SHOULDN'T ALL BREAST UNITS BE THIS GOOD?

In the cool, antiseptic atmosphere of the operating theatre, surgeon Peter Jones is removing a cancerous tumour from a woman's breast.

In the adjoining theatre, his wife and fellow surgeon Sue is carrying a similar procedure.

The scene is Maidstone Hospital in Kent, where the couple are the only husband-and-wife team in the UK to head a breast clinic.

And they believe it is their close relationship that has turned it into one of the most successful in the country.

It consistently achieves the highest survival rates in South East England, with the lowest mastectomy rates and a low local recurrence rate.

The couple work alongside each other, seeing patients, discussing their care and operating. Often, they start operating at 7.30am and do not leave the outpatients clinic until after 7pm.

The clinic is based on co-operation. Every case is discussed and the best treatment plan decided at a weekly meeting of the the 20-strong breast team. It includes Mr and Mrs Jones, breast physician Jenny Weeks, oncologist David Pickering, pathologist Stephen Humphreys, radiologist Dr Ali Sever radiographers and breast care nurses.

At the lunchtime round-table discussion, every member of the team views the mammograms, studies the pathology and examines the medical history.

Mr Jones says "We believe it is vitally important for the whole team to be involved in every patient's care. The whole team makes a joint decision as to the best treatment for each woman.

"In the past, women would often have their treatment decided by one person. They would undergo mutilating mastectomy without being offered reconstruction, and the treatment was as frightening as the diagnosis.

"We are passionate breast conservationists and believe far too many mastectomies are still performed nationwide.

"If for any reason a mastectomy must be recommended, we always offer immediate reconstruction. Women are entitled to the best cosmetic outcome

The clinic sees 250 newly-diagnosed breast cancers every year out of the 2,500 women referred.

Thankfully, most lumps are not cancer, but the uncertainty as they wait for the diagnosis still causes untold anxiety for women. Every week 50 new patients came through the doors and another 80 return for follow-up appointments.

Yet Mr and Mrs Jones pride themselves on seeing the majority of women at their next available outpatients clinic, and on treating all women equally, whatever their age.

More than a third of the 35,000 women diagnosed with breast cancer every year in the UK are over 70 and a recent study by the Cancer Research Campaign revealed that older women are being denied surgery because doctors believe them too frail to be operated on successfully.

This certainly isn't the case at Maidstone. Today, Mrs Jones is operating a 93-year-old woman.

Gwen Grant was reluctant to have surgery. She did not want to have a general anesthetic or stay in hospital overnight.

So it was agreed her lump could be removed under local anesthetic, she could keep her hearing aid throughout, so that she could understand what was going on, and she would go home the same day.

Unfortunately, Diana Baker needed more radical surgery.

Chemotherapy failed to educe the size of her tumour, so Diana 61, needed a mastectomy. She had reconstructive surgery at the same time, using muscle taken from her back. Now, just two months after the operation, she is delighted with the outcome.

"I discovered the lump on my 60th birthday," says Diana, who runs a hat hire shop. "I was shocked when I was told I had cancer. You think that only happens to someone else. But if cancer is the worst word you hear, chemotherapy is definitely the second worst. I was terrified.

"But everyone at the unit was amazed, especially the breast care nurses. I could phone them at any time if I had the slightest worry and they always answered my questions and eased my fears."

During the five-hour operation, Mrs Jones removed Diana's left breast and rebuilt it by pulling tissue and muscle round from her back.

"I was delighted to be able to get it all done in one operation and I am really pleased with the result," says Diana.

"I still have a cleavage and can wear low-cut tops. The whole experience has not been bad at all.

"I did get a build-up of fluid around the scar tissue in my back at first and had to visit the clinic to have it drained off about very third day. But I coped quite well with that. There was no point sitting in a chair and feeling sorry for myself. I haven't got a nipple on my left breast and am deciding whether or not to have one."

Mr and Mrs Jones are anxious that all women should receive the best breast cancer care wherever they live.

They are involved in the Government's National Cancer Collaborative, through which specialises share expertise and knowledge. They have set up a website offering information and advice to women throughout the country and have also launched a charity, the Mid Kent Breast Cancer Research Appeal.

Mr Jones says "With the ever increasing financial demands on the NHS and increasing incidence of breast cancer, the service can always be improved. A better, quicker service requires more money than the NHS can allocate to breast cancer, which is why we need a charity."

Mid Kent Breast Cancer Research Appeal.

c/o Mrs M Rapson, Maidstone Hospital, hermitage Lane, Barming, Kent ME16 9QQ. Tel 01622 224111.