UCL Division of Surgery and Interventional Science


Breast Cancer Treatment - Doctor’s Dilemma or Patient’s Choice?

15 October 2018

A joint conference organised by The Latte Lounge, Pink Ribbon, Europa Donna and the Surgical Interventional Trials Unit, UCL The Royal Society, 6-9 Carlton House Terrace, SW1Y 5AG, 31st October

A groundbreaking women’s health conference is being held on Wednesday 31st October, during Breast Cancer Awareness Month, to address three key areas where women are often denied the information they need to make a shared decision with their doctors regarding their own health needs.

This conference has been planned by a group of eminent breast cancer specialists, in partnership with well-informed womens’ groups-  the Latte Lounge (Top tips for women over 40), the Pink Ribbon charity, and Europa Donna, the European Breast Cancer Coalition. The aim will be to  help women already diagnosed or at risk of developing breast cancer, to take a more active role in this partnership. We hope that women will come away with a better understanding of the cancer treatments available to them. 

Topics to be discussed will include:

  • Finding the balance between the benefits and harms around mammographic screening
  • Pros and Cons of hormone replacement therapy (HRT)
  • Intraoperative radiotherapy after breast conserving surgery /lumpectomy.


The most important demographic sub-group in modern society are women aged 40-65 - so often caught between bringing up children at the same time as worrying about their ageing parents - and often pursuing a career as well. Sometimes regarded as “The filling between two slices of bread”.

Women in this age group are also often entering their peri-menopausal years and going on to suffer the consequences of the menopause. As well as the climacteric syndrome, these women often have to cope with feelings of low self-esteem and depression. Because of the heavy burden they carry, they often put their own health needs to the bottom of the priority scale.

Breast cancer is also an important threat to this age group - both physical and psychological. These days it is considered essential for doctors to involve their patients in the decision-making process, but in truth, far too many doctors merely pay lip-service to this ideal.


We sympathise with both sides of this dialogue because the subject is so complex, so difficult to understand. Even experts themselves share many differences of opinion. What’s more, there is now an ethical and legal obligation to share these uncertainties with our patients when we are looking for informed consent before invasive diagnostic or therapeutic procedures. The patient must gently be made aware of the delicate trade-offs between improving length of life at the expense of quality of life (QOL) and patient reported outcomes (PROMS). Our obsessive focus on the threat of breast cancer means that few in the lay public know the good news - that breast cancer has slipped out of the top seven causes of death for women. Yet certain treatments for breast cancer might even increase the risk of treatment-induced mortality, particularly from cardio-vascular (heart and circulation) disorders and other cancers. For this reason, limitation of the lengthy traditional postoperative radiotherapy is emerging as a valuable means of reducing toxicity without compromising radiotherapy’s undoubted clinical effectiveness. A single treatment with targeted intraoperative radiotherapy under the same anasetheic as the definitive cancer operation has many benefits. This treatment, called TARGIT IORT, pioneered in UCL, has already been adopted in over 350 centres in 35 countries and over 20,000 women have been treated successfully.

Quite apart from this, many women in this age group are denied the undoubted benefits of HRT - the unjustified fear of breast cancer impairing both its cognitive and bone-strengthening benefits of HRT. In short, the totality of women’s overall health and quality of life must always come first.

Women must not be passive in their search for good health! Surely our patients should educate themselves more fully in order to properly participate as equal partners in the doctor-patient relationship.


This conference, timed to fall within “Breast Cancer Awareness Month”, hopes and intends to start the ball rolling. Book here.