When diagnosed with breast cancer, you will hear your surgeon or oncologist talking about ‘the MDT’. What is the breast cancer MDT? MDT stands for multidisciplinary team meeting. It means a meeting of doctors and other health professionals from different medical specialities (disciplines).
Who goes to the breast cancer MDT?
Most breast cancer units have an MDT once a week. Because of this, a few different types of professionals attend:
- Surgeons: Usually a breast surgeon will present each case. The surgeon tells everyone a bit about the patient and what is wrong with them. This means that the surgeon normally has the patient notes and reads from them or checks information.
- Radiologists and Radiographers: Radiologists are specialist imaging doctors and they interpret mammograms, ultrasound scans and breast MRI scans. They also use scanners to undertake image-guided procedures such as biopsies. The radiologist usually sits at a computer and uses it to display the scans for each patient. They will point out the abnormal areas and discuss any additional scans that they think are required.
- Oncologists: There are 2 types of oncologist. Medical oncologists normally look after patients receiving chemotherapy. Clinical oncologists deal with the specialist area of radiotherapy. Both of these treatments help manage breast cancer.
- Pathologists: These doctors specialise in analysing tissue samples and reporting them. So this might be a biopsy from the breast or a lump removed at surgery. The pathologist determines what the disease is and what treatments it might be sensitive to. The MDT then works out how advanced the cancer is.
- Breast Care Nurses: These are highly qualified nursing staff who contribute to the MDT in many ways. They often know the patient and their background well. BCNs can use this information to help the team plan the best treatments. They might be with you at your clinic appointments and they are often the first point of contact for patient problems.
- MDT coordinator: This is a critical team member who coordinates all of the aspect of the meeting. The coordinator creates a list of patients to be discussed and makes sure that the outcome of the MDT is recorded in the notes.
What do the meetings discuss?
There are a few different categories of patients that are discussed at an MDT.
- Patients who have just been diagnosed with breast cancer: in this case the team discuss the type of cancer, whether it has spread and what the best treatment is.
- Biopsies that have shown benign (non-cancerous) disease: the MDT checks that there is no sign of cancer that has been missed and recommends treatment or follow-up if needed.
- The results from operations: after surgery the pathologist examines the tissue that has been removed. The pathologist checks that the whole cancer is out. After discussion, the MDT recommends if more surgery is required or if the patient needs radiotherapy or chemotherapy.
- People who have been found to have breast cancer that has spread: even if you have metastatic cancer (with secondaries) there are lots of new treatments that can help you live well for as long as possible.
- Patients who are having chemotherapy before surgery: we keep a close eye on patients who need chemotherapy before their operation. This might be trying to reduce the size of disease before surgery or because the disease had spread to the lymph nodes when it was diagnosed. Either way, it is important to check images of the cancer to make sure that it is responding to treatment. If it stops responding then surgery can be arranged sooner if needed.
Do doctors ever disagree with each other at an MDT?
Yes- very often, in fact! Think of it a bit like a court case- each professional has to test the arguments of the others to make sure that they are making good decisions. If everyone agrees with each other all of the time then medicine doesn’t advance, change or improve. Doctors and surgeons can often have have robust disagreements about certain aspects of management but then listen to each other and make a decision that is best for the patient.
How will I know what the MDT decides?
The MDT should only make a recommendation to you about your treatment. All treatments will be discussed with you and nothing will be done without your consent. The patient’s decision is the most important part of the whole process and sometimes the MDT may feel that there are options for treatment and leave the choice to you. We try to give you the best information about benefits and risks that we can. Usually, when you see your surgeon or oncologist they will be able to explain the recommendation of the MDT.