Aiming for excellence

Since taking up his post at St Mary’s in September 2007, consultant breast surgeon Mr Richard Sainsbury has greatly improved treatment for breast cancer patients on the Island and people are even travelling from the mainland to be treated by him. But it is his dream that in the future St Mary’s Hospital could become a Centre for Excellence in the treatment of breast cancer, with a dedicated building and more essential equipment.

“I was made very welcome here,” said Mr Sainsbury. “I’ve got a good team, treat nice people and I want to move it forward.”

A pioneer in the discipline of breast cancer surgery, Richard Sainsbury moved from the Royal Free and University College Medical School, London where he had been Senior Lecturer and Honorary Consultant Surgeon and Head of Breast Services at UCH since 2000. He has retained his ongoing research programme at University College Hospital in London, concerning the mechanisms of breast cancer, and he works there one day a week. He is also Consultant Breast Surgeon at Southampton University Hospitals NHS Trust, has a weekly private clinic in Harley Street and is actively involved in advising government bodies on the optimisation of breast services.

Mr Sainsbury’s work often brings him into the corridors of power. “I was at a dinner at the House of Lords and met Lord Sainsbury,” he recalled. “We argued amicably as to who had the name the longest and which family was the oldest.”

The first new addition Mr Sainsbury made when he moved to the Island was to introduce the testing of the sentinel or guardian nodes during the operation to remove breast cancer. This was something he had pioneered during his work at the Royal Free and UCH in London.

“We’re now one of only two units in the country where the sentinel node injection can be given without the patient having to travel to a Nuclear Medicine Department,” explained Mr Sainsbury. A sentinel node probe was purchased in 2007, totally through the efforts of fundraising across the Island. It can mean less invasive surgery for patients as the one or two sentinel nodes, are detected, removed and tested and if found to be clear no more need to be taken.

Previously many nodes were removed during a lumpectomy or mastectomy and this could cause problems with lymphoedema later – a chronic disease that can make the arm swell which cannot be cured. “The sentinel node probe is a big success and is working very well,” said Mr Sainsbury.

“We now want to test the pathology of the sentinel nodes during the operation but need the money for the OSNA (One-step nucleic acid amplification) machine to do this,” said Mr Sainsbury. £75k is needed and local fundraising is nearing the halfway mark.

“It is hoped that at some stage that the use of an Ultrabeam radiotherapy machine will be explored on the Island too,” said Mr Sainsbury. This machine, which gives radiotherapy during lumpectomy surgery, is a very expensive piece of technology at £400k.

“We would really like a proper building for the breast cancer unit – you can overhear conversations in the building at the moment,” said Mr Sainsbury. “We’re very keen to provide the whole service under one roof, particularly so that patients don’t have to walk across the car park between clinics. It would also allow the specialists to discuss patient’s care and encourage multi-disciplinary working,” he stressed. “Maybe some of the out of work builders could come and give us a hand,” he added good-naturedly.

At present the breast-screening unit is in a bungalow to the far right of the car park and breast biopsy is also carried out there. The breast cancer nurses are based in the Applegate bungalow, which is on the right just before you get to the breast-screening unit, and it is here that you can drop in for advice and help. They offer fittings for prosthesis and bras, and dressings for post operative and post radiotherapy wounds and information and support for those who’ve only just been diagnosed with breast cancer. A drop in service for existing patients who might have new concerns is also offered there.

When you come for your initial appointment with a consultant it is at Outpatients in the main part of the hospital. When you return to see the doctor or consultant for your diagnosis and test results you also visit Outpatients. This means that there are currently three different buildings to negotiate during your treatment for breast cancer and, if you need radiotherapy, you have to travel to Southampton.

The breast cancer surgical team is comprised of Mr Sainsbury, his Associate Specialist Mr Babu, oncologist Mr Marshall and pathologist Mr Jamil with Caroline Rubin and Jill Shead leading the breast screening team. Three breast cancer nurses; Jasmine Light, Marie Bugden and Mary Seymour, are based at Applegate with their PA Julie Wilson.

“Since Mr Sainsbury joined us we are now able to see everyone within two weeks of referral by their GP which is the government’s directive,” said Jasmine Light. “Sentinel node detection and biopsy has been very successful and has led to a decrease in the number of patients suffering with lymphoedema, which is really important because it is a very debilitating condition.”

“Patients are now able to come in on the day of surgery and go home on the same day which has cut costs drastically. Those having reconstruction usually stay only one night. Previously patients were staying for up to four nights. We’re also doing some research into the 20 year figures since 1988 as both St Mary’s and Southampton hold all records from that period,” she added.

The incidence of breast cancer on the Island is similar to elsewhere but this common disease does affect ten percent of the population and early diagnosis and treatment is essential. “It’s a disease of affluence although this also has an influence over whether the disease is diagnosed,” said Mr Sainsbury. “Age has something to do with it,” he added. “We’re seeing post menopausal women who are carrying too much weight. It doesn’t matter in pre menopausal women but after the menopause women have higher levels of oestrogen which feeds most cancers. Possibly exposure to other chemicals and alcohol abuse can be contributory factors,” but there is good news for mothers. “Having full term pregnancies is protective, regardless of the method of delivery,” he stated.

On the subject of elective breast removal for those in high-risk categories, Mr Sainsbury was not overly enthusiastic. “For some people it’s appropriate but we’d go into a lot of counselling beforehand,” he stressed. “People over estimate the risk drastically. We certainly over treat some people,” he continued. “Some cancers are very slow growing and would never harm a person in their lifetime.”

Richard has had quite a few celebrity clients. He was catapulted into the limelight after operating on Amanda Mealing, the actress who plays Connie Beecham in Holby City. “I did her original breast cancer surgery and helped with her reconstruction surgery,” said Richard. Strangely Amanda is also married to another Richard Sainsbury who works as a scriptwriter. “She refers to us as her two Richard Sainsburys,” laughed Richard.

Mr Sainsbury’s appointment now means that reconstructive surgery is now on offer at St Mary’s – previously patients had to travel to Winchester or Salisbury and further afield for this service. Often the breast reconstruction can be done during the operation to remove the cancer, whereas previously this was not always advised. Mr Sainsbury also offers a full range of cosmetic breast procedures for private patients, including augmentation and reduction, at the Mottistone Suite.

There are three types of breast reconstruction on offer. Latissimus Dorsi brings the muscles and flesh from the back to construct the breast and implants can also be used with this method. Sometimes the nipple can be saved or Mr Sainsbury can construct a nipple at a later date. Pigment tattooing to colour the skin around the nipple to mimic alveoli can also be done.

Implants are the second and most well known method of reconstruction although if skin has been removed the third method of using tissue expanders is used. These are like deflated balloons and they are gradually increased in size over a period of months to stretch the skin.

“We also want to be able to offer lipo filling for patients which will reduce any deficit in the breast after reconstruction surgery,” said Jasmine Light.

Richard keeps his boat on the Island and, although he lives in Hampshire, is often over here at weekends. “I’m here as often as possible in the summer. I like Yarmouth and I’m making my way through the 171 pubs, and I love the ice-cream shop on Cowes seafront,” he told me. “I’m still waiting to see a red squirrel and I was told it never snowed on the Island! I’m finding there are a lot of local Island myths.”

Let’s hope that founding a Centre for Excellence in the treatment of breast cancer here on the Island isn’t just a myth that doesn’t appear.

If you wish to donate money, cheques should be made payable to the Breast Care Nurses Trust Fund and the nurses can be reached on 534562.