Recent years have seen an increased emphasis on early diagnosis of breast cancer through public education with instruction in breast self-examination, regular physical examinations by the family doctor and the use of mammography. It is hoped that this trend will lead to earlier diagnosis for a sizable proportion of women with breast cancer and thus to a better prognosis.

One result of earlier diagnosis has been the increasing number of women seen with in situ disease. This has led to re-evaluation of both the risk to these individual women and subsequent recommendations for management of in situ disease while still conserving the breast.

Long term follow-up has confirmed that wide excision followed by radiation therapy produces survival and local control which is equivalent to mastectomy, so that breast conservation is now considered standard therapy for most women with operable breast cancer. Attention to the details of surgical technique is important to achieve a high level of local control while maintaining an optimal cosmetic result.

Adjuvant systemic therapy has been demonstrated to reduce the risk of cancer recurrence and improve survival. Adjuvant systemic therapy with either chemotherapy or hormonal therapy should be offered to women according to the treatment policies as defined in Adjuvant Systemic Therapy. These policies are reviewed continuously by the provincial breast systemic policy group and updated accordingly. The role of combining both tamoxifen and chemotherapy continues to evolve.

For patients with locally advanced disease, early utilization of systemic and locoregional therapies shows promising results. In the management of metastatic disease the prime interest continues to be reduction and possible prevention of morbidity with emphasis on the quality of life.

Weekly conferences are held (Tuesday p.m..at the Vancouver Island Cancer Centre; Friday p.m. at the Vancouver Cancer Centre; Friday p.m. at the Cancer Centre for the Southern Interior and every 2-4 weeks on Tuesday afternoons at the Fraser Valley Cancer Centre) to consider the multi-disciplinary management of patients. This may be related to the initial treatment of patients or to the management of metastatic disease. The conferences are attended by diagnostic radiologists, medical oncologists, pathologists, radiation oncologists and surgeons. The clinical history, examination, the pathology slides and diagnostic imaging studies are reviewed. The family physician and surgeon are welcome to attend any conference when a patient of theirs is being presented.

Women with breast cancer are requesting information about their diagnosis and treatment options and should be encouraged to decide which treatment pathway is best for them. A delay of a few weeks between the diagnosis and definitive treatment has not been shown to be harmful and can allow a woman time to gather information and consider her options. A goal of the Alliance for Breast Cancer Information & Support is to provide Information Kits to those newly diagnosed. These kits provide Resources and navigational tools to guide individuals to credible information sources and access community services.  The Alliance for Breast Cancer Information & Support provides these kits free of charge to diagnosed persons in BC and the Yukon thanks to the generous support from the Canadian Breast Cancer Foundation, BC/Yukon Chapter.  Kits are available through surgeons or call the Cancer Information Service at 1.888.939.3333.  The BCCA library has videos, pamphlets and books for loan to patients - call 604.675.8001 or 1.888.675.8001. See also Regional Services and Patient/Public Info. 

The following is our current approach to patients with breast cancer. It is not intended to be a comprehensive manual on breast cancer and its treatments nor is it intended to imply that the approach given here is the only acceptable approach. The text, Diseases of the Breast, edited by Harris, Morrow, Lippman & Hellman, Lippincott-Raven , Philadelphia, 3rd ed. (2004), is a good source for a more comprehensive discussion of breast cancer.