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From the yard.
Breast Cancer Care
Behind the waiting room wall is a corridor full of consultation rooms, treatment rooms and ultrasound rooms. From the radiologist to the oncologist, from the oncologist to the breast nurse: breast cancer care at Tergooi MC and AVL is organized in such a way that all specialists work in one department. If a patient moves from one room to another, it happens in the same corridor. “Patients don’t have to leave the department for consultations and examinations.” This is very nice, points out Heilingmann, who has been an oncologist at the hospital since 2018 and specializes in breast cancer and melanoma.
Tergooi MC works closely with AVL. “We meet online every Tuesday evening. Anyone who comes here with breast cancer is discussed with AVL. After the operations we discuss the patients again. The plan that the patients receive here is in any case approved with the protocols and the way of working at AVL. That is very nice.
X-ray specialist
We move from Hellingman’s consulting room to the room where radiologist Esteban van Keulen and physician assistant Hester Kjoss are examining x-rays. The chest x-ray is shown from above and from the side. A white ball is clearly visible at the bottom. Here are illustrations that clearly illustrate the passion and dedication to breast cancer care. Van Keulen talks about a new mammography method that they have been able to offer at the Breast Cancer Center since November. “Before the examination, you will receive contrast fluid into your bloodstream. This gives us a better view of suspicious abnormalities,” explains the radiologist. This method is mainly used in women with denser glandular tissue.
There is a fancy machine in the X-ray room. The doctors explain how a mammogram works and show the different plates that are pressed against the breasts. Small, large, wide, narrow, or for a specific area: there is one for each breast. paddle Present. Also a curved panel – intended to make mammography less painful for women with sensitive breasts. “Our specialist lab technicians are here to reassure women and ensure that mammography goes as smoothly as possible,” they explained.
Edith (44 years old) has breast cancer: “My friends will cut my hair when the time comes”
Rapid diagnosis
Radiologist Rietz Mann and surgical oncologist Caroline Drucker, both of whom work at AVL, work closely with Heilingmann. They join our online conversation in the treatment room. The three specialists say that women end up at the breast cancer centre in different ways. Women are referred via the population survey, to which women aged 50 and over are invited, or via their GP. Heilingmann: “Doctors can also refer patients to us quickly if they suspect breast cancer. Every day we reserve four to five places for these rapid diagnoses. On one day, we perform a mammogram and an ultrasound and, if necessary, a biopsy. We then discuss our findings.” Radiologist Mann intervenes: “More than 60% of people who come do not get anything further from the radiologist. Based on the images and ultrasound, we can often tell that nothing serious is going on.
In a small group of women, more research is needed than just imaging. “Then the radiologist does a puncture or biopsy on them. This is then examined by the pathologist. The cytology results are usually available within 24 hours. If a biopsy is done, it will take 48 hours to get the tissue test results. But for the majority we can tell within a day whether it’s good or bad. That way I can give a perspective and explain a little bit about the scenarios if we start the treatment process. “Even though the treatment plan isn’t available right away, I can provide information,” says Helingman.
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Caroline Drucker and Wrightsman.
high risk
In addition to women referred to AVL and Tergooi MC due to complaints or population screening, women with an increased risk of breast cancer come to the breast cancer centres.
Someone who is very interested in this is surgical oncologist Caroline Drucker. “My additional focus is early diagnosis and screening in women at increased risk. We have a special screening clinic that serves women at increased risk. We are currently busy renovating our early diagnosis center for everyone at increased risk. This center is designed to find cancer early, preferably when it is very small. We try to prevent the cancer from developing if possible.
Clinical Geneticist
The first step is always the doctor, says Drucker. “GPs have a general idea of which women have a reason to refer to a clinical geneticist. It is the clinical geneticist who determines the risk of hereditary breast cancer.
How is this risk determined? “Family members who have had breast, ovarian and prostate cancer and at what age are identified. This, together with a number of other risk factors, such as breast tissue density and certain lifestyle factors, provides a risk assessment with an appropriate screening plan. According to this plan, these women will be screened regularly in the future, and this can be done with us or at Tergooi MC.
