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Posts tagged ‘breast cancer’

Breast cancer: Drug ‘halves’ risk of tumours

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A “landmark study” shows a drug can more than halve the development of breast cancer in high-risk women.

A trial on 4,000 women, published in the Lancet, showed anastrozole was more effective, cheaper and had fewer side effects than current medications.

It stops the production of the hormone oestrogen, which fuels the growth of the majority of breast cancers.

Doctors and campaigners are asking health services to consider offering the drug to healthy women.

Some countries already offer the drugs tamoxifen and raloxifene to prevent breast cancer.


Analysis

James GallagherHealth and science reporter, BBC News

The use of drugs to prevent cancer has the potential to transform care – a mastectomy is no longer the only preventative treatment.

But who should get the drugs?

There are side-effects to chemicals which affect the hormone oestrogen so these drugs will not be given to all women.

Meanwhile, those with very high risks, such as BRCA gene mutations, may think the risks are still too high even with medication so may still opt for a mastectomy.

A challenge for cancer research will be to identify those women who would gain the most from treatment.

Advances in genetics and new ways of analysing breast tissue are getting a clearer picture of a woman’s risk.

However, it is important to remember that many lifestyle choices have a huge impact too.

Breast feeding, reducing alcohol intake and loosing weight will all cut the risk of breast cancer.

They both block oestrogen activity, however, they also increase the risk of cancers of the womb, deep vein thrombosis and hot flushes.

Aromatase inhibitors, such as anastrozole, stop oestrogen being produced in the first place and are already used as a treatment for breast cancer.

‘More effective’

The study at Queen Mary University of London has followed women with a high risk of breast cancer, based on their family history, for an average of five years.

It showed that out of 2,000 high-risk women given no treatment there were 85 cases of breast cancer in the study.

But in the same number of women given anastrozole there were 40 cases, with virtually no side-effects.

Lead researcher Prof Jack Cuzick, who also pushed for the introduction of tamoxifen, told the BBC: “I think this is an exciting moment, breast cancer is by far the most common cancer in women and we have a chance to reduce cases.”

He added: “This class of drugs is more effective than previous drugs such as tamoxifen and crucially, it has fewer side effects.”

Prof Cuzick said there was now enough evidence to consider offering the drug.

Breast cancer cells
Oestrogen is behind up to 80% of breast cancers

Prof Montserrat Garcia-Closas, from the Institute of Cancer Research in London, who led the world’s largest study into the causes of breast cancer, told the BBC: “This is a very significant and very important finding.

“The question now is will it reduce mortality and that will require longer term studies.

“But it adds very important evidence for recommending the drug as an alternative to tamoxifen, we now need to identify those women at highest risk who will benefit the most from this treatment.”

Post-menopause

Both tamoxifen and anastrozole are cheap as the patents have run out on the drugs. For five years of treatment, tamoxifen would cost £157 and anastrozole £137.


This landmark study shows that anastrozole could be valuable in helping to prevent breast cancer in women at higher-than-average risk of disease”

Kate LawCancer Research UK

However, anastrozole cannot prevent the ovaries producing oestrogen so it would work only after the menopause. Tamoxifen works both before and after.

In 2013, the National Institute for Health and Care Excellence, in England and Wales, said high-risk women, over 35, should be offered tamoxifen or raloxifene.

The decision affected around 500,000 women. Cancer Research UK estimates that 240,000 of them would be suitable for anastrozole.

Prof Mark Baker, from NICE, commented: “We will certainly consider this research – along with all other available evidence – when the NICE guideline on familial breast cancer is next updated.”

But he cautioned that tamoxifen was recommended for just a “relatively small percentage” of people so far.

Dr Caitlin Palframan, the head of policy at the charity Breakthrough Breast Cancer, commented: “The challenge will be ensuring drugs like these are actually offered on the NHS, as many eligible women still don’t have access to the risk-reducing treatments already recommended in national guidelines. ”

Kate Law, the director of clinical research at Cancer Research UK, which part funded the study, said: “This landmark study shows that anastrozole could be valuable in helping to prevent breast cancer in women at higher-than-average risk of disease.

“We now need accurate tests that will predict which women will most benefit from anastrozole and those who will have the fewest side-effects.”

via BBC News – Breast cancer: Drug ‘halves’ risk of tumours.

