West Herts Breast Care Unit
Breast Oncology
Surgery is just one of the ways that we can treat breast cancers. Based on the microscopic examination of the tissue removed at surgery, our oncology team will recommend other treatments that are likely to be of benefit. Sometimes these treatments are appropriate as initial therapy, for example if the patient is not fit for surgery or if the cancer is advanced.
Endocrine treatment
The majority of breast cancers show features that make them susceptible to treatments that block the effects of the female hormones. This is usually in the form of a daily tablet, Tamoxifen. It may be appropriate to offer one of the newer Aromatase Inhibitors (Arimidex, Aromasin or Femara), in sequence with or instead of Tamoxifen, but usually only in postmenopausal patients.
Chemotherapy
Chemotherapy is considered in more advanced or more active cancers or where the cancer shows features that indicate it will not respond to endocrine treatment. The treatment is given as an outpatient at Mount Vernon Hospital, usually every six weeks for six cycles.
There are a number of different agents that can be used, as well as many techniques to minimise side effects of the treatment. If the arm veins are difficult to cannulate it is possible to place a Hickman line, which is tube tunnelled under the skin from a vein and coming out below the collar bone, or a PICC line (peripherally inserted central catheter) which comes out at the arm. This makes administration of the treatment very much easier and more comfortable.
Radiotherapy
Radiotherapy is recommended to protect the rest of the breast where surgery has removed the cancer and its immediately surrounding tissue only. It is also sometimes recommended after a mastectomy for more advanced or more active cancers. The treatment is given in sessions lasting a few minutes (Monday to Friday, with some choice as to time of day), usually for three and a half weeks, at Mount Vernon Hospital.
Herceptin
Some 20% of breast cancers will show features that predict a response to Herceptin treatment. This is an antibody treatment and like chemotherapy is given by a drip into a vein as an outpatient at Mount Vernon Hospital. The course is usually one treatment every three weeks for one year. The treatment is given into a Portocath, which is similar to the Hickman line used for chemotherapy, but ends in a reservoir beneath the skin below the collar bone. This avoids having a line hanging from the skin for the duration of the treatment.
Oncology Staff
Dr David Miles, Consultant Medical Oncologist (Breast)
Qualifications: MD MBBS BSc; FRCP
David Miles trained at University College London with postgraduate training at Kings College, University College and Guys Hospital. Following an ICRF Fellowship in the Guys Breast Unit leading to an MD, he was appointed senior lecturer/consultant to the Guys Breast Unit in 1995. In 2004 he was appointed as Consultant in Medical Oncology at Mount Vernon Hospital, spending two days of the week in the West Herts Breast Care Unit.
His research interests are in the biological treatment of breast cancer and he is National and International Principal Investigator in studies of novel agents in breast cancer. He regularly chairs and presents at national and international meetings.
Mark Harrison, Consultant Oncologist
Qualifications: PhD MBBS; MRCP FRCR
Mark Harrison is based at Mount Vernon Hospital and provides the radiotherapy service for our breast cancer patients. He trained at the Royal Free Hospital with post qualification training in Cambridge, Hammersmith, St Mary's, Middlesex and Great Ormond Street Hospitals. He was an ICRF research fellow at Clare Hall Laboratories for work leading to a PhD in Cell Biology.
He also specialises in treatment of upper and lower gastrointestinal cancers. Research interests include clinical aspects of DNA repair modification, chemoradiation of oesophageal and rectal cancer and integration of new agents into upper GI treatment schedules. He is currently regional advisor of The Royal College of Radiologists as well as a member of the NCRN rectal, advanced colorectal and chemoradiation sub-groups.
Jackie Evans, Research Sister
Qualifications: RGN 2000, Haematoncology diploma/specialist Nurse 2003, Management and care of chemotherapy 2005, Advanced Communication Skills 2007
Jackie qualified from University of Hertfordshire in 2000 and worked on the haematology ward in Hemel Hempstead General Hospital, progressing to Ward Manager in 2006. She remained in this position until 2009, when she joined the oncology research team based at Mount Vernon and St.Albans Hospital.
As a research nurse Jackie is involved in the recruiting to, screening for, treatment on and following up for clinical trials. She attends the oncology clinic and breast multidisciplinary meeting on the Wednesdays at St Albans City Hospital. The remaining time is based at Mount Vernon Hospital.
