Vital cog in the wheel - Dr Sue Fraser describes the privilege of being a breast physician

Dr Sue Fraser is president of the Australasian Society of Breast Physicians. After working as Clinical Director of BreastScreen in Cairns for 15 years, Dr Fraser now works in various roles in breast medicine in Queensland and New South Wales. She also lectures at James Cook University in Cairns.

I worked as a general practitioner for 14 years, including 10 years as a solo GP in Cairns. When I sold my practice, good friends who were radiologists and a breast surgeon asked if I wanted to run a breast clinic they were starting in Cairns. I trained for three months at the Wesley Breast Clinic in Brisbane before the Cairns clinic opened in 1992 as a multidisciplinary private diagnostic clinic. We had wonderful support from radiologists, surgeons and pathologists. It took a while for GPs to get used to the idea of referring women to the clinic, but they came around. In 1994, our clinic landed the contract for BreastScreen in Cairns. We were the only private facility doing public screening and we had a one-stop shop — a screening program and a diagnostic program sharing all staff and equipment.

The many roles I have are an indication of the variety and opportunities in the work of a breast physician. Last year I started working with a very busy breast surgeon on the Gold Coast, Dr Daniel de Viana. It is a very different role to the diagnostic work I was used to. I assist him in surgery and do postoperative follow-up. When I was a diagnostician, I gave the patient good or bad news and handed them back to their GP for further management. With specialised follow-up, I have an ongoing role and can get to know my patients. I also have several other roles, including working as a breast physician two days a fortnight in Cairns; as a senior medical officer for the public breast surgeon in Cairns; and reading films for St George Hospital in Sydney. I also work for BreastScreen in Cairns and on the Gold Coast.

With the increasing incidence of breast cancer, the role of breast physicians is becoming more important. Women with breast cancer are followed for a minimum of five years and some for longer. Women with breast cancer have a lot of post-treatment issues. The surgeons are so busy seeing all the new patients with breast cancer, they don’t always have time to manage all the follow-ups and women presenting with benign breast conditions. Breast physicians have the time and expertise to manage these women.

Breast physicians play a key role in multidisciplinary teams. The role varies according to the location in which the breast physician works. In most services, in addition to taking a breast history and doing a clinical breast examination, breast physicians are responsible for coordinating the team and correlating the results of imaging, examination and pathology. After being a solo GP for years, I love the team aspect of breast medicine. The patient knows they have all these people managing their care.

The Australasian Society of Breast Physicians is a bit like the orphan who is looking for a home. Our society has been around for more than 20 years and we have about 50 Fellows. We have had many obstacles to gaining professional recognition by a specialist college, but we are working hard to achieve this goal. We have a revised training document, which we think stands up to scrutiny, and we’re working to have that validated by one of the colleges in the future.

Breast surgeons who work with breast physicians say they couldn’t manage without them. In my work I have had the amazing experience of diagnosing women, being the assistant in the operating theatre, and being involved in their follow-up care. Breast physicians know a lot about many aspects of breast medicine. We are the generalists of breast medicine and pull it all together for the patient in a holistic way.

It’s been a privilege to help build the profession of breast physicians in Australia. Our profession has been able to develop within the multidisciplinary team, and our work has added to holistic care. Our society has been a tight-knit and unified group — unified by our passion for our work. It’s a great privilege to work as a breast physician. I have no plans to retire — I get up every day and look forward to work.