Last week I mentioned to a patient that “her case” had been discussed at our breast tumor board, and there was a consensus opinion (i.e. all present agreed with my recommendation).
What is a breast tumor board? At most community oncology centers and hospitals there are “tumor boards”. There used to be one, but over time we have segmented them out. Breast tumor board at our hospital meets twice a month. It is a gathering of breast surgeons, radiation oncologist and medical oncologists along with pathologists, radiologists and nuclear medicine experts. At our conference we also have social workers, the Psychologist who is devoted to breast cancer patients (more in another blog), our patient navigator, the cancer center director, the clinical trial coordinator, and other people who work extensively with breast cancer patients.
These people gather every other week to review complicated cases and also discuss an overview of breast cancer care at our hospital. Typically what happens is a woman’s case is presented by her physician (anonymously of course) and discussed.
The pathology is reviewed and discussed by the pathologist. Films are reviewed and discussed by radiologists and nuclear medicine physicians.
Depending on who is presenting the case the other oncologists have a chance to discuss - the three oncologists (surgical, medical, and radiation) - are well represented.
Sometimes the issue involves a surgical question. The radiation oncologists always have a chance to express an opinion on what benefit radiation may have for the patient. And the medical oncologists discuss the role of hormonal therapy and chemotherapy.
Sometimes there is debate - we medical oncologists particularly like to engage in friendly debate, quoting studies in the literature or at recent conferences that might apply.
Surprisingly there is sometimes disagreement among the oncologists, because there may be more than one right way to treat a patient. Usually there is a consensus, and it is reassuring when there is agreement.
The presentations mirror what we see clinically in proportion - most cases are newly diagnosed with discussion focusing on adjuvant care. Neoadjuvant (chemotherapy or hormone therapy) treatment is often discussed because it is rapidly evolving. Patients with metastatic disease are sometimes discussed with various strategies being explored.
The conference serves several purposes. It provides patients with multiple opinions and enhances their care. It provides a forum for discussion of breast cancer care at our hospital. And it provides ongoing education for all who attend.
Kevin Knopf is a hematologist in San Francisco, California and is affiliated with California Pacific Medical Center. He wrote for HealthCentral as a health professional for Breast Cancer.