The team, triple assessment approach allows concern s to be heard, writes Dr Muiris Houston, Medical Correspondent
The need for multidisciplinary team working (MDT) and triple assessment to bring down the death rate from breast cancer has been highlighted during the current debate about how best to organise breast services in the State.
So what do MDT and triple assessment mean in practice for a woman who develops symptomatic breast disease and who requires further assessment? The triple assessment of a breast lump in a dedicated clinic means a woman will undergo radiology (usually a mammogram), examination by a specialist breast surgeon, and a biopsy of the lump which will be examined by a pathologist specially trained in breast pathology. Clinics offering triple assessment aim to carry out all elements of the assessment at a single visit.
Under guidelines issued by the National Quality Assurance Group for Symptomatic Breast Disease Services earlier this year, dedicated breast centres should be staffed by at least two consultant breast surgeons, two specialist radiologists, a team of specialist nurses and at least two consultants with an expertise in breast pathology. The reason for this is to ensure that no one specialist operates in isolation and can discuss difficult cases with a colleague working on the same site.
Having all health professionals involved in a woman's care located in one place enables multidisciplinary team work to take place. The centre of this concept is the holding of a weekly conference attended by all staff at which both the diagnosis and the future treatment of the patient are discussed. Every detail of the patient's case is put up for discussion, from the GP's referral letter through to the pathologist's report.
Some cases will require little diagnostic discussion. The patient will either have benign breast disease or will clearly have breast cancer. But some cases can be difficult to call. For example, the mammogram and the biopsy may be negative but the surgeon and/or the radiologist will still be concerned about the nature or consistency of the breast lump. And it is in these cases that a multidisciplinary approach really helps.
MDT allows the lone voice of concern to be heard. It offers a forum for an individual doctor to express an intuitive sixth sense about a particular case. By giving a value to a minority view it frequently triggers a decision to retest or re-examine the woman involved. And it is this process that essentially makes it less likely that a woman with breast cancer will be misdiagnosed.
A formal multidisciplinary approach has been shown to improve survival from breast cancer by at least 20 per cent. The fact that MDT is not standard practice in breast cancer care in the Republic is a major reason why we lag behind other European states in breast cancer survival statistics.
The MDT approach to diagnosis works well in planning treatment because it allows surgeons, radiotherapists and oncologists to decide on the best doses and sequence of treatments for the individual patient.
The advantages of MDT are that it increases expertise and facilitates peer review and scrutiny.