Living after breast cancer

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Stacy Cutrono, left, US University of Miami’s exercise physiologist, takes the pulse of Judith Cornille, who just completed her exercise workout. – MCT

 

Breast cancer survivors get guidance for their post-treatment lives.

JUDITH Cornille survived breast cancer. The lumpectomy. The radiation. The utter shock.

But even as she recovered from treatment, her mind was on the future: Now what?

“Everyone was telling me to get on with my life, but I was still reeling emotionally,” recalled Cornille. “This wasn’t what I had planned.”

Cornille, 65, was lucky. She enrolled in the new Breast Cancer Survivorship Clinic at the University of Miami’s Sylvester Comprehensive Cancer Center, a three-month-old programme that supplements routine care provided by a breast oncologist with a multidisciplinary approach to managing the long-term effects of cancer and the side effects of treatment. The programme offers nutritional counseling, physical rehab and fitness training, psychiatric counseling and integrated medicine, including acupuncture, yoga and tai chi.

“It’s like a GPS after treatment,” Cornille said. “It helps me to know what I should expect and what I can do to feel better. It does a lot for the psyche.”

The Breast Cancer Survivorship Clinic is part of a growing movement within the healthcare system to help survivors adjust to their new life, post cancer.

As more of them lead longer, healthier lives, hospitals are reorganising their services by offering a one-stop shop that gathers together various disciplines.

“We’re moving toward a collaborative model,” said Dr Beatriz Currier, who heads up the psychiatric part of the clinic. “We are all tackling the symptoms from our different expertise and a major asset is that everything is centralised.”

 

Breast cancer survivor Judith Cornille, left, works closely with UM's exercise physiologist Stacy Cutrono in their U Survive & Thrive program, at the University of Miami's Wellness Center, October 4, 2013. (Marice Cohn Band/Miami Herald/MCT)

The Breast Cancer Survivorship Clinic at University of Miami’s Sylvester Comprehensive Cancer Center is a programme that supplements routine care provided by a breast oncologist with a multidisciplinary approach to managing the long-term effects of cancer and the side effects of treatment. – MCT

For years, breast cancer patients were released with little guidance on how to deal with post-treatment issues, everything from depression to weight gain, to sleep problems and sexual dysfunction. But that is changing as more patients of all cancers survive.

There are almost 14 million cancer survivors in the United States and that number is projected to increase by 31%, to almost 18 million, by 2022, according to the National Cancer Institute.

The medical community has realised such numbers demand follow-up guidelines to ease the lives – and the worries – of these former patients.

That’s why the influential Institute of Medicine issued a report in 2005 recommending that all patients, after completing treatment, receive a survivorship care plan (SCP), a blueprint that helps a survivor steer her way through the maze that is post-treatment life.

A care plan includes both a record of care the patient has received and a follow-up plan about psychosocial effects of treatment, prevention of new cancers and surveillance of recurrent cancers, among other things.

The American College of Surgeons considers these survivorship plans such an important part of post-treatment cancer care that in 2011 its Commission on Cancer announced that it would require all of its accredited facilities – where about 70% of new cancer patients are treated – to provide these plans to all patients by 2015.

Because breast cancer survivors comprise the largest percentage of survivors, 22%, it was a natural step for local hospitals to begin implementing SCPs with them.

“They have a spectrum of issues but they are also more open, more motivated to deal with them,” Currier said.

At the Sylvester clinic, the initial visit includes a two-hour screening to determine the issues a patient is facing. If, for example, she suffers from fatigue, she might see the psychiatrist, exercise physiologist or nutritionist, perhaps even an integrated medicine specialist for acupuncture or yoga.

All these disciplines can offer help.

The Breast Cancer Survivorship Clinic sees about five new patients a week. It is now open only to Sylvester patients, but Currier says it might one day open to other breast cancer patients who have been treated in other cities and institutions.

Cornille’s first appointment was with the exercise physiologist. Eager to get her life back on track, she had tried the gym on her own, but her efforts were short-lived.

“I was on the elliptical for five minutes and my legs were like jelly,” she recalled.

So she registered with the U Survive & Thrive programme at the survivorship clinic, where exercise physiologist Stacy Cutrono tailored an exercise routine and followed her through 16 supervised sessions.

