Dr Fiona Hegi-Johnson raising breast cancer awareness

In this month’s MediStays blog we celebrate Breast Cancer Awareness month and chat to Dr Fiona-Hegi-Johnson. Fiona is a Radiation Oncologist specialising in the care of women diagnosed with breast cancer. She works at the Peter MacCallum Cancer Centre in Melbourne, at the Parkville (city) and Moorabbin campuses. Every year, Fiona cares for hundreds of women diagnosed with early and late stage breast cancer. She was recently honoured to speak to the Think Pink community, a charitable organisation supporting women diagnosed with breast cancer and their families. Here Fiona shares some insights into her presentation at Think Pink.

Fiona Hegi-Johnson Think Pink Breast Cancer

Thanks for your time Fiona! Can you share some of the insights from your presentation with the MediStays community?

Thank you, it was a wonderful opportunity to visit Think Pink. The topic of my presentation was metastatic breast cancer, which describes cancers that begin growing in the breast and spread to other parts of the body. Some women are diagnosed with a primary breast cancer that has spread to other parts of the body early. Other women have received treatment for their primary breast cancer and return many years later with secondary breast cancers in other parts of the body. The biology of the secondary (metastatic) cancers determines which medical options are available. I shared many of the treatment options for metastatic breast cancer with the Think Pink community. These treatments include clinical trials and new options such as immunotherapy.

How do you select the right treatment for metastatic breast cancer?

To choose the right treatment, we work as a team of many different medical specialists including radiation and medical oncologists and surgeons. The first factor we consider is the type of treatment(s) our patients wish to receive. We also consider the biology of the cancers, including the number of secondary cancers, their location and symptoms they are causing. Depending on their location, we also consider the potential for treatment-induced side-effects. In addition, we consider how fit the patient is for treatment and, if they are travelling to the city for treatment, how long they wish to be away from home.

 Some of our community may have heard of the term ‘oligometastatic disease’ – what does this mean?

Oligometastatic cancers describe cancers that have spread from the primary site (breast) to form between 1-5 new cancers. It is important to know how many secondary cancers there are as this determines what treatment options are available.

And, what treatment options are available for women with 1-5 secondary breast cancers?

Stereotactic Ablative Body Radiotherapy (SABR) is a relatively new treatment option to treat oligometastatic breast cancers. This treatment delivers high doses of radiation therapy in approximately three doses. This is different to conventional radiation therapy which involves up to 30-35 treatments. SABR is a highly technical treatment that requires precise targeting of these high doses of radiation. This treatment option is showing promising results for patients with metastatic breast cancer.

Fiona Hegi-Johnson Think Pink Breast Cancer

Diagram showing a CT scan with a secondary breast cancer in the spine. SABR is used to deliver a high radiation dose to the cancer, while avoiding radiation dose to the spinal cord, lungs, heart and oesophagus. Courtesy, K Unicomb (University of Newcastle) and F Hegi-Johnson (Peter MacCallum Cancer Centre)

How about treatment options for women with more than five secondary cancers?

Ladies presenting to our clinic with many more cancers also have treatment options, including systemic treatments such as chemotherapy and endocrine therapies. These treatments can also be combined with SABR and many patients experience long-term survival, good quality of life and less repeat treatments. Some of these treatment can now be given as tablets, or given by chemotherapy units in smaller hospital close to where patients live to avoid them having to spend time away from their families.

Are there any clinical trials for women with secondary breast cancers?

Yes, absolutely. There are several clinical trial options for women diagnosed with metastatic breast cancer. These depend on the site(s) of the secondary cancers and also the types of treatments (if any) that women have received in the past. Several trials available to Australian women are run by the Trans-Tasman Radiation Oncology Group (TROG). These include:

  • “CORE”, a study of conventional treatments compared to SABR for secondary cancers (outside the brain). This study is for patients with less than 3 metastases.
  • Local HER-0 is a study using radiation therapy to treat secondary HER2+ breast cancers in the brain. This study is for patients who can receive treatment with Herceptin for their metastatic disease and who then need treatment to disease in their brain.
  • AZTEC compares SABR to an immunotherapy drug in women with advanced triple negative breast cancer. This is for patients with metastatic triple negative breast cancer. Patients can have more than 5 metastases, but as long as at least one area can be treated with SABR they can have a new immunotherapy and SABR and enter this clinical trial.

If women are living in regional or rural areas, are they able to access these new treatment options?

Yes, absolutely. I care for many women travelling long distances from rural and regional communities. We understand it can be very difficult for them to travel long distances, especially when they have families at home and need to organise transport, accommodation and meals. We have an excellent team to support them and many of these newer treatment options require much shorter stays in the city than they used to. There are also many cancer centres in regional centres and some offer clinical trials. When possible, we can also access telehealth to discuss treatment options and follow-up appointments. This is an excellent option for country women and saves them another trip back to the city.

Where can women find out further information?

It is always best to ask your doctor for further information if you have been diagnosed with metastatic breast cancer. Ask about your treatment options, including clinical trials. There are many different reputable websites to visit including the Australian organisation Breast Cancer Trials. You can also visit the TROG website for further information about the clinical trials I mentioned earlier. And, Think Pink is a wonderful organisation supporting Victorian women with breast cancer and their families.

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