A breast physician is a medical practitioner with special training in the diagnosis and management of breast disease. This relatively small group of specialized clinicians has a unique and constantly expanding role in multidisciplinary breast teams in Korea. The importance of the team approach is well-known and in the field of breast cancer there is evidence that patients cared for by a multidisciplinary team (MDT) rather than a series of individual practitioners have an improved survival 10 years following diagnosis [1]. National and international clinical practice guidelines [2] endorse multidisciplinary care as the preferred approach to manage breast cancer. However, few studies have looked at how these guidelines are followed by the medical community. Also, the definition of MDT varies both in the literature [3,4] and among health professionals, with no one interpretation being a perfect fit for all situations.

A recent report [3] described that surgery, chemotherapy and hormonal therapy are the most common treatment options for women, thus requiring input from a variety of breast cancer specialists during treatment planning. Care provided by an MDT is thought to offer patients the most appropriate evidence-based care as management plans are based on a broad range of expert knowledge [4]. Improvements in communication and decision-making among health professionals in coordination of care for their patients are other potential benefits. However, the outcomes of the MDT approach have not been rigorously evaluated and evidence from published empirical studies and reports on any benefit is limited [4,5].

This study aimed to assess the current workings of MDT meetings throughout Korea through surgeons' reports and their current commitments to MDT breast meetings, and to determine any perceived areas where there was potential for improvement.

A questionnaire was sent out to 307 members of The Korean Breast Cancer Society (KBCS) who worked at comprehensive or university medical centers in Korea. The mailing lists of the KBCS members were obtained with the approval of the society. From December 2008 to February 2009, the survey was distributed by surface and electronic mail, with an initial mailing followed by another distribution to non-responders eight weeks later. MDT was defined with different specialists working as teams cooperatively with each other and their patients to diagnose, treat and mange breast cancer. The questionnaire was comprised of an introductory cover letter in which the purpose of the survey was indicated; a section soliciting general information from the responder regarding gender, age, hospital volume, affiliation of the department and experience with breast cancer treatment; and the main portion that solicited MDT information including use/non-use of the approach, membership structure, schedule of meetings, contents of meetings and opinions concerning the MDT approach in the treatment of breast cancer.

Presently, the vast majority (97.4%) of breast health specialists regarded MDT meetings as an effective method for treatment planning and believed that these meetings result in substantial improvements in care for women with breast cancer. The majority of respondents who do not currently participate in MDT meetings (95.6%) regard them as valuable and necessary.

Large numbers of surgeons, oncologists, pathologists and radiation oncologists regularly attend MDT meetings in Korea. Most often, the meetings are led by a breast surgeon. Although most respondents (95%) described that follow-up involved the Department of Surgery with or without adjuvant chemotherapy, the high level of attendance for medical oncologists was particularly noteworthy given that international audits of MDT functionality consistently reveal that medical oncologists are least likely to attend the meetings, of all medical specialists [6,7]. This is not surprising, however, given that most oncologists in our sample were based in comprehensive or university cancer centers where oncology services are most commonly available.

Presently, the presence of psychologists in MDTs was limited despite clinical practice guidelines [2] highlighting the importance of psychosocial care for cancer patients and the well-documented elevated levels of psychosocial morbidity and unmet emotional and supportive care needs associated with diagnosis and treatment of breast cancer [8,9]. Also, there was a low level of participation by other support personnel such as data managers, coordinators and social workers. Psychosocial issues were not discussed in the majority of responses, yet it is not possible to tell from this data whether links to psychosocial services were in place outside of the meeting.

All newly diagnosed breast cancer patients were discussed in 45% of MDT meetings, a figure less than 60 to 94% noted in studies from the United Kingdom [6,7]. Discussion of benign cases was infrequent (8% of cases).

The schedule, content and composition of MDT meetings varied in the responding institutions. Some meetings were less likely to discuss all patients. Some meetings had a less frequent schedule or were informal, to the point of personal communication between several participants being regarded as an MDT.

The main limitation of our study was that most responders (57/66) were surgeons. So, our results could not show opinions of all MDT members. While it is acknowledged that there may be a bias in reporting of self-attendance by those completing the survey, this study was conducted with an adequate sampling strategy for a relatively large objective. This national study is the first to ascertain the involvement of breast cancer specialists in MDT treatment planning meetings in Korea. It has also provided an insight into MDT meeting structure and format.

Sometimes there is no discussion with a patient prior to the operation. This falls outside current international recommendations. There is a need for more detailed advice with regard to organization and running of MDTs to ensure that all patients with breast cancer can reap the potential benefits of having all aspects of their management discussed at appropriately staffed MDTs.

The MDT approach in breast cancer does have drawbacks that include delayed decision making, allocation of increased time and more manpower, time limitation, confusion, gain and loss among departments and difficulty in managing numerous patients. However, the addition of a breast physician to the team has advantages for all team members and for the patient. A breast physician can enhance the continuity of care and communication between team members. Working in partnership with a breast physician may be of particular benefit to the breast surgeon, allowing the surgeon to focus on newly diagnosed cancer patients and patients with benign disease who require surgery [10].

In conclusion, the majority of health professionals regard MDT meetings as an effective method for treatment planning and a relatively active MDT approach exists in most major centers in Korea. Further work is needed to ensure that MDTs function and co-operate as intended, and that all breast cancer patients have access to an MDT.