Surgical oncology is rapidly evolving and knowledge from different but related domains is needed to face the complexity of diseases and adequately manage them.
The more we know about the disease we are treating the more we will be able to modulate therapeutic decision planning from case to case. This is true for breast cancer management in general and surgery in particular: oncoplastic surgery and multidisciplinary and personalized care have evolved greatly in the last decades.
With the evolution of medical knowledge and the new "biological approach" collective discussion has gradually become the norm, at least in large and advanced centers for cancer treatment and research.
Breast cancer patients began to be treated by a group of doctors, no longer by the single figure of the surgeon. No doctor today can manage such complexity alone. Those who still claim to do so either have lagged behind culturally or are driven by purely economic considerations. In both cases, they operate in an ethically inadequate manner. Patients run the objective risk of not receiving the best possible treatments, but simply the treatments that doctor, to whom they turn, is able to offer.
Today we are starting to collect evidence on the positive impact the multidisciplinary approach can have in terms of overall survival, reducing the risk of error and refining the quality and precision of care.
Patients, for their part, express greater confidence in undergoing treatment knowing that their case has been evaluated and discussed by different professional figures rather than by a single doctor, whose decisions may be affected by confounding subjective factors. The multidisciplinary team offers the benefits of a second or third opinion in a practical and effective way, increasing the sense of safety of patients and their families.
The multidisciplinary approach has the potential to improve the quality of cancer treatments because it is able to cope with the complexity of current scientific knowledge and the biological-molecular approach to disease, it reduces the margin of error of the individual and finally increases the possibility of identifying the best possible treatment for each specific case.
However, these conclusions come from the assumption that everyone in the multidisciplinary team faces the commitment to define the therapeutic indications with the utmost responsibility and the level of knowledge and competence of the leader and all the members of the group must be adequate to the task.
This aspect is not least in terms of importance and opens the question of the training of doctors working in modern oncology. The multidisciplinary approach necessarily requires a modern, multidisciplinary preparation that goes beyond knowledge in the context of one's specialty. This is the only way to sit at the discussion table, understand and speak the colleague's "language" and express an informed opinion.
Unfortunately, institutional training has lagged behind and many residency programs fail to provide trainees with the required clinical exposure and theoretical knowledge to understand the interface between tumour biology and locoregional and systemic therapies.
To overcome this problem and promote the highest multidisciplinary standards of care, a panel of experts from across Europe including patient advocates have gathered in a common platform, led by ESSO, to produce a unitary effort aimed at defining a unique certification process in breast cancer surgery across Europe.
The BRESO, Breast Surgical Oncology project, involving some of the most important professional breast surgery societies as well as Europa Donna – The European Breast Cancer Coalition, is now a reality and aims at developing a system of certification for specialist training, recognized at the European level.
Considerable effort is required, but once again, we are witnessing the process of oncological modernization, the ultimate aim of which is to raise standards even further in the treatment of breast cancer, as also demanded by patient associations.
The participation of Europa Donna, as a breast cancer advocacy organisation committed to the importance of the multidisciplinary team* will undoubtedly contribute to the legitimacy and success of the BRESO initiative.
This time we are writing a new page in history of training for breast cancer specialists.
Reference articles
Transforming Breast Cancer Together: Impact of COVID-19 on Breast Cancer Patients, 2020
Eur J Surg Oncol. 2020 Mar 26. pii: S0748-7983(20)30368-1. doi: 10.1016/j.ejso.2020.03.220. [Epub ahead of print]. Breast cancer treatment in the modern era of multidisciplinary oncology: Now we need new models of training. Meani F1, Kovacs T2, Spanic T3, Costa A4.
European Breast Cancer Conference -EBCC 10- Manifesto on breast centres/units 2016
The Breast - article by Susan Knox June 2015 – The European Patient Advocacy Perspective on Specialist Breast Units