Barts and The London Cancer Centre
As pioneers of the one-stop breast care clinic, Barts and The London Cancer Centre has taken the standard of breast care services to new heights with the state-of-the-art breast care centre, which opened in September 2004.
The centre is housed in the Grade 1 listed West Wing at Barts Hospital. Alongside the very best technology and clinical care, the screening and diagnostic unit leads the way in combining first class clinical services, state-of-the-art technology and genuine attention to the quality of the environment. The West Wing underwent careful renovation to ensure that historical features were preserved while the space was adapted for clinical use, bringing the most up-to-date screening and diagnostic services under one roof, whilst creating a healing, reassuring, comfortable, private and dignified environment.
We provide the full spectrum of breast cancer care from screening and diagnostic services through to all treatment types including surgery, chemotherapy, radiotherapy, hormone and biological therapies. We also provide reconstructive surgery. Individual care is co-ordinated by a team of specialists which include breast surgeons, pathologists, radiologists, medical and clinical oncologists and breast care nurses. The medical and clinical oncologists also provide care for patients at the University Hospitals of Homerton, Newham and Whipps Cross.
At Barts Hospital, we have pioneered both the one-stop and multi-disciplinary team approach to the management of breast disease, and are able to offer seamless care from diagnosis through to treatment on one site with the aid of experienced Clinical Nurse Specialists.
Diagnosis is done in our one stop clinic, and is likely to include:
A mammogram is a special low dose x-ray of the breast to identify any abnormal changes. We were the first unit in the country to provide full-field digital mammography for all our patients, meaning that a digital image is taken of the whole breast. By taking digital images, our specialists can view mammography images instantly, enabling us to quickly identify problem areas and plan treatment. Having a mammogram this way is also more comfortable and much quicker for patients.
An ultrasound scan can provide different information to the mammogram and in particular can tell the difference between a solid lump and a fluid filled cyst.
Aspiration cytology or fine needle aspiration cytology (FNA) involves taking a sample of cells from the breast using a small needle and syringe. It may be necessary to remove a larger piece of breast tissue using a needle biopsy.
MRI scanning – this procedure uses electromagnetic energy rather than x-rays to take images of the breast, and it enables us to detect breast cancer in situations where ordinary mammography is less effective. It is only used for breast screening in very specific circumstances, where the clinician feels it is appropriate.
The management of patients with breast cancer can involve the full spectrum of treatment types including surgery, chemotherapy, radiotherapy, endocrine and biological therapies. However, not all treatment options will be necessary in all women.
A recommendation regarding each patient is always made within our multidisciplinary team and the type of treatment will depend on the patient’s age, grade and stage of tumour and other biological features of the cancer. Thus it is possible for patients with the same cancer to have different treatment options. Our standard treatment guidelines follow those set down by national bodies such as the National Institute for Health and Clinical Excellence (NICE). Trial treatments for new drugs in national studies may be offered as an alternative to the standard treatment.
Surgery
This is usually but not always the first treatment option. Surgery is aimed at removing the cancer together with some surrounding normal breast tissue. Many women are able to have breast conserving surgery, but for some complete removal of the breast (mastectomy) is necessary.
An operation to remove some lymph glands from the armpit (axilla) is necessary to check to see whether the cancer has spread. The most appropriate surgical options for the management of both breast and armpit will be discussed individually with you and the breast care nurses will help guide decision making.
Radiotherapy
This is necessary following the majority of breast conserving surgery and sometimes following a mastectomy. This is a special type of x-ray treatment which is given to kill any cancer cells and to prevent local recurrence in the breast or chest wall.
Chemotherapy
This is a special drug treatment which may be recommended to some women following surgery. Adjuvant treatment is given to reduce the risk of recurrence, sometimes chemotherapy is given before surgery to improve the surgical options by shrinking the breast cancer first. It is usually given every 3-4 weeks as an outpatient, over a period of 4-6 months.
Hormone treatment
This is given in tablet form and needs to be taken daily for a period of about 5 years. It will be given after chemotherapy but can start with radiotherapy.
Biological therapy
For example Herceptin, is given either following or together with some forms of chemotherapy and is typically given every 3 weeks for a year.
Breast reconstruction
This may be offered at the time of primary surgery or later by the breast surgeon or with the plastic surgeons. Wherever possible our surgeons will aim to conserve the breast.
We treat approximately 300 patients with breast cancer each year.
There is an active research programme in breast cancer, led by both clinicians and basic scientists, which is undertaken at the Institute of Cancer, Barts and the London, Queen Mary School of Medicine and Dentistry. The programmes of research include study of cell adhesion molecules and myoepithelial cells, regulation of genes involved in breast cancer, the development of endocrine resistance in breast cancer and the analysis of genetic changes associated with cancer growth.
Our team is also involved in the running of two national studies (GLACIER and ICICLE) which are aimed at identifying genetic variants which cause susceptibility to early preinvasive forms of breast cancer, lobular carcinoma in situ or LCIS and ductal carcinoma in situ or DCIS respectively.
The surgical unit has a number of full-time research fellows and extensive publications in peer-reviewed journals. It is actively involved in several national clinical trials. In-house audits have been published in peer-reviewed journals with successfully completed audit loops.
The consultant breast surgeons are actively involved in training doctors with an interest in breast disease, and are founder members of the renowned Glasgow Breast Trainees Meeting.
Many members of the multi-disciplinary team are involved on the panels of national and international committees, national trial management groups and faculties of meetings.
We actively participate in national and international oncology trials. The majority of these are co-ordinated by the National Cancer Research Network. All patients providing they are suitable will be offered access to one or more of these trials.
Cancerbackup - www.cancerbackup.org.uk/Cancertype/Breast
Central and East London Breast Screening Service
For general enquiries and advice call 020 7601 7032 (direct line to Breast Unit’s secretarial staff). This number can also connect to the appropriate consultant/member of staff.
Breast Unit Service Manager: either through 020 7601 7032 above, or via main hospital switchboard 020 7377 7000 ext 2807.
Medical oncology: 020 7601 8521
Clinical oncology: 020 7601 8527
Breast Care Nurses: 020 7601 8490 (direct line)