Centre of care

When breast physicians first began working in Australia more than 20 years ago, their work centred around screening and diagnosis, mostly in breast screening or diagnostic clinics including BreastScreen services that were being implemented at the time.

Now breast physicians oversee or coordinate a woman’s care, not only helping to bind the work of the multidisciplinary team, but to be the bridge between a woman’s general practitioner and her surgeon.

“We coordinate everything”, says Dr Pfeiffer, who is medical director of BreastScreen on the Sunshine Coast in Queensland. “We see the women when they first come in, we examine them, and we decide what investigations they need. Once they’ve had those investigations, we give them the diagnosis and make the referral to the appropriate specialist. Depending on the settings in which we work, we might be involved in their ongoing follow-up, in liaison with their GP.”

Dr Pfeiffer is one of 50 Fellows of the Australasian Society of Breast Physicians, a small but passionate organisation that links the network of breast physicians in Australia and New Zealand who are involved in breast screening clinics or breast diagnostic centres. Many are clinical directors or program managers of screening programs.

Associate Professor Nehmat Houssami, who started work as a breast physician 21 years ago when the profession was in its infancy, now works as a consultant clinician at the NSW Women’s Breast Centre at the Royal Hospital for Women in Sydney, among other roles.

“I started when [the specialty] was very much centred on breast screening or seeing symptomatic women attending dedicated breast clinics”, she says. “Most breast physicians are still working in a screening environment and in symptomatic clinics, but some also collaborate with surgeons, in theatre and in immediate post-op follow-up.”

Associate Professor Houssami, who is also a public health physician, now mostly sees high-risk patients, such as women who have had breast cancer or women who have breast cancer gene mutations.

She recalls that her main reason for becoming a breast physician was the opportunity to spend time with women after screening for breast cancer to discuss results.

“For most women, I could give them good news, but for women who had cancer, I could spend time discussing the results with them and providing as much information as they needed”, she says. “I often had more time than the surgeon to counsel them about their treatment options.”

The role also allowed her to pursue her interest in breast medicine more broadly without confining herself to one conventional specialty.

“In my intern year, breast cancer work appealed to me, but I didn’t really want to be a surgeon, radiologist or oncologist”, she says. “When a job came up at the Sydney Breast Clinic, it gave me the chance to learn various skills and to have a broad role across breast medicine. That’s still part of the appeal for me.”

Conversely, Associate Professor Houssami says the field may suit young doctors who want to specialise in one aspect of breast cancer but are not sure which specialty to choose.

“Working as a breast physician exposes you to a lot of different aspects of care: you see the diagnosis side and you see patients after surgery, so it’s a good grounding”, she says. “I have trained a couple of doctors who started working as a breast physician and then specialised in radiology.”

The big issues

The biggest issue facing breast physicians in Australia is that their profession is not recognised as an independent medical specialty, Dr Pfeiffer says.

“We have just revised our training document, which we hope will be a major asset in gaining recognition from a specialist college”, she says. “It is comparable in depth and breadth to the training documents of other colleges recognised by the Australian Medical Council and sets out our training curriculum.”

Associate Professor Houssami says that while breast physicians work closely with others as part of the multidisciplinary team, the lack of recognition as a specialty can be professionally challenging and may deter doctors from joining their ranks.

“Working as a breast physician may be perceived as not as secure as other specialties”, she says. “Although jobs do come up on a regular basis, there aren’t guaranteed training posts, so that can be quite difficult, particularly if you’re a young doctor looking to train in a specialty.”