How is a colour television related to breast cancer?

What specifically do you focus on within cancer treatment and research?

In my daily role as a doctor in the oncology department, I encounter patients who have recovered from breast cancer and are healthy, as well as patients who cannot be cured and therefore require ongoing monitoring and treatment for the remainder of their lives.

Therefore, it is essential to explore new and improved techniques for detecting and tracking the progression of the disease. Our research team collaborates across different specialties to devise more precise and targeted diagnostics for breast cancer patients.

The treatment for breast cancer is tailored to the individual. When the cancer has metastasised to other organs, we base the medical treatment on the results of the biopsy. For these patients, treatment will be lifelong, necessitating regular scans, blood tests, and potentially further biopsies to customise the treatment plan to the individual patient's needs.

All patients receive scans to monitor the cancer and its progression. Scanning is my area of expertise.

Why do you perform scans?

When women undergo treatment for breast cancer, we conduct scans to assess whether the treatment is effective, namely if the tumour is reducing in size. We also check for indications of the disease reoccurring or new cancerous developments emerging.

As long as the treatment is proving effective, we continue with the chosen approach. If at any point the treatment ceases to work, we switch to an alternative treatment.

Most facilities today employ what is known as a CT scan for follow-up purposes. Typically, women are scanned every three months.

What do you look for in the scans?

We assess whether the cancer treatment is impacting the disease. The treatment may either stabilize the cancerous node or cause it to shrink.

We also check for any spread of the cancer to the bones. For instance, this could result in holes in the bones, similar to the appearance of Swiss cheese. The challenge lies in detecting bone metastases on a traditional CT scan, which can be quite difficult. It is much easier with a newer type of scan called a PET scan.

Why do you scan so frequently?

The necessity for frequent scanning arises from the difficulty in tracking the disease, particularly as many patients develop bone metastases. Consequently, we often perform scans, possibly utilizing various types of scanning techniques to ensure no detail is overlooked. This process necessitates numerous visits to the hospital, as that is where the scans are conducted.

Conducting numerous scans is costly for our healthcare system, both in terms of time and resources. It is also burdensome for the patient, who must manage many hospital visits and allocate additional time for these scans. Furthermore, there is usually a waiting period before patients receive their scan results, a time often with much anxiety for the patient.

Why is the new type of scanning superior?

A PET scan with a glucose tracer is a more accurate scanning method, which displays changes in cancer in vivid colours, similar to the light in a light bulb, rather than merely indicating the size of the cancerous node in grey tones. Changes in activity—signifying whether the disease is progressing—will appear as increased brightness in the image, occurring before any changes in size are detected. Therefore, we can observe increasing disease activity on a PET scan before any size changes become apparent on a CT scan.

The new type of scanning can be likened to transitioning from a black-and-white TV to a colour TV. It becomes considerably easier to identify the cancerous node when it is highlighted.

Previous studies have shown that the earlier we detect increased activity in the disease, the sooner we can modify the treatment. This allows us to switch treatments before the patient's condition deteriorates to a point where they can no longer tolerate the next course of treatment. This approach could result in fewer hospitalisations, fewer scans, and, hopefully, a better and longer life for our patients.

What constitutes a success for you as a doctor?

To assist the patient in making critical decisions about treatment and finding their personal balance between the treatment, side effects, life aspirations, and overall quality of life.

As an oncologist, I consider it a success when I can contribute to a situation where the patient no longer needs my services. Ideally, the patient should spend as little time in the hospital as possible. Frequent visits for scans, blood tests, or hospital stays do not equate to quality of life.

What are the future directions of your research?

We have initiated a significant new EU project, which is a comparative trial between CT and PET scans. We believe that utilising PET scans will enable better and more tailored treatment pathways.

There is also evidence suggesting that patients may live longer and have a better quality of life if we use PET scans instead of CT scans. We often advocate that "earlier is better"—now we aim to verify this.

Additionally, we are collaborating on a specialised type of blood test that can detect cancer cell DNA in the blood, essentially providing a cancer footprint. We hope this will reduce the need for frequent scans in the future.

Is there an aspect of your work that you particularly enjoy?

I particularly enjoy the aspect of communication. It's crucial that patients comprehend what they are experiencing, why, and what my expectations are regarding the treatment's effect. It's equally important that other researchers are familiar with my work, allowing us to learn from one another.

I'm constantly striving to enhance communication. That's why I've experimented with different formats, such as video. I noticed that some of the major journals began creating video abstracts, but they were somewhat dry. This inspired me to try something different. The result was a video about Gerda, a patient with breast cancer.