Breast cancer detection rate figures can prove misleading

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I WAS the radiologist with responsibility for breast radiology (my job title was ‘general radiologist with an interest in breast disease’) until my early retirement at the end of 2010.

I have recently seen the letter from Julie Stokes about the replacement breast surgeon.

It would appear that the topic is generating opinion which is becoming very (almost too) public. I should be grateful for the opportunity to add my own comments.

The local cancer charities pushed hard in my early years as radiologist for the provision of call/recall breast screening.

Since its introduction, this up-rated service has resulted in high breast cancer pick-up rates in the island over the past two years. Indeed figures for the first year of screening showed a pick-up rate of breast cancer which was the best of any region in the UK by a significant amount.

This is down to the quality of pictures provided by the radiographic staff at Westmoreland Road and the film readers in Coventry who decide which ladies need to be recalled for further tests and treatment.

It is recognised that the first full round of screening boosts the numbers of breast cancers detected which then return towards the underlying (pre-screening) rate. Therefore the figures over the past two years cannot be used as the basis for the amount of recurring work from breast cancer which can be expected in future.

The underlying rate for the incidence of breast cancer in the island is approximately 55 new patients per year. I am told that the figures for the first half of 2011 confirm this impression.

Mastectomy is required in the minority of breast cancer patients and there are many ways of achieving reconstruction for those who need it.

Setting up such a service here would require discussion by hospital administration with theatre staff, anaesthetists and ultimately the newly appointed breast surgeon; in management jargon a ‘business plan’ is required.

It would be most unusual to invite any locum consultant to introduce a new service. When a permanent breast surgeon is appointed, I would expect the hospital to discuss with that person what level of breast reconstruction is appropriate here and which patients would be better referred to a plastic surgery centre (oncoplastic breast surgery).

Whether the hospital needs a surgeon who does only breast surgery or breast and general surgery will clearly revolve around the workload.

The previous surgeon and his team dealt with this surgical work in approximately two days per week. If there is to be expansion of the service to provide – for instance - breast reconstruction in island then this would require more time.

To appoint a consultant surgeon to look after 55 new breast cancer patients each year plus the follow-up of patients who have completed their treatment (and patients with benign breast disease) would not, in my opinion, provide enough work for a full-time post.

The alternatives are therefore to make the job part-time (usually an unpopular and unattractive option) or give that person other surgical work to make the job full-time.

Adding extra responsibility to the breast surgeon post does not imply that a reduced level of skill in breast surgery (or the associated general surgery) is required. Any surgeon appointed here to a post ‘with an interest in breast disease’ would automatically have experience in general surgery which would have been acquired prior to breast specialisation. The current breast surgery locum will undoubtedly have experience in the type of general surgery required for the proposed job.

I believe I am right in saying that any medical consultant post which is appointed on a permanent basis must be advertised and interviews held. In the interest of fairness, an existing locum cannot simply be made permanent however capable the locum and however desirable it might seem.

From what I have seen and heard, everyone involved wants the best appointee for the post of breast surgeon. I wish the hospital well in its search for a permanent replacement for Mr Malcolm Clague and hope that everyone is happy with the person who is eventually chosen to succeed him.

May I take the opportunity of thanking the staff at Noble’s and particularly the radiology staff and the breast radiology team who made working at Noble’s such a pleasure over the last 12 years.


Union Mills.

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