Many women, knowing they need surgery for breast cancer, are afraid of looking disfigured after their operation. The question, on day one, is how and where to find a specialist breast surgeon. Personal recommendations cannot always be relied on. Often, we end up in the hands of surgeons who lack the knowledge and expertise needed to care for patients with breast cancer.
The 2020 launch of the BRESO curriculum ‒ a certified specialist training course for breast cancer surgery ‒ marked an important milestone in progress towards improving the quality of care for people with breast cancer. I feel it was also a bit of a personal achievement, as this is something I had been campaigning for over many years.
I’m now calling on surgeons, patient advocates and policy makers to take action to help us urgently reach the next milestone – the point at which every breast cancer patient can have confidence that their surgeon is capable of maximising their chance to achieve the best possible outcome.
I was lucky ‒ a highly qualified oncoplastic breast surgeon performed my surgery and removed the triple-negative tumour in 2000, and again in 2005 and 2018. Grateful to be alive, I decided to volunteer and support his patient organisation.
My involvement with the breast cancer patient community started with art. Though I had never painted before, after my second surgery I created a painted story of my survival, called Message of Hope. By disseminating this video worldwide on YouTube and cancer websites I have been able to encourage cancer patients over many years, as well as inspiring them to unlock their own creative potential, which can heal both soul and body.
International cancer organisations in Europe invited me to show this video and the 22 paintings at their conferences. I began to give speeches about‚ “Cancer and Art walking hand in hand,” and truly enjoyed my unexpected success.
Through this work, I became aware of the many mutilations and unnecessary mastectomies performed by surgeons without specialist training; all this caused literally a deep shock to me. I began to reflect, and I tried to figure out how I could make a difference. So I started to raise this issue in speeches, pointing out the urgent need for a European breast surgeon certification.
In 2016 I held an exhibition at the European Parliament in Brussels. At the opening I emphasised in my speech that there was an urgent need for a formal European Breast Surgeon Certification, as well as for standardisation of training and academic education across Europe, because it takes a specialist to deliver a positive impact on survival and quality of life of the patient.
I was grateful that Cancer World published my Call-to-Action, brightened up with my painting “The Expert Eye”. This was the beginning of my dream to push the issue with passion and perseverance, realising that this would not be an easy task.
The first important step for accredited specialist breast surgical care came when the European Society of Surgical Oncology (ESSO) and the European Society of Breast Cancer Specialists (EUSOMA) set up a working group in 2017. This was a forceful initiative that I took part in as a patient advocate.
Organisations involved in training, certification and trials then came on board in 2019 to create the Breast Surgical Oncology Certification Group (BRESO), with a mission “to develop the highest standards of breast surgical oncology in a multidisciplinary setting, for the benefit of breast cancer patients who should receive the best available care across Europe, no matter which country they live in.” They collaborated to develop the Breast Surgery Theoretical and Practical Knowledge Curriculum, which was launched online in 2020.
BRESO is recognised by UEMS, the European Standards in Medical Training, as providing a Europe-wide accreditation of specialist breast cancer surgeons. It offers two pathways to certification: a Prospective Certification, open to surgeons within five years of completing their surgical training, and a Retrospective Certification, open to surgeons with more than five years’ experience working at consultant/attending level.
In my opinion, this breast surgery certification initiative marks a milestone in breast cancer history. But it will only protect patients from substandard surgery if it is put into practice at every centre where breast cancer is treated.
We can all do our bit to ensure that happens.
As a general rule, each candidate who qualifies for the certificate will be added to the list of BRESO certified surgeons, which will be publicly available.
- Certified breast units‒ and indeed all centres where breast cancer surgery is performed ‒ should insist on BRESO certification for any surgeon involved in this work.
- Patients should have the right to access treatment by BRESO certified surgeons at certified breast units, and should have the right to the information they need about the benefits of specialist treatment and how to access it.
- Policy makers at regional, national and European level should recognise breast cancer surgery as a surgical oncology subspecialty and include mandatory BRESO certification for all surgeons who operate on breast cancer patients, as a key element in their cancer policies.
Did I believe in this success and progress of the project as I began my pioneer work? No, I am truly overwhelmed and deeply grateful for the hard work done by all the BRESO Group Members during the past years.
During my long journey with chemo and radiation therapy, I learnt not only to fight, but also to stand up and raise my voice to end the inequalities in treatment received by breast cancer patients. The more people who join this fight, the faster we will get there.
Featured image credits: Shirley Bianca L. Müseler, Patient Advocate, Advisor to the BRESO Working Group (centre), speaking at the European Parliament; ‘The Expert Eye’ (left) and ‘Silence’ (right) – part of Shirley Bianca’s Message of Hope collection of paintings, republished by courtesy of Shirley Bianca