We learn about Steve Biko Academic Hospital Breast Unit.
The Steve Biko Academic Hospital (SBAH) Breast Unit/University of Pretoria was established in 2014; this fell in line with national and international thrust towards anatomic regionalisation of healthcare.
Prior to 2014, all the surgical firms in the Surgery Department managed breast malignancy and chronic benign breast conditions. The then new HOD, Prof Mokoena, established subspeciality units managed by speciality surgeons and these include: the Upper GIT (Prof Mokoena), Hepato-Pancreas Biliary (Dr Brand and Dr Maluleke), Colorectal (Dr Oyomno and Prof Montwedi) and Breast/Endocrine (Prof Ntlhe, Dr Jekel and Dr Docrat).
The SBAH Breast Unit delivers a world-class multi-disciplinary service to patients in our referral area of the SBAH/University of Pretoria, including far-flung satellites e.g. Witbank, Nelspruit and other regions.
Monday clinic: Multi-disciplinary team planning meeting, where patient management is individualised based on the patient, tumour characteristics and molecular profile. Constant communication with team members between clinic days go far with regard to streamlining and improving patient care.
The unit prides itself in providing treatment within two to three weeks in cases where surgery is needed. We currently do not have a surgery backlog or waiting list. For patients who receive neo-adjuvant therapy (treatment before surgery), surgery is performed four weeks later, as per protocol.
Wednesday clinic: The clinic starts at 08:00 and ends at 16:00. We see 200 patients per month with breast complaints and about 30 have breast cancer. These patients receive their surgical procedures as per indication within two to three weeks after having first been seen.
We have two full-day operation lists per week. Many of our indigent patients present with advanced disease, including some, interestingly, with a strong family history of the disease.
Friday clinic: Caters for fast-tracked patients, where the referring doctor communicates directly with Prof Ntlhe in a one-minute or less telephonic conversation. Both the Prof and the referring doctor determine that the patient clinically has breast cancer. The patient may then be referred for mammography, ultrasound and/or biopsy
This mechanism is highly appreciated by both patients and doctors. This type of communication is standard when referring patients who sustain multiple trauma, according to principles espoused by the Advanced Trauma Life Support (ATLS) course for physicians in trauma care. This system would be highly beneficial if adopted for breast cancer.
Teaching and research
Both undergraduate and postgraduate students are tutored from the rotation first day in the unit. The students go through systematic breast history, examination and investigations aimed at treatment.
Research is afforded to registrars, and medical scientists particularly with regard to immunology in breast cancer, or familial breast cancer.
Dr B Phakathi et al: The effect of HIV Infection on the surgical, chemo-and radiotherapy management of breast cancer. A prospective cohort study. (International Journal of Surgery. Volume 34, Oct 2016, 109 – 115.)
SBAH Breast Unit staff members
Surgeons: Prof LM Ntlhe, Dr H Jekel and Dr F Docrat.
Plastic Surgeons: Dr S Selahle and Dr M Rebeiro.
Pathologist: Prof M Bida.
Radio-oncologist: Prof R Lakier.
Medical oncologist: Prof L Dreosti, Dr D Minyuku.
Radiologist: Prof Z Lockhat, Prof F Suleman, Dr N Makhanya, Dr N Vikakazi and Dr Hanekom.
Nuclear medicine: Prof M Sathekge and Prof M Vorster
Specialist breast care nurses: Sr. Atong, Sr. Mamabolo, Sr.Ntandane and Sr. Olivier.
Social worker: Thulani Maxeke
Administration staff :Audrey Nkutshweu and Hyne Steenkamp.
Other departments are invited as necessary e.g. MRI Unit/orthopaedics etc. and are always eager to help.
MEET OUR EXPERT – Prof LM Ntlhe
Prof LM Ntlhe MBChB (Natal) FCS (SA) is the head of Steve Biko Academic Hospital Breast Unit. He has an interest in breast and endocrine surgery and was involved in the establishment of the Breast and Endocrine Unit at Steve Biko Academic Hospital/University of Pretoria Faculty of Health Sciences.