Cornille said she was “very encouraged” to see her endurance and strength improve on every visit to the gym.

“It starts as hand-holding, then it takes off,” Cutrono said. “They take what I teach them and they go from there.”

Heidi Rowland, a 57-year-old breast cancer survivor, has seen both Cutrono and the nutritionist for follow-up care. In a couple of months, she will visit Currier for a cognitive assessment. These appointments are in addition to her follow-ups with the breast oncologist.

“To have to see several physicians who don’t talk to each other and are in different places would be very stressful,” she said. “It would be daunting, so it’s great to have everyone gathered in one place and everyone talking to each other.”

Other local hospitals have launched survivorship care plans for their breast cancer patients. Advanced Medical Specialties oncologist Dr Grace Wang, who chairs the Commission on Cancer (COC) committee for Baptist Health, has worked on the survivorship plan template the hospital gives to survivors for more than a year.

To those guidelines she plans to add a list of available community resources, as well as a financial component because cancer “can cause financial distress to so many of our patients”.

Wang sees SCPs as a vital part of “a team effort” to reduce the recurrence of cancer and offer support to survivors so they can comply with post-treatment care. “You’re educating and keeping them on task about what they should be doing,” she said.

At the Memorial Center Institute in Broward, psychiatrist Patrick Reynolds, who heads a multidisciplinary oncology support system, has been supervising the rollout of the SCPs for breast cancer patients. Like other centres, Memorial plans to add other cancer survivors in the future.

“In the past, people fell through the cracks,” he said. “The pieces were there, but the care tended to be fragmented. What we’re doing now is formalising the process so survivors don’t get lost in the follow-up.” – The Miami Herald/McClatchy-Tribune Information Services

via Living after breast cancer – Health | The Star Online.

Early awareness the key

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From left Watanabe, Vemanna, Abdul Rashid, Leong and Melinder being briefed about the campaign.

 

A lingerie company has roped in the media to raise awareness of breast cancer, writes Nadia Badarudin

BREAST cancer is a major killer of women. But how many of us really care about the media messages and campaigns on breast cancer? How many of us think “it’s not going to happen to me” or that “it’s someone else’s problem”?

Since its establishment in 2003, lingerie manufacturer Wacoal Malaysia has been organising the Pink Ribbon campaign every October through various channels nationwide, aimed at spreading knowledge on early detection of breast cancer.

Realising that ignorance isn’t bliss when it comes to breast cancer, Wacoal Malaysia recently launched its 2013 Pink Ribbon campaign.

With the New Straits Times as its exclusive media partner, the company has chosen to spread awareness and to kickstart the campaign among the members and family of the public “mouthpiece” itself — the media.

The launch of the 2013 Pink Ribbon campaign was held at the New Straits Times Press headquarters in Bangsar on Oct 10. Speaking at the launch, Wacoal Malaysia executive director Takashi Watanabe said the fight against breast cancer and advocating the importance of early detection have been part of the company’s social responsibility.

He said: “Breast cancer is curable if detected early, and we can never emphasise enough on the importance of early screening. This year, the campaign is aimed at combating ignorance. There is no better way to generate and maximise the awareness than through the media.

“We hope that our collaboration with NSTP will enable us to spread the information further and to wider audience more effectively,” he said before jointly launching the campaign with NST deputy group editor Abdul Rashid Yusof.

Present at the event were Wacoal Malaysia director and general manager Vincent Leong and National Cancer Council (Makna) deputy general manager Vemanna Appannah.

SPLASH OF PINK
The campaign started with Pink Ribbon ambassador, Miss World Malaysia 2013 Melinder Kaur Bhullar, sharing her knowledge on breast cancer prevention and healthy living.

There was also an exhibition on cancer, covering from preventive to post-cancer information. One of the interesting booths displayed is Remamma, Wacoal’s product range for women who have undergone mastectomy.

Wacoal Malaysia’s experienced beauty advisors were also on hand to impart knowledge and tips on breast self-examination and bra-fitting to employees of NSTP.

Apart from games and giveaways, mammogram screening was also available on-site at the National Cancer Council (Makna) mobile mammography unit.

