Comprehensive Breast Health Center and Breast Cancer Surgery:
Breast cancer screening/prevention, breast cancer surgery, personalized therapy and precision medicine.

Breast cancer surgery: mastectomy/ lumpectomy/immediate or delayed breast reconstruction

Overview

Breast cancer is one of the major public health burdens and remains an unmet need around the world. Breast cancer management requires a specialized multidisciplinary team to identify the most appropriate choice for patients through shared decision-making. The treatment includes breast surgery (mastectomy, lumpectomy, breast reconstruction, minimally invasive surgery), chemotherapy, targeted therapy, immunotherapy (neoadjuvant or adjuvant treatment), radiotherapy, and various ongoing global clinical trials. Fertility issues and information from genetic analysis should also be considered during decision-making. Here we show the multidisciplinary team of the Comprehensive Breast Health Center (CBHC), Taipei Veterans General Hospital (Figure 1).

Figure 1. Organization of the Comprehensive Breast Health Center (CBHC), Taipei Veterans General Hospital.

What we provide from the Comprehensive Breast Health Center?

We provide one stop breast health care from the service counter, which could guide and direct our patients to their specific need such as breast imaging (sonography, mammography, tomography and magnetic resonance imaging). In addition to out patient department, the cashier, blood test collection room, waiting area and dispensary are all located in the same area at the 2^nd floor of the Chung-Cheng building, facilitating a rapid and successive breast health care service (Figure 2).

Figure 2. One stop breast health care service.

Treatment outcomes

With our efficient one-stop integrated service, treatment outcomes including overall survival and breast cancer-specific survival of breast cancer rank the top in Taiwan and all over the world. From Sep-2015 to Dec-2021, a total of 8,480 consultations were performed, 305,476 person-times were served, 5,382 new cases of breast cancer were diagnosed, and the retention rate was 96.4%.

Breast surgical procedures

Breast surgical procedures include breast-conserving surgery (lumpectomy) and mastectomy. The choice of surgery is based on disease characteristics, patient preferences, and the feasibility of further radiation therapy or not. The locoregional treatment for axillary staging includes sentinel lymph node biopsy or axillary lymph node dissection. Sentinel lymph node mapping and excision can be performed concurrently during the same surgery. If a negative sentinel lymph node is harvested, there is no need for further axillary surgery. On the other hand, axillary lymph node dissection will be performed for a positive sentinel lymph node biopsy.

Breast reconstruction is a surgical procedure to rebuild a new breast after the total removal of an involved breast. Breast reconstruction can be performed immediately after mastectomy or with a delayed procedure. It deserves notice that we provide pre-operative 3D imaging to simulate the outlook after reconstruction, facilitating the communications and decision makings between surgeons and breast cancer patients (Figure 3).

Figure 3. Pre-operative 3D imaging to simulate the reconstructive outlook.

Precision medicine

We provide a wide range of genetic testing for breast cancer risk prediction and to identify biomarkers for targeted therapy. For instance, multi-gene expression assay can help to determine the necessity for cytotoxic chemotherapy based on the risk of primary tumor. On the other hand, next-generation targeted sequencing provides an unlimited chance to identify potential therapeutics based on mutations from cancer tissue. In fact, our team provide one of the largest genomic profiling data-base in Taiwan and our study showed that two-thirds of invitees of targeted sequencing were identified with at least one actionable mutation (Figure 4).

Figure 4. Two-thirds of Taiwanese breast cancers were identified to have at least one actionable mutation based on targeted sequencing.

Long-term follow up of breast cancer patients with eHealth system

Thanks to the treatment improvement, most breast cancer patients enjoy long-term disease-free/overall survival and complete remission is not uncommon for breast cancer survivors. Consequently, long-term follow up becomes a must for breast cancer patients and we provide an eHealth care system to monitor the disease control and any discomfort from our patients (Figure 5).

Figure 5. eHealth care system for breast cancer survivors as a stand-alone mobile application.

Estimated cost

Costs associated with the procedure depend on the choice of surgical methods and may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Conclusion: one-stop service provide endless welfare and health to all women around the world

We invite all women visit our Comprehensive Breast Health Center for the multidisciplinary team service if you have any doubt of breast health. Choose wisely based one the unprecedented strengths:

• More than 1,200 breast cancer patients per year
• Comprehensive database of more than ten thousand patients with long-term follow up and complete clinicopathological features
• Up-to-date clinical trials
• One of the largest genomic data-base including WES, WGS, targeted sequencing, RNA-seq, microarray, NanoString nCounter, and liquid biopsy
• Multidisciplinary team including surgeons, physicians and experts in basic, translational research to conduct research of precision medicine and e-health

Figure 6. One-stop service provide endless welfare and health to all women around the world.