On the job Prof. dr. Vivianne Tjan-Heijnen medical oncologist ‘You have breast cancer’ will always be one of the most difficult messages I have to deliver as an oncologist. Luckily, we are living in a time with more medical possibilities than ever before, especially if a cancer is discovered at an early stage. Chemotherapy, radiation therapy, surgery; most people know about these types of treatment. Alongside these traditional options, immunotherapy and hormone therapy are also taking on a more prominent role. This wide range of options does raise the question of when to apply which therapy. After all, every patient and tumour is unique and not everyone will benefit from the same treatment to the same extent. In a tumour with little or no sensitivity to hormones, hormonal therapy is bound to have a limited impact. Advanced technologies enable us to gauge the nature of a tumour more precisely, by compiling a DNA profile and through ever more accurate imaging, for example. This knowledge subsequently allows us to apply the most effective treatment method. Patient choice is a leading factor in this process, which we refer to as shared decision-making. Some patients might want to undergo all possible treatments, whatever the cost. Other might come to terms with their shortened life expectancy more quickly and seek the best possible quality of life for the time they have left. If a patient may want to have children in the future, we take this into account during chemotherapy by freezing egg cells or embryos, for example. If necessary, we perform embryo selection to prevent any hereditary breast cancer risk in the next generation. To assist our patients during their illness, we are developing decision aids based on scientific evidence. This allows people to make a well-informed and properly considered choice on whether or not to go down a certain treatment route. We are always on our patients’ side to help them choose the best possible path. Over the past thirty years, prognoses for breast cancer patients have improved in leaps and bounds. Thanks to the medical progress we have made, the chance of survival has increased by twenty percent. We want to keep up this trend by continuing to innovate. Proton therapy, for example, offers great potential. Patients undergoing a mastectomy are offered innovative breast reconstruction choices, which may preserve sensory nerves. We are ensuring that patients can make the most of our knowledge, right from the moment they are first diagnosed.
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