Pioneering master's degree in breast reconstruction launched

Breast cancer patients across the UK will in future be treated by doctors trained in both cancer and plastic surgery as the world's first pioneering master's degree in breast reconstruction launches tomorrow.

A shortage of specialists means currently women with breast cancer face a postcode lottery in accessing timely reconstruction surgery which means in some parts of the country less than 10 per cent have their breast rebuilt following a mastectomy. Experts says that the University of East Anglia's Master in Surgery in Oncoplastic Breast Surgery qualification will become the international benchmark for breast cancer care and ensure future patients have access to the highest standard of surgery, regardless of where they live.

Nearly 46,000 people are diagnosed with breast cancer every year, of which 20 per cent are women under the age of 50. Survival rates have improved drastically over the last 20 years which means more than half a million people in Britain living with a breast cancer diagnosis. For large numbers of these women, the psychological impact of losing a breast is one of the hardest things to deal with, according to Breast Cancer Care.

The philosophy behind Oncoplastic surgery recognises the importance of this loss, and aims to give women the best cancer operation, while at the same time leaving them looking cosmetically as good as they can, said Fiona MacNeill, one of the country's leading oncoplastic surgeons from the Royal Marsden NHS Foundation Trust in London.

But at 15 years old, oncoplastic surgery it is a relatively new speciality, which means in many areas oncologists [cancer specialists] must refer women to a plastic surgeon for reconstruction of their breast, who may work at another hospital. The national audits have also found that the information given to women about their options to reconstruct the lost breast varies across the country.

The fourth audit, to be published in March, will for the first time name and shame the worst NHS trusts and private hospitals after comparing operations, outcomes, pain relief and patient satisfaction. At the Royal Marsden, 43 per cent of patients undergo reconstruction after a mastectomy - more than double the national average, according to last year's figures.

Miss MacNeill said: "Britain has always led the world in surgical training and this innovative course is another world leader. It is setting a benchmark for the standard breast cancer patients can expect in the future... it will address some of the issues raised by the audits."

Around 20 trainee surgeons are in the first cohort of the two year course, 80 per cent of which will be taught through e-learning, including live weekly simulated tests involving complex cases. Perhaps most importantly, the students will gain invaluable practical experience through working with one of 50 specialist surgeons.

This will help, in part, overcome the training gap left by the introduction of the 48hour European Working Hours Directive introduced last year which the Royal College of Surgeons have long campaigned against.

Professor Jerome Pereira, an honorary professor at UEA and pioneering breast surgeon from James Paget University Hospitals, is one of the doctors behind the new course. "Our aim is to increase the standards of training in order to give patients the best quality of care, wherever they are, as we know how important breast reconstruction can be for women's body image and quality of life. The European Working Hours Directive means surgeons only do 7,000 hours of training before they become a consultant, whereas people of my generation did 30,000. This course will help overcome that problem and produce the country's most qualified breast surgeons, skilled in the full range of the most cutting edge techniques."

Case studies

Christina Quilter, 30, from Bury St Edmonds, was diagnosed with an invasive right breast tumour four years ago - 10 weeks before her wedding. She underwent a total mastectomy, but despite being desperate for breast reconstruction, the information she received from her oncologist and plastic surgeon was confusing and inconsistent.

Two years after her mastectomy, she finally reached the top of the waiting list, but, days before the reconstruction she discovered new lumps in her neck so the operation was cancelled. Now diagnosed with incurable, but stable cancer in her lymphatic system, she is no longer eligible for plastic surgery.

Ms Quilter said: "The surgeon couldn't understand why it was so important for me, as if it was just a cosmetic issue. But as a young woman it meant everything, it's what made me feel like a woman, but I was denied the opportunity to have the surgery. I hate my deformed body. After talking to other women from across the country, I wish I'd lived somewhere else."

Marcia Mercier, 44, from north London was diagnosed in May 1998 with an early stage tumour. Her surgeons discussed the options with her straight away and she chose to have a mastectomy and a saline implant, which were both done at the same time.

"I had a really good experience which I now share with women who ring the Breast Cancer Care helpline. Reconstruction hasn't stopped me doing anything and I was really happy with the results."