Around 360 patients a year are diagnosed with breast cancer at Bath’s Royal United Hospital - half of them from west Wiltshire. MARION SAUVEBOIS meets breast radiologist Dr Dorothy Goddard to discuss the issues around detection, prevention and hopefully a cure

EVERY year nearly 5,000 women pass through the Royal United Hospital’s Breast Unit.

The vast majority are treated for benign pain and symptoms but an unlucky 360 patients come away with a breast cancer diagnosis.

As cancer continues to take lives, spread to a greater cross-section of the population and affect unprecedented numbers of patients under 35, being aware of the early signs and remaining vigilant at all times regardless of age is more vital than ever, explains consultant breast radiologist Dr Dorothy Goddard.

“We advise people to be breast aware,” says Dr Goddard, who joined the Breast Unit at RUH in 1993. “It means knowing what is normal for you and getting to be familiar with yourself by feel and by look. Something as simple as handwashing in the shower is a good way of feeling the breast underneath the armpit. It’s also worth standing in front of the mirror with your arms by your side and then raising them up to the ceiling. When you put your arms up, make sure the breast doesn’t change shape. If the skins puckers, for example, it can be an early warning sign.”

The RUH Breast Unit is one of the most up-to-date facilities in the South West. It boasts state-of-the-art breast imaging equipment and is one of very few trusts in the region with digital mammography, tomosynthesis, which creates a 3D picture of the breast using X-rays, and breast MRI.

Most patients will be seen at RUH within two weeks of being referred by their GP and receive all necessary mammograms and ultrasounds - women under 35 usually only tend to be booked for an ultrasound - as well as biopsy during their first visit.

Biopsy results take up to a week - a major improvement on the standard six weeks just a few decades ago.

This is all part of the hospital’s push to detect cancer sooner and save countless lives.

“Part of the reason we do this and encourage people to see their GP as soon as they notice something is to make a diagnosis at as early a stage as possible,” adds Dr Goddard. “Then the treatment can be curative and the outlook much better. Early stage means a very low grade cancer; that’s usually less than 2cm in size and before it has spread to the lymph glands. If it’s diagnosed and treated early, two out of three people will be able to live for more than 20 years.”

Half of the 360 new cases diagnosed annually come from west Wiltshire. Three of all patients on average each year are men.

The team at RUH counts five breast surgeons and four breast radiologists. A business case will soon be put forward for a sixth surgeon to join the unit.

A number of new medical and technical development over the past few years have significantly improved treatment for patients. Much faster diagnosis and greater awareness generally have gone some way to identifying cancer sooner. Oncoplastic reconstruction, which sees surgeons perform reconstructive surgery at the same time as a mastectomy, has also removed a huge hurdle and eased a heavy psychological burden for patients.

Survival rates have seen a welcome rise since the 1970s, when just four in 10 patients beat cancer or lived beyond 10 years subsequently, compared to eight in 10 today, according to Dr Goddard. But a concerning new global trend is undeniably the soaring number of under-35s affected by cancer.

“It used to be unusual and we used to see one or two a year, but now it’s more like five to 10 and it’s a phenomenon we’ve noticed nationally. Our youngest patient this year was 24.

“Unfortunately we don’t understand why that is. We know that breast cancer is more common in more affluent women.”

More promising survival rates are in no small part due to annual campaigns and a greater understanding of the tell-tale signs of breast cancer. However, this increased awareness has meant many people are now at times unnecessarily referred to breast units across the country, putting more strain on consultants and potentially slowing down the referral process for cancer patients.

“We have generated this awareness and the other side of the coin is that we’re seeing more benign breast pain than should be seen in breast services.

“So it’s about how we manage to pick the people that are more likely to have breast cancer so it doesn’t swamp the system. It’s going to be a very practical day by day challenge. There is no room for complacency.”