A donation drive is being held nationwide as part of the Pink Ribbon initiative where the proceeds will be channelled to Makna’s mobile mammography services. The services are provided for both urban and rural areas, to improve access and affordability for women to receive early screening tests.

PINK WITH HOPE

THE Estee Lauder Companies’ global Breast Cancer Awareness campaign turned 21 this year and the Petronas Twin Towers were bathed in a beautiful pink hue on Oct 18 and 19.

The colour pink serves as a symbol of hope as breast cancer is the biggest cause of cancer deaths among women in the country.

The KLCC Lake Symphony Fountain will also be illuminated in pink until the end of the month.

“Early detection saves lives. Through awareness and education, we hope that women will do the right things such as monthly self breast examinations and for those above 40, annual mammograms,”

“This is the first step to help prolong our lives in any case of breast cancer,” said Esteen Lauder brand general manager and campaign chairperson Katrina Liew.

Past campaigns have seen the Kuala Lumpur Tower, Sultan Abdul Samad Building, Bintang Walk, Pavilion KL, Fahrenheit 88, and the National Science Centre illuminated in pink.

 

via Early awareness the key – Health – New Straits Times.

Walking ‘cuts breast cancer risk’

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Post-menopausal women who walk for an hour a day can cut their chance of breast cancer significantly, a study has suggested.

 

The report, which followed 73,000 women for 17 years, found walking for at least seven hours a week lowered the risk of the disease.

The American Cancer Society team said this was the first time reduced risk was specifically linked to walking.

UK experts said it was more evidence that lifestyle influenced cancer risk.

A recent poll for the charity Ramblers found a quarter of adults walk for no more than an hour a week – but being active is known to reduce the risk of a number of cancers.

Recreational activity

This study, published in Cancer Epidemiology, Biomarkers & Prevention followed 73,615 women out of 97,785 aged 50-74 who had been recruited by the American Cancer Society between 1992 and 1993 so it could monitor the incidence of cancer in the group.


We know that the best weapon to overcoming breast cancer is the ability to stop it occurring in the first place.”

Baroness Delyth MorganBreast Cancer Campaign

They were asked to complete questionnaires on their health and on how much time they were active and participating in activities such as walking, swimming and aerobics and how much time they spent sitting watching television or reading.

They completed the same questionnaires at two-year intervals between 1997 and 2009.

Of the women, 47% said walking was their only recreational activity.

Those who walked for at least seven hours per week had a 14% lower risk of breast cancer compared to those who walked three or fewer hours per week.

Dr Alpa Patel, a senior epidemiologist at the American Cancer Society in Atlanta Georgia, who led the study, said: “Given that more than 60% of women report some daily walking, promoting walking as a healthy leisure-time activity could be an effective strategy for increasing physical activity amongst post-menopausal women.

“We were pleased to find that without any other recreational activity, just walking one hour a day was associated with a lower risk of breast cancer in these women.

“More strenuous and longer activities lowered the risk even more.”

Baroness Delyth Morgan, chief executive of Breast Cancer Campaign, said: “This study adds further evidence that our lifestyle choices can play a part in influencing the risk of breast cancer and even small changes incorporated into our normal day-to-day activity can make a difference.

She added: “We know that the best weapon to overcoming breast cancer is the ability to stop it occurring in the first place.

“The challenge now is how we turn these findings into action and identify other sustainable lifestyle changes that will help us prevent breast cancer.”

via BBC News – Walking ‘cuts breast cancer risk’.

Many women still confused over breast cancer


PETALING JAYA: Many Malaysian women are still very confused over breast cancer, leading to difficulties when making decisions on how to deal with the disease, experts said.

The situation is further compounded by the fact that many prefer to seek alternative therapies in the early stage of the disease and only get medical help when the cancer has spread.

Cancer Research Initiatives Foundation (Carif) chief executive officer Prof Dr Teo Soo Hwang said women also did not necessarily have correct information on the disease.

She clarified that breast cancer was not one disease but 10 different diseases at the genetic level, all of which could be called breast cancer.

Each type needed separate treatments, she said.

“It is different types of treatment for different patients. All of this is very difficult to understand and they need to make decisions,” she said.

She added that women who were diagnosed with breast cancer also had other issues to deal with, including body image, psychosocial concerns like fear of losing their husbands or of being disowned by their families because of the stigma and affordability of treatment.

