The advances and challenges in breast cancer care

We sat down with Mr Dimitri Hadjiminas, consultant breast surgeon at The Harley Street Clinic, part of HCA Healthcare UK, to discuss the progress made in breast cancer care, the challenges still to overcome, and what motivates him in his work.

The journey to improved outcomes

"I trained in general surgery in the 1980s and early 1990s," said Mr Hadjiminas, "and at that point, breast cancer was not well treated in the UK - we were probably one of the worst countries in Europe, if not in the West in terms of results. For me, those poor results served as a stimulus during my training, and are why I decided to focus in surgical breast oncology - I thought I would be able to have an impact in that field."

Over the last 25 to 30 years, the quality of breast cancer care and the treatment available in the UK has improved dramatically, significantly improving patient outcomes and survival rates. "We’re now one of the best countries in the world for cancer care and it was a few factors that came together at the same time that drove this," Mr Hadjiminas explained.

"One thing is that we started working in multidisciplinary teams, and around the same time, in the 1990s, we started to include oncologists in the decisions that surgeons were making. There was also the release of the Forrest report, which outlined the potential impact a breast screening programme could have on improving outcomes. The awareness that this report created meant that more women were being screened for breast cancer, leading to much earlier diagnosis."

Innovations in breast cancer care

"As things began to change, surgeons, radiologists, oncologists and other specialists, were beginning to subspecialise in breast health too. The coming together of increased awareness, more accessible screening and more specialised healthcare professionals has made an enormous difference in achieving more positive results."

Mr Hadjiminas continued, "In addition to these factors, new drugs were being developed and trials were becoming much more effective. As a result, the mortality rate of breast cancer today is down by more than a third compared to in the 1980s, which is an enormous reduction! While we’re seeing the number of breast cancers being diagnosed going up, there are many less people dying, which is a significant improvement."

The challenge to overcome

In the last 2 decades, there have been enormous advances in the drugs that are available for the most aggressive types of breast cancer, the so called HER2-positive and triple-negative types. In a way, the type of breast cancer that was traditionally regarded as the one carrying the best outcomes was almost left behind.  However, in recent years there have been new drugs that are being developed for this type of breast cancer as well and the future now looks extremely promising. There is no doubt in my mind that the downward trend of breast cancer mortality that started in the late 1980s will continue for several more decades to come.

In addition to this, research is being conducted to look into the order in which patients receive their treatments. "Around 25% of cancer patients have the most aggressive types of tumours, and in most of these cases it will be recommended that they have a complete mastectomy after chemotherapy," Mr Hadjiminas explained. "The usual sequence would be to perform surgery and then give radiotherapy. However, through research, we’ve now found that surgery is feasible on tumours that have already been irradiated and that this also provides better reconstructive outcomes. This was previously considered to be a risky option, but we have proven that it is in fact safe. So, for patients that would like to have a reconstruction, it’s now recommended they receive chemotherapy followed by radiotherapy treatment before any surgery."

Reassuring patients

Although there are still challenges surrounding breast cancer care, it’s vital to remember that technology is constantly advancing and new treatments are becoming available all the time.

"The surgical techniques we use at The Harley Street Clinic are the best around and there’s not a single type of breast cancer treatment we don’t have access to," said Mr Hadjiminas. "Myself and my team provide every individual with the best care we possibly can. We have an excellent team of consultant oncologists and radiologists here who provide all the care anyone could ask for."

Describing his motivations for working in the field, Mr Hadjiminas shared, "I get a lot of personal satisfaction when a patient does well. I feel extreme happiness when I follow up with a patient 10 or 20 years later and they’re still alive and well. Some of my patients had cancers that were very dangerous initially, so it’s particularly satisfying to see them doing so well years later. That’s my main motivation to carry on my work."


Read about how we diagnose and treat breast cancer at HCA Healthcare UK

Find out more about Mr Dimitri Hadjiminas

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