more studies from different countries (including China, Canada, South Korea, India, Denmark, the Netherlands, the United States of America) comparing BCT with mastectomy. The findings of these studies support the earlier study done in Australia, demonstrating better outcomes with BCT. The most recent study is one from Sweden, published in May 2021, where researchers have categorically stated that BCT yielded better survival than mastectomy.2 In addition, BCT is associated with lower risk of surgical complications than mastectomy, with or without reconstruction.3,4 Therefore, if both interventions are valid options, mastectomy should be regarded as the inferior form of treatment with poorer outcomes.
So wherever possible, Dr Tan’s advice is for patients to choose BCT whenever breast cancer surgery is required.
Why do patients choose mastectomy if BCT results in better survival outcomes?
Firstly, there is the misconception, which is often perpetuated, even by healthcare professionals, that more extensive surgery like mastectomy results in longer survival. This is known to be no longer true. 2
Secondly, it is technically more difficult to perform good breast conservation surgery without significant deformity. There may be a difference in treatment philosophy, surgical training and approaches. The local administrative structure does not recognise the complexities of good breast conservation surgery and hence, it does not incentivise BCT. Not many surgeons are such strong advocates of BCT as Dr Tan, who is willing to perform wide excisions for malignant breast tumours (BCT) despite lower benchmark fees compared with mastectomy.5 It is Dr Tan’s opinion that many more Asian women are candidates for breast conservation surgery but have been denied it.6
Of note, it is technically more challenging to perform BCT for women with more than one cancer in the same breast. Notwithstanding, Dr Tan has published a report which shows that all of her patients with multiple cancers in one breast and who underwent BCT felt that the cosmetic result after treatment was satisfactory, good or excellent. None of her patients in this series reported a poor outcome. There is no other study done locally and regionally which focuses on patient satisfaction with BCT with multiple cancers.7
In summary, Dr Tan has reported BCT rates higher than all other local and regional institutions. These high BCT rates do not compromise cosmetic or survival outcomes. Her results are consistent with internationally published data.6
How can we increase the rates of Breast Conservation Treatment locally?
The first way to do so would be to participate in breast screening programmes. The use of regular mammography and ultrasound examinations of the breast is a good way to detect smaller and early cancers which in turn increases the likelihood of BCT.
Another way would be for the doctor to communicate the data and evidence available relating to BCT.8 This is so important that a world renown surgeon, Professor Michael Gnant from the Medical University of Vienna cited Dr Tan’s work (jointly performed with Professor Edibaldo Silva from University of Nebraska Medical University) at the St Gallen International Breast Cancer Conference in March 2021. There is a pressing need to inform a woman diagnosed with breast cancer that wherever possible, she should undergo BCT. She needs to know that she does not have to undergo a mastectomy and lose her breast in order to have better survival.
If you or your loved ones have been offered mastectomy or total breast removal for breast cancer, you may wish to consult Dr Tan, who has decades of experience with high BCT rates, to see if breast conservation is possible, for it might mean improved outcomes for you. Survival gain with BCT may be as high as 56%-70%!2
- Martin MA, Meyricke R, O’Neill T, Roberts S. Breast-conserving surgery versus mastectomy for survival from breast cancer: the Western Australian experience. Ann Surg Oncol 2007;14:157-64
- de Boniface J, Szulkin R, Johansson ALV. Survival after breast conservation vs Mastectomy adjusted for comorbidity and socioeconomic status. JAMA Surg, doi:10.1001/jamasurg.2021.1438
- Chatterjee A, Pyfer B, Czerniecki B et al. Early postoperative outcomes in lumpectomy versus simple mastectomy. J Surg Research 2015;198:143-148.
- Jagsi R, Jiang J, Momoh AO et al. Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg 2016;263:219-227.
- Fee benchmarks advisory committee report 2020. https://www.moh.gov.sg/cost-financing/fee-benchmarks-and-bill-amount-information
- Tan MP, Sitoh YY. Are breast conservation treatment rates optimized for Asian women with symptomatic malignancies? ANZ J Surg 2019;89:529-535.
- Tan MP, Sitoh NY, Sitoh YY. Perspectives of Cosmesis following Breast Conservation for Multifocal and Multicentric Breast Cancers. Int J Breast Cancer. 2015;2015:126793. doi: 10.1155/2015/126793
- Tan MP, Silva E. Addressing the paradox of increasing mastectomy rates in an era of de-escalation of therapy: Communication strategies. Breast 2018;38:136-143
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