Current State and Role of Private Breast Clinic in Korea

First, breast cancer can be diagnosed with mammogram, and, if necessary, sonogram and biopsy. In the United States, with large population of breast cancer patients, breast cancer diagnosis has been standardized. This was necessary since there were differences in results based on individual experiences. Therefore, in 1992, the American College of Radiology (ACR) imported Breast Imaging Reporting And Data System (BI-RADS) for use in describing mammographic findings.(2) Category is classified according to the degree of expected malignancy showing guidelines if it is normal; whether follow up or biopsy is necessary for abnormal lesions. The contents have been revised through constant mediations of opinions. Followed by the first revision in 1995, the second revision was established in 1998, and the third revision in 2003, including ACR-BIRADS-US, MRI.(3) Even though the classification of BI-RADS of sonogram is similar to those of mammogram, they are divided in detail focusing on the characteristics of its own.

Nowadays, in Korea, BI-RADS classification from the United States is being used and biopsies are performed accordingly. However, it has never been studied if the classification is applicable for breast evaluation in Korea. For example, in Japan, meetings of Japan Association Breast Thyroid Sonogram (JABTS) are held twice a year to set standardization fitting their actual state by examination and revision of the category. As a matter of fact, since I have patients in my own practice, I often personally thought BI-RADS classification revision should be done to suit Korean society. To achieve more professional aspects in our meetings, we need constant revision and compensation on the BI-RADS classification of Koreans.

Second, data of breast screening should be collected. In the United States, after basic mammogram is taken in women under 40s, mammogram is recommended every 1-2 yr between 40 and 50 yr of age depending on risk factors and annually for women over 50 yr of age. Since 2003, ACR recommends sonogram for high risk groups. In Korea, self-examination if recommended for women under 35; women between the age of 35 and 40 need to be checked by a doctor, and those over 40 need an annual mammogram unless they belong to a high risk group.

However, according to clinical experience, there are inconsistencies following these guidelines. Considering that incidence of breast cancer occurs in younger age in Korea and that unlike American women, many Korean women have dense breast, limitations of mammography should be assessed. Although fewer American women have dense breasts, a great deal of research has been done on the limitations of mammography. As a result of comparative analysis of palpable breast cancer with 132 cases by Stavros(4) in 2004, lesions were not observed in 34 cases (26%), lesions were considered benign in 5 cases (4%). Korean women have much more dense breasts; it has been reported that 50-90% of women have dense breasts, depending on the hospital. However, data on the limitations of mammogram are few. Therefore, KABC has a great deal of task to fulfill. Data needs to be collected and revised constantly regarding starting period, interval, ending period, examination tools of breast cancer screening and guidelines for high risk group.

Third, after diagnosis of breast image, biopsy is performed for confirmation. There are various methods for confirmation such as fine needle aspiration, core needle biopsy, incisional biopsy, excisional biopsy and vacuum-assisted biopsy device. These days, biopsy method is selected depending on each hospital and personal experience. It is important to establish guidelines to select the most appropriate procedures according to images of the lesion.

The first aim of the breast clinic is early detection of breast cancer. The clinic focuses on this primary aim, and general hospitals are also focused on breast cancer diagnosis and treatment. It is obvious that KBCS has the same interest. Therefore, it is natural that there is less concern for benign breast disease. In fact, many patients visit breast clinics for symptoms such as breast pain, inflammation or for benign mass in addition to breast cancer. Even KBCS has few approach methods for benign disease. Moreover, the Journal of KBCS does not include research articles on benign breast disease. KBCS should be more concerned than ever about benign breast disease and provide opportunities to discuss, share opinions and give presentations about treatments.

In current medical practice, it is rare for a disease to be limited to a specific department. As boundaries are collapsing, conflicts are fostered between departments. However, this trend will not change, only worsen in the future. It is actually predicted that doctors with same interest of disease of an organ, concerning treatment to management will gather together regardless of their specialties. In other words, surgeons should be able to practice all kinds as a primary physician relating to disease of the breast. This includes breast cancer diagnosis, breast reconstruction and especially management after breast cancer surgery.

In the present state, patients have been highly satisfied with cancer treatment due to the remarkable system but in cases of care after treatment, they have been unsatisfied. Following cancer diagnosis, anxieties of patient and families have been endless; patients want to know what the survival rate is, which treatment is better, and where they should receive medical attention. Anxiety about nutrition, stress, and exercise is extreme.(5) The most frequent question is about diet. Most of the time, the answer is to eat well. If you think of food accounting for 35% of cancer development and treatment, nutrition education and awareness are extremely important. Stress is known as a root cause of all current diseases, and one of the factors in development of cancer. Patients feel uneasy when they undergo cancer surgery and chemotherapy. Advising them to take it easy is not enough to reduce their anxiety. Approach to soothe their anxiety should be administered after the patients' mental state has been evaluated. Cancer patients tire easily as a result of surgery and the side effects of chemotherapy. However, exercise for cancer patients is important.

According to cancer prevention guidelines from the United State cancer association, exercise could reduce cancer risk by as much as 35% if people exercised more than 30 min a day and more than 5 days per week. New access to exercise, including aerobic exercise, rather than just body movement, is necessary. Numerous patients pay attention to exercise, stress management, nutrition and complementary medicine while there are only few hospitals and doctors who actually address these needs. Surgeons should be concerned about this problem.(6) Surgeons who, make diagnosis, operate on, give medication, observe patients regularly should feel responsible to resolve a patients' curiosity. This is especially appropriate for surgeons working at KABC clinics.

Although KABC has a short history of its own, it has become the most successful and specialized group among many primary clinics in Korea. There is a possibility that breast cancer incidence may increase in the future and many problems remain to be solved. That is why many more young doctors specializing in surgery is required to participate. I hope young breast cancer surgeons build professional knowledge of breast cancer surgery in university hospitals and as emerge as primary clinicians, giving efforts to approach breast cancer from diagnosis to surgery, chemotherapy, cancer care and complementary medicine, and to collect experimental data.