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Investigation
The purpose of screening is to detect breast cancer when it is small and has not spread. “At this stage it is very treatable. In this way, screening prevents deaths from breast cancer. Of course, this does not mean that breast cancer occurs less often,” explains Mann.
The path that a woman at risk takes varies from person to person. “Some women benefit more from mammography, others from MRI. This is partly due to the breast tissue,” explains Drucker. “We create a tailor-made plan, each woman is unique. This sometimes includes lifestyle advice, for example on exercise, healthy weight and alcohol consumption. We inform and motivate women, so that they also pay attention to prevention. You can have a positive impact on the risk, so that the chance of developing breast cancer is as low as possible.”
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Helingman hopes that Dutch healthcare will focus more on spreading awareness about the importance of a healthy lifestyle. “This needs to change, at least in breast cancer care, because people often have no idea that you can reduce your risk yourself. Few people know that exercise is absolutely essential. This should be part of care in Dutch hospitals. They make room for this in the early diagnosis centre at AVL, which is very good,” says Helingman. Drucker shares this view: “It would be great if women knew what they could do to control their own risk. Although lifestyle advice has limited impact, especially for women at high risk.
Breast surgery
Some women have a genetic mutation that significantly increases their risk of developing it by 60 to 80 percent, such as the BRCA-1 or 2 gene mutation. “Women who are at such high risk find it stressful and exciting to come in for a checkup every time. We hear that from them, too. There is a group of patients who would prefer to have surgery and remove all of the breast tissue. We will then have discussions about that. Removing breast tissue can significantly reduce the risk of breast cancer, but it is not zero. I always want to discuss that,” Hillingman shares.
That’s why she believes it’s important to tell patients all the aspects of the procedure. “As surgeons, we know the downside very well: you can also experience complications from surgery. If complications arise, sometimes you have to operate again. You also have to explain to them the downside of surgery. That’s part of our profession. Is that difficult? Well, I also really enjoy doing it, because you’re a good doctor. Patients need to know all the aspects before they make a big decision.
Kim, 32, carries the BRCA1 gene and opted for preventive breast surgery.
The choice between continuing screening and having preventive surgery is up to women. “There is no wrong choice, and it can vary,” Drucker says. “There are many women who do both. We often start screening until they reach a certain age or have children. Then they choose to have preventive surgery,” says Mann.
to guarantee
Women who do not have an increased risk can also worry unnecessarily, say experts. “We see that women want to come in more often. If there is no reason to have a scan, it is not really necessary. There are also disadvantages, the radiation increases every time,” says Mann. “What we encourage is that women only have a scan when there is a real indication for it,” adds Drucker. “We are happy to provide insight into the risks and explanations about when a scan is necessary.”
At the same time, they see that women don’t come in at all for fear of mammograms. And that worries them. “A lot of people are a little bit afraid of the mammogram, but there are all sorts of good lab technicians who do it. Women may find it uncomfortable, but not all women experience it that way,” Drucker says.
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This topic was also discussed in the room with radiologist Van Keulen and physician assistant Kjos. Van Keulen regrets that there are women who are afraid of screening. “It is scientifically proven that it is still the best way to detect breast cancer. It is short, effective and can be seen by the radiologist right away. We really hope that women will realize the importance of screening.”
Mama Center
In the meantime, Drucker has to go to an appointment. She concludes with a message: “We encourage any woman who thinks she may be at increased risk to discuss this with her GP. If in doubt, go to the doctor. That’s the most important thing.”
After the talks we meet with breast care nurse Susanne van der Meer. Once the women learn that they have some form of breast cancer, things move very quickly. For the specialists, after about twenty minutes of explanation, it is – frankly – time for the next patient. The women are cared for by the breast care nurse. “It is a wonderful job to do,” she says cheerfully. “It is very nice to be there for the women. They can ask questions and come to us with their feelings. We provide information, guidance and support.”
It is clear that the entire department works with passion and joy at the Breast Cancer Center, with a clear common goal, as Hillingman sums it up: “To provide the best care for women.”
This article is part of the LINDA Dossier on Women’s Health. Learn more?
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