Multidisciplinary approach to the management of breast cancer in Hong Kong

Introduction: Treatment of breast cancer has become more complex and sophisticated in recent years, and a multidisciplinary team approach to management is now recommended worldwide. The present study reviews the applicability of the multidisciplinary approach to the management of patients with breast cancer in a private hospital. Methods: Between September 2003 and April 2005, a total of 579 consecutive patients undergoing breast cancer surgery were studied. Patients receiving neoadjuvant chemotherapy or who had metastatic disease at presentation were excluded. Demographic and operative details, pathology, and recommended adjuvant therapy were discussed in the weekly multidisciplinary breast conference involving breast surgeons, pathologists, and radiation and medical oncologists. Results: The mean age was 48.6 years. A self-discovered breast lump (80%) was the most common presentation, whereas screening mammography accounted for only 12.2%. The accuracy of preoperative mammography, ultrasonography, fine-needle aspiration cytology, and core biopsy were 66.5%, 80.7%, 89.4%, and 98.9%, respectively. Mastectomy was performed in 49.3% of patients, of whom 22.0% underwent immediate reconstruction. Eighty-five percent of patients underwent concomitant axillary surgery, comprising either sentinel node biopsy (49.9%), sentinel node biopsy followed by axillary dissection (38.7%), or axillary dissection alone (11.4%). The mean size of invasive tumors was 2.3 cm, and lymph node metastases were detected in 40% of patients; stage 0, I, II, and III disease was present in 14.2%, 34%, 44.5%, and 7.2% of patients, respectively. Adjuvant hormonal therapy, chemotherapy and radiotherapy were recommended in 62.4%, 51.2%, and 64.9% of patients, respectively. Conclusions: Breast cancer in Hong Kong most often presents as a breast lump discovered by self-examination. The role of screening mammogram has to be reevaluated. Multidisciplinary teamwork is essential for optimizing decision-making about adjuvant treatment interventions in such patients.