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Breast Cancer Awareness Month

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    Sophia Courtaux writes about Breast Cancer Care’s campaign to raise awareness of secondary breast cancer and improve rates of diagnosis and ensuring correct treatment for those affected.

    By Sophia Courtaux

Breast Cancer Care is the only UK wide charity providing care, information and support to those affected by breast cancer. October 2016 is Breast Cancer Awareness Month, with a particular focus on achieving earlier diagnosis, funding research and providing comprehensive and unique support to those living with or affected by secondary breast cancer.

What is secondary breast cancer?

Secondary breast cancer is also known as metastatic, advanced or stage 4 breast cancer. It occurs when breast cancer cells have spread from the breast to other parts of the body, such as the bones, liver, lungs and brain.

A recent study from Breast Cancer Care has revealed an estimated 36,000 people are living with secondary breast cancer in the UK and each year around 11,600 people die from the disease.

Symptoms and statistics

From a survey of 840 people launched by Breast Cancer Care, 72% of respondents had had a previous diagnosis of primary breast cancer while for 28%, their diagnosis of secondary breast cancer was their first diagnosis (meaning that the breast cancer had already spread at the point of diagnosis).

Breast Cancer Care highlights some of the signs and symptoms of secondary breast cancer:

  • pain in bones (for example in the back, hips or ribs) that doesn’t improve with pain relief, or lasts for more than one to two weeks and is often worse at night;
  • unexplained weight loss and a loss of appetite;
  • constant nausea (feeling sick);
  • discomfort or swelling under the ribs or across the upper abdomen;
  • feeling constantly tired;
  • a dry cough or a feeling of breathlessness;
  • severe or ongoing headaches;
  • altered vision or speech.

Survey results revealed only 22% were aware of the possible signs and symptoms of secondary breast cancer. 20% thought they knew but did not recognise the correct signs and symptoms and 58% did not know the symptoms at all.

More worryingly, a survey of NHS hospital Trusts revealed that two thirds did not know how many of their patients had secondary breast cancer. Breast Cancer Care are therefore campaigning for improvement in this area, to ensure that all patients with secondary breast cancer receive the correct care.

What does this mean?

There is a clear lack of knowledge of the signs and symptoms of secondary breast cancer. More needs to be done to ensure that woman are provided with information when finishing their hospital-based treatment for primary breast cancer so that they are aware of the possible signs and symptom of secondary breast cancer and how they can get back into hospital care if they have a symptom or concern.

If woman are not made aware the above symptoms could be wrongly misinterpreted, therefore the purpose of raising awareness is to bring these symptoms to the forefront of minds in order to encourage them to get checked regularly and to seek advice from their GP if they have any suspicions.

What changes are being made?

The National Institute for Health and Care Excellence (NICE) is currently in the process of updating their clinical guidelines “Early and Locally Advanced Breast Cancer: Diagnosis and Treatment”. This guideline provides recommendations about the treatment and care of people diagnosed with primary and locally advanced breast cancer across England and Wales. Currently the guideline states that patients treated for breast cancer should have an agreed, written care plan including ‘signs and symptoms to look for and seek advice on’. Breast Cancer Care is calling for the updated guideline to include a clearer guidance on the importance of informing patients of possible signs and symptoms of secondary breast cancer.

Along with this, it is recommended that NHS England should work to improve services for those living with and beyond cancer. This includes provisions of information for those finishing treatment, covering:

  • Potential markers of recurrence /secondary cancers and information on what to do in these circumstances;
  • A key contact point for rapid re-entry if recurrence markers are experienced or if serious side effects become apparent.

It will be interesting to see if these recommendations are implemented as a matter of priority.

What can GP’s do?

It is recognised that GP’s are under enormous time pressure. Symptoms such as nausea and back pain, are too vague and can be attributable to a number of causes not related to breast cancer. These factors can make it very difficult to correctly identify potential secondary breast cancer cases. It is however important that possible signs and symptoms are adequately investigated to either rule out or diagnose secondary breast cancer.

Breast Cancer Care have made suggestions for GP’s for those patients who have a previous primary diagnosis, including:

  • A flagging system on patient records which reminds the GP to consider a person’s previous breast cancer diagnosis;
  • Use of a treatment summary, which includes the opportunity for the specialist team to communicate symptoms that require referral back to them;
  • A guide to ‘red flag’ symptoms, such as back pain, consider in conjunction with flagging system;
  • Resources for GP’s provided by Breast Cancer Care;
  • Direct entry back into the hospitals/breast care team, without a need for a referral by a GP.

Our Experience

My colleagues and I in the Clinical Negligence team are fully supportive of raising awareness of breast cancer with a view to achieving diagnosis and the correct treatment as early as possible. Unfortunately we often see cases where our clients have suffered from a delay in diagnosis of breast cancer due to negligent failings in their medical treatment. Delayed diagnosis can lead to the cancer advancing requiring more extensive treatment and a worse prognosis for the patient.

Increasing awareness of symptoms for both patients and doctors is vital to try and ensure diagnosis at the earliest time therefore potentially improving the UK’s survival rates for this cancer.

 

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