Jana de Boniface

Jana de Boniface

Affiliated to Research | Adjunct Professor | Docent
Visiting address: Elite Hotell, plan 2, Eugeniavägen 6, 17164 Solna
Postal address: K1 Molekylär medicin och kirurgi, K1 MMK Bröstkirurgi, 171 76 Stockholm
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About me

  • I am a general surgeon trained in Berlin and Västerås, today specialising
    in oncoplastic breast surgery. The seat of my clinical activities is Capio St
    Göran's Hospital, one of the three large Breast Centers in Stockholm.
    Born in Giessen, Germany, I moved to Humboldt University in Berlin after
    school and studied medicine as well as violin (Universität der Künste)
    until receiving my graduations in 1996 and 1999. I did my doctoral thesis on
    viral hepatitis C and psychological side effects of Ribavirin and interferon
    treatment and later continued with a PhD thesis on sentinel node biopsy in
    breast cancer at Uppsala University.

Research

  • My research, through a position as senior researcher at Karolinska Institutet,
    is focussed on two main clinical areas: axillary surgery and oncoplastic breast surgery.
    In addition, we have recently started a randomized trial within exercise oncology.

    Axillary surgery in breast cancer has undergone an enormous development since the 1990s.
    While we always performed an axillary clearance before that time, removing at least 10 lymph
    nodes from the armpit regardless of whether they were tumor-bearing or not, we today get more
    and more restrictive about the extent of axillary surgery. The reason for that if of course mainly
    the known risk of lymph edema, affecting about 20-25% of women after axillary clearance,
    and the fact that breast cancer is diagnosed earlier today, making is less likely that extensive
    axillary surgery contributes to any survival benefit at all.

    In the 1990s, the sentinel node biopsy was introduced, identifying the first lymph node/s
    draining the breast and representing the remaining axillary nodes.
    It is established today that no axillary clearance needs to be performed in case of
    a negative sentinel node. There are, however, additional data questioning the
    benefit of further axillary surgery even in the event of a tumor deposit (metastasis)
    in the sentinel node. We therefore started a large randomised trial, the SENOMAC Trial
    (www.senomac.se [1]) analysing the effect of the omission of axillary clearance in this situation

  • the first results have been presented in San Antonio in December 2023 and the
    publication on recurrence-free survival is in press.

    The next step of reducing axillary treatment is the randomized T-REX trial
    testing to reduce radiotherapy to the armpit, and the AXSANA study assessing how
    much axillary surgery we need to perform after preoperative chemotherapy.

    Oncoplastic surgery is the use of plastic surgical methods in order to make breast
    cancer surgery less mutilating, maintaining the same safety
    that conventional methods provide. While I actively promote the knowledge
    and use of oncoplastic techniques through training courses and certification
    processes, the issues of oncological safety and quality of life are the focus
    of my oncoplastic research. Thereby I try to support the safe use of volume
    displacement methods as well as reconstructive options, but am also involved
    in analyses on the reasons for regional differences and the patient-reported
    outcomes after such surgery, especially in patients irradiated after
    implant-based reconstruction.

Teaching

  • Teaching oncoplastic breast surgery is a passion of mine as I believe that we
    can thereby provide tailored surgery to breast cancer patients. The complex
    assessment of tumor, stage, planned treatment, together with patient factors
    such as own desires and priorities, expectations, body shape and comorbidites
    is fascinating. To disseminate "oncoplastic thinking" and craftsmanship, I
    lead the annual national oncoplastic course in Sweden and have recently
    joined the Oncoplastic Breast Consortium (https://www.oncoplasticbc.org/
    [1]).
    [1] https://www.oncoplasticbc.org/

Articles

All other publications

Grants

Employments

  • Adjunct Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 2024-2028
  • Affiliated to Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 2023-2026

Degrees and Education

  • Docent, Karolinska Institutet, 2014

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