Dr Teo said it was important to know that breast cancer was curable if treated early and with the right decisions and support.

To this end, Carif has undertaken a series of programmes and research, among them a collaboration with the Ladies Professional Golf Association under which funds are used for a subsidised mammogram programme and women who take the test also donate a blood sample for research and answer a questionnaire.

It also has a patient navigation programme to help women make key decisions about their breast cancer.

University Malaya Medical Centre consultant breast surgeon Prof Dr Nur Aishah Mohd Taib said alternative therapy was “strongly embedded” in Malaysian society and confused some women, who equated it to hospital therapies.

“One of the factors why they present late is health literacy,” she said. “Some women don’t even know that cancer can spread and that it is dependent on time.

“A lot of women have difficulty making decisions so they normally choose the easier ones first and then go to the hospital as the last resort.”

Dr Nur Aishah also said there were misconceptions that caused women to avoid going for a biopsy as they believed they tak boleh kena besi (the disease would spread if any metal cuts into the flesh).

Dr Teo said patients also sometimes focused on the side effects like losing their hair rather than the efficacy of the treatment.

Research has shown that 7% of patients do not complete their treatment and resurfaced later.

Some centres treating breast cancer have reported up to 15% of patients who completely “disappear” from treatment.

Breast cancer hits 18% of the Malaysian population and is one in three cancers that women get.

A study carried out in University Malaya Medical Centre, which was published in 2011, found that five-year survival rates had improved in patients sampled, with Chinese improving from 63% to 81.4%, Indians from 57% to 80.4% and Malays from 46% to 58.3%.

Further studies are being done to find out why Malay women have lower survival rates although they have half the risk of developing breast cancer compared to the Chinese.

Besides the disparity between women living in rural and urban areas, said Dr Nur Aishah, single women who were highly-functional also tend to be at higher risk as they might not be able to cope with the diagnosis.

Dr Teo added that the women were often given anecdoctal stories that alternative treatment worked for other patients but she reminded that it might not have been cancer but other conditions like a fluid-filled cyst.

She said some women even turned up with joss stick burns after seeking alternative treatment.

Survival rates for stage one cancer, said Dr Nur Aishah, was beyond 90% while it was beyond 85% for those with stage two.

Stage three and four cancers had survival rates of 50% and 10% respectively, she said, adding that it was important to note that there were women who had stage four breast cancer and were still alive.

“People still have a very fatalistic connotation to cancer. We should change the mindset of the community and tell them it can be overcome. You have to stomach the side effects but you can survive this,” she stressed.

Carif also obtains funding from other sources including the Education and Health ministries, Sime Darby, Petronas and Estee Lauder.

It also provides free genetic counselling and testing for women who have high-risk features, which allows them to determine if they have the BRCA1 and BRCA2 gene mutation that increases their risk to breast cancer.

via Many women still confused over breast cancer – Nation | The Star Online.

‘Chemotherapy-sparing’ test offered

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Nearly 50,000 women are diagnosed with breast cancer in the UK each year

 

A breast cancer test that could spare thousands of women the ordeal of chemotherapy has been approved for use in the NHS in England and Wales.

The test works out the odds of a some tumours spreading round the body and can be used to decide whether the gruelling course of drugs is necessary.

The National Institute for Health and Care Excellence approved the test, saying it was a significant step forward for patients.

Cancer charities welcomed the decision.

Breast cancer is the most common cancer in the UK, affecting 48,000 women each year. About 9,700 would be suitable for the test.

Chemotherapy can be used after surgery to reduce the chance of breast cancer spreading or coming back.

However, the drugs kill both cancerous and healthy tissue, which can lead to side-effects including fatigue, feeling sick, hair loss, change in appetite and hot flushes.


We know that chemotherapy can have side effects such as sickness and hair loss and many patients find it to be extremely gruelling; so a test which enables patients to avoid it will be welcomed by many.”

Sally GreenbrookBreakthrough Breast Cancer

The Oncotype DX test, which looks at characteristics of the cancerous cells to see how likely they are to spread, should help doctors decide more accurately which patients will need chemotherapy.

Prof Carole Longson, from NICE, said testing some patients would be cost effective.

She said: “Breast cancer patients face significant emotional and psychological strain when considering chemotherapy.

