Nearly 250 of us, the largest attendance ever for the RCR Breast Group Annual Scientific meeting, met in Cardiff in early November.
The conference opened with an excellent and entertaining lecture from Dr Raj Persaud of Radio 4 fame and consultant psychiatrist at the Maudsley Hospital in London. He cleverly revealed how concentrating on one task can result in us ignoring important issues around us. The video he showed included a gorilla crossing centre stage which almost all present did not notice, as we were concentrating so hard on a counting exercise he gave us. Extremely enlightening! He gave an important and different perspective on communicating and breaking bad news to patients.
Further speakers on the first morning also concentrated on communication, both within the breast team, Dr Sue Cat from Brighton, and liasing with patients. This was a particularly enjoyable lecture from Dr Michael Greco in Exeter. It is a sad fact that most of us in our working lives will have significant complaints made against us and some of the complex issues surrounding this and the role of the NHS litigation authority were comprehensively explored by Ms Mary Mundew, a lawyer from London.
Further invited speakers showed us the differences in practice across Europe. From Germany was Professor Christiane Kuhl who showed beautiful images and described her free access to Breast MR imaging for a far larger proportion of patients than would be possible in most centres in the UK. The Italian's wide use of Sentinel lymph node biopsy with intra-operative histology was elegantly presented by Professor Georgia Rissato, who also gave us a beautiful talk on Breast ultrasound. Last year's RCR Breast Group Bursary winner, Melanie Smith, also described European differences following her visit to Stockholm where fine needle aspiration cytology is used more frequently than in the UK and stereo-tactic biopsy more often used than ultrasound guidance.
Fascinating rare cases were presented by local South Wales Radiologists, including ductal carcinoma insitu presenting as multiple blood filled cysts. The first afternoon ended with an excellent review of current practice in interventional breast radiology from Dr Peter Britton and the significant implications of larger volume breast biopsies for the Pathologist.
The National Museum and Gallery of Wales was the venue for the conference dinner. This was very successful and in glorious surroundings. (Cor Meibion) Burry Port Welsh male voice choir ended the evening in suitable style.
Despite the success of the previous evenings dinner, the second day began with good attendance at a session on new advances in imaging. Topics ranged from MR diffusion imaging to monitor chemotherapy, 3D imaging to compare ultrasound and MR, electric impedance scanning of the breast through to PET scanning. The review of PET in breast cancer patients from Dr Sharon Hane from London was particular welcome. Her evidence based discussion of the role of PET in staging breast cancer, evaluation of brachial plexopathy and the response to chemotherapy will undoubtedly add weight to many unit's bids to have their own PET scanners.
Mr Richard Rainsbury, breast surgeon from Winchester, gave us an excellent overview of oncoplastic breast surgery. Somewhat depressingly he also described the challenges facing breast surgery as a specialty. In common with breast radiology, there are many more vacant consultant posts than interested specialist registrars at present. It is hoped that as more trainees have the possibility of learning onco-plastic skills, this imbalance will be redressed.
Our second morning ended with a very high quality scientific session. The prize for best proferred paper was awarded to Bill Svensson and colleagues for a paper entitled "Real time breast ultrasound elasticity imaging. Report on a new imaging modality soon to be available on a machine near you." This was a joint paper between Bill (Hamersmith) and some colleagues in the USA
The meeting poster prize was awarded to Liz Kutt and colleagues for a poster entitled: Using arbitration to improve communication and 'minimal signs' cancer detection in breast screening. E Kutt, J Basten, A Jones, M Lamont, P Hynam, J Selley (Bristol).
We then returned to discuss work-force issues in more detail. It was extremely pleasing to hear that advanced practice for radiographers has extended across the spectrum of screening and symptomatic breast units. The experience of both a senior radiographer and consultant radiologist in training advanced practitioners was very welcome, both for those undertaking training already and for those considering it.
Professor Stuart Field presented the results of the 2003 survey into workforce, funding, litigation and morale in Breast Imaging Departments across the United Kingdom. This was very similar to the survey undertaken in 1998 and showed that "inspite of a significant number of units employing breast clinicians and advanced practitioners, there is still a substantial shortfall in the workforce such that in 1997, 40% of units had vacant posts and this has now risen to 60%". More worrying perhaps, is that the survey also showed that although money for extending breast screening up to age 70 and to two views at each round has been included in Primary Care Trust budgets from 2003, over half of the country's screening units have not received this money as yet. A considerable shortfall in the provision of equipment adds to the problems reported by units across the country. On a brighter note, there has been a drop in the fear of litigation and a slight improvement in morale of breast radiologists generally. Indeed, there has been a substantial reduction in the number of radiologists thinking of giving up breast screening.
This was an upbeat note on which to end the meeting. Next year the conference will be held in London on November 1st and 2nd.
Details of this and many other issues of interest to Breast radiologists can be found on the RCR Breast Group website, www.rcrbreastgroup.com , which is regularly updated and enthusiastically organised by Dr Chris Flowers.