On 16 February, Tokushukai established a breast cancer study group as part of its oncology project and held its first meeting at Shonan Kamakura General Hospital in Kanagawa. The group aims to promote more evidence-based standard treatment for breast cancer across Tokushukai. More than 60 healthcare professionals attended, hearing reports on the latest developments in treatment. The initiative is expected to improve outcomes across the Group and promote clinical research and trials that take advantage of its scale.

Providing patients with better cancer care

In his opening remarks, Yoshiro Niitsu, Specially Appointed Professor in the Department of Molecular Target Exploration at Sapporo Medical University and supervisor of the Tokushukai oncology project, said: “Our original aim was to provide learning opportunities for the many healthcare professionals involved in breast cancer care. We approached colleagues about a month ago, received their support, and have now been able to hold this first meeting.”

Kazuhiko Sato, Director of the Breast Oncology Center at Tokyo Nishi Tokushukai Hospital, who played a leading role in establishing the group, then gave a keynote lecture on recent breast cancer treatment trends and the latest information from Japan and overseas.

Reviewing the history of breast cancer surgery, Sato explained that treatment had previously focused on local approaches such as surgery and radiotherapy. “Its characteristics as a systemic disease are now clearer, and treatment has shifted towards an emphasis on patients' quality of life,” he said.

He described three less invasive approaches enabled by early detection: breast-conserving therapy, sentinel lymph node biopsy and partial-breast irradiation as part of breast-conserving therapy.

Breast-conserving therapy combines breast-conserving surgery with irradiation of the whole breast. It became widely used after studies in the 1980s found survival and local recurrence rates broadly comparable with conventional mastectomy. In Japan, about 60% of patients, mainly those with relatively small tumours, now receive this treatment.

Sentinel lymph node biopsy removes only the sentinel, or first-draining, lymph nodes receiving lymph from around the breast, for pathological examination.

If no metastasis is found in these nodes, the likelihood of spread to other nodes is low, allowing axillary lymph node dissection, or removal of nodes in the armpit, to be avoided.

Because breast cancer often spreads to axillary lymph nodes, removing the tumour alone was considered insufficient, and axillary nodes were also removed during surgery.

However, greater awareness of mammography and changes in attitudes to breast cancer have led more patients to receive treatment early. Increasing numbers of removed lymph nodes showed no metastasis, prompting the introduction of sentinel lymph node biopsy.

Partial-breast irradiation is an alternative to whole-breast irradiation that treats only the area around the site of breast-conserving surgery.

Conventional whole-breast irradiation raises concerns about physical burden and complications. Patients on remote islands and in rural areas without radiotherapy facilities also face the substantial burden of travelling long distances for treatment.

Meanwhile, most local recurrences after breast-conserving therapy occur near the original tumour, leading to questions about the need to irradiate the entire breast.

These considerations have generated interest in partial-breast irradiation. Sato's centre actively provides this treatment and reports that many patients welcome it.

Sato also emphasised the importance of preoperative and postoperative chemotherapy as adjunctive treatment. In the United States, wider use of such treatment has reduced breast cancer mortality.

“Standardising treatment through common regimens, or cancer treatment plans, is essential to using adjunctive therapy effectively,” he stressed.

Development of an information system

In the session on regimens, Dai Iwai, a senior pharmacist at Tokyo Nishi Hospital, reported on the breast cancer hormone therapy regimen review committee. Rai Shimoyama, Head of Surgery at Shonan Kamakura Hospital, presented the status of breast cancer regimen development.

On anticancer drugs and IT systems, Yasuhiro Kadotani, Deputy Head of Pharmacy at Shonan Kamakura, discussed the present and future of Tokushukai's oncology system. Iwai and Sato also gave reports on promoting breast cancer clinical research.

Tokushukai has a network of 66 hospitals in Japan and two overseas. It is advancing IT systems to share information using Group-standard codes for diagnoses, medicines and other data.

In 2008, the oncology project began developing information systems for cancer registration and data analysis. It is examining standard chemotherapy for major solid tumours and working to standardise treatment through common regimens based on unified Group protocols.

The new breast cancer study group is expected to accelerate standardisation of cancer treatment across Tokushukai and help provide patients with better care.

At the end of the meeting, Tokushukai Executive Director Nobuaki Shinozaki outlined the Ministry of Education, Culture, Sports, Science and Technology's personalised medicine project, which will enter its third phase in April. He requested cooperation from Group hospitals in a personalised medicine initiative covering 13 cancers and drug eruptions.

Source: Tokushukai Newspaper, 25 February 2013, No. 866