At Home Christian Jessen 2014 - 193

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of pain alone is rarely a sign of breast cancer.
In order to reassure women that they do not
have cancer, it is important to help women
understand the underlying cause of their pain
in order to stop them from feeling more anxiety
and exacerbating the pain further as a result.'

One-stop breast clinic

'I run a one-stop breast clinic at Spire Bristol
Hospital for women with concerns or specific
breast symptoms such as pain, distortion of
shape, lumps and nipple discharge,' explains
Mr Cawthorn. 'At the clinic, I assess patients
by examination and ultrasound, as well as
painless needle biopsies when needed, to
confirm that their lumps are - usually - harmless.
'I also spend time teaching women how to
properly examine their breasts, showing them
exactly what to look and feel for. The price of a
visit to the one-stop breast clinic in Bristol is £200.'

Screening for different ages

'All women who are over 45 years of age
benefit from mammogram screening,' advises
Mr Cawthorn. 'Women who consider themselves
to have a higher risk of developing breast cancer
can also request to have a scan at a younger
age. I offer a risk assessment programme that
takes into account the number of family members
with breast cancer, in addition to other risk factors
including the patient's age, their weight and
height, along with their age at first pregnancy.
'The risk assessment programme helps
patients to decide what - if any - screening
they want. Having their level of breast cancer
risk accurately assessed can be reassuring.'

What's new in the treatment
of early breast cancer?

'Most women who have breast cancer detected
at an early stage will have a lumpectomy

Radiotherapy source
is placed in the
centre of the balloon

How do breast lumps develop?

Mr Cawthorn says: 'The female breast is a very
sensitive organ that is designed to produce milk
in response to the hormones oestrogen and
prolactin. I find it a shame that, despite the advice
given to all women to be 'breast aware', nobody
tells women why their breasts are often lumpy.
'The real reason for lumps forming is due
to stress and the imbalance of oestrogen in
women as they get older. This imbalance of
hormones can cause the breast tissue to swell,
producing what feels like a lump, or cause milk
ducts to "blow up" and form cysts. The symptom

followed by three weeks of daily treatment with
radiotherapy to the remaining breast,' says Mr
Cawthorn. 'Intraoperative radiotherapy (IORT)
of the breast is a type of breast radiation
administered as a single treatment during surgery,
while the patient is still under anaesthesia.
'IORT is considered an effective and safe
alternative to standard breast radiotherapy,
which is usually administered after a
lumpectomy on a daily basis for up to five
weeks. For many women, IORT makes breast
conservation and breast radiotherapy a far
more practical and convenient treatment option.

'In the operating theatre, the breast surgeon
places a specially designed inflatable balloon
applicator into the space where the tumour was
removed (see diagram), and then delivers the
entire dose of radiation in as little as 10-20
minutes. When the patient wakes up from
surgery, the tumour has been removed and the
area surrounding it has been treated with
radiotherapy. Following the combined surgery
and radiotherapy, the patient will not
require any additional radiation treatment.
'I am the first surgeon in the south west to
perform this treatment at the Spire Bristol
Hospital. For any patients considering this new,
innovative treatment, the tumours must be small
(less than 2cm), and be a low-grade cancer
that has not spread to the lymph nodes.'

Looking towards the future

Mr Cawthorn continues: 'If you need a
mastectomy and a possible breast reconstruction,
it is something that you will need to discuss with
the surgeon and the breast care nurse. We
will provide you with information on all the
different types of reconstruction available to
you, in addition to their suitability. This often
depends upon where the radiotherapy is
needed after the mastectomy takes place.
'I specialise in one-stage implant-based
reconstruction, which is performed at the same
time as the mastectomy in order to preserve
the skin and nipple in one single operation.
This is made possible by using an animal
-derived tissue graft called an acellular matrix
(ADM), which helps to create a better cosmetic
appearance. I have developed a new
technique of placing the implant wrapped
in the ADM on the muscle, rather than
underneath it, in order to give a more natural
result. This technique is also less painful and
does not affect shoulder movement.
'The diagnosis of breast cancer is massively
upsetting to an individual. However, with the
skilled support of our breast care nurse, and
the multi-professional team of radiologists,
pathologists, psychologists, oncologists, and
plastic surgeons with whom I work, more than
90% of women are cured. They also enjoy
an excellent quality of life following treatment
- including good cosmetic outcomes.'

FOR MORE INFORMATION
Find further details on the screening and
treatment options discussed in this article, or
book an appointment at the one-stop breast
clinic, by contacting Mr Cawthorn's
secretary on 0117 980 4056.


http://www.spirehealthcare.com/bristol/

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