“A test that can help to predict better the risk of the breast cancer spreading, and therefore the potential likely benefit of additional chemotherapy, represents a significant step forward for patients.

‘Good decision’

The test will not be used on all women with breast cancer. Those considered at intermediate risk – and with oestrogen receptor positive (ER+), lymph node negative (LN-) and human epidermal growth factor receptor two negative (HER2-) subtypes of early breast cancer – will be tested to see if chemotherapy is necessary.

Sally Greenbrook, a senior policy officer at Breakthrough Breast Cancer, said: “This is a good decision from NICE.

“We know that chemotherapy can have side-effects such as sickness and hair loss and many patients find it to be extremely gruelling, so a test which enables patients to avoid it will be welcomed by many.

“It’s important to remember that Oncotype DX is only suitable for certain types of breast cancer, so some patients will still need chemotherapy.

“It’s also important to make sure that this test is made available to doctors and that systems are in place to ensure that patients are able to benefit from it.”

via BBC News – ‘Chemotherapy-sparing’ test offered.

Studies show surgery boosts survival for stage 4 breast cancer patients

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Cancer Centre at the National University Cancer Institute, Singapore.

Researchers from the National University of Singapore have found growing evidence that suggests surgery for stage four breast cancer may have a positive impact on survival.

SINGAPORE: There is growing evidence to suggest that surgery for stage four or metastatic breast cancer has a positive impact on survival.

Mestastic breast cancer is a stage of cancer when the disease has spread beyond the breast to other areas of the body.

Surgery is normally not recommended at this stage, but findings from studies by the National University of Singapore (NUS) have shown otherwise.

A 59-year old patient, who wishes to remain anonymous, was diagnosed with breast cancer in March 2013 when a tumour was found in her left breast. Further scans showed she had metastatic disease that had spread to the bone.

After discussing treatment options with her doctor, she decided to undergo hormonal therapy. If reassessment scans show a good response, she is opting to undergo a mastectomy.

The patient said: “(I want to have the surgery) for the peace of mind… I mean, there is no guarantee that it (the cancer) will not come back. But at least at this point of time when it’s removed, at least you have the peace of mind that… (the cancer cells are) totally removed.”

Metastatic breast cancer patients are not usually offered surgery as the cancer is at an advanced stage and the life expectancy is shorter compared to other stages.

Doctors said the focus at this point is not to aim for a cure, but to maintain the patient’s quality of life.

But research in recent years has shown that surgery in these patients could prolong their life.

A study on metastatic breast cancer patients in Malaysia by researchers from NUS’s Saw Swee Hock School of Public Health found that patients who had breast surgery had a two year survival rate of 46.3 per cent compared to 21.2 per cent for women who did not have surgery.

A smaller study in Singapore, conducted by NUS’s Yong Loo Lin School of Medicine, backed these findings. It found that patients who underwent surgery had a median survival time difference of 31.6 months compared to 20.6 months for patients who did not.

The research looked at 166 patients from the National University Hospital (NUH) Breast Cancer Registry who were diagnosed with metastatic breast cancer, and who had followed up treatment at NUH. Eighty-two of these patients received primary breast surgery.

The surgery is recommended for patients who meet three requirements: they must be below the age of 60, have limited stage four breast cancer which has not spread beyond the bones, and the cancer has been determined that the tumour can be safely removed without leaving any traces behind.

But doctors are still cautious about the findings.

Mikael Hartman, an associate professor at NUS’s Saw Swee Hock School of Public Health, said: “The difference in survival is substantial between patients who have surgery versus those that do not have surgery.

“But I wouldn’t go as far to say this is actually true. It may be true. It may also be that we, as surgeons, are better at picking patients who are going to live longer and we offer surgery to them while at the same time, those who are not going to live a very long time, we don’t select them for surgery.”

Dr Hartman said the next step is to do a larger study to better understand the impact of surgery on patients. He adds that if the data supports surgery, it would be a paradigm shift where surgery will be offered to metastatic breast cancer patients on a larger scale.

Dr Hartman also said that at least 10 per cent to 15 per cent of patients are diagnosed with metastatic breast cancer in Singapore.

– CNA/gn

via Studies show surgery boosts survival for stage 4 breast cancer patients – Channel NewsAsia.

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