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Navigating Breast Cancer Treatments

New patients often face a confusing series of decisions. Here’s how to map the route to recovery.

En español | About 550 American women are diagnosed with breast cancer every day, a figure that has not changed in the past five years. What has changed is the knowledge that at least five or six different kinds of breast cancer exist, according to Dr. Susan Love, a breast surgeon at the University of California, Los Angeles, and author of the updated fifth edition of Dr. Susan Love’s Breast Book.

"It's become enormously complicated for the woman who's trying to navigate the decisions," Love says. "You have to match the treatment with the tumor." Still, that is no reason for women to throw up their hands and leave the decision making to their doctors.

"Take a deep breath," says Love. "This is not an emergency. You have time to sort things out." 

Many of the choices a breast cancer patient makes will change her survival odds very little, if at all. For the most part, women can base their decisions on things such as which treatment best fits their lives, inclinations and close relationships. So if you have been recently diagnosed, where do you start?

Define your cancer

First, a woman needs to “parse out” from the pathology report and with her doctor what kind of cancer she has. One key question is whether the cancer is invasive (i.e., on the move) or noninvasive. Some in situ, or noninvasive, cancers are not immediately life-threatening, although all need treatment because they can develop into invasive cancers. If your cancer is invasive, another key question is whether it has already spread beyond the breast.
 
Gathering even this basic information can be confusing and overwhelming, however. "Take a tape recorder to every visit with your doctor," Love says. "You'll be able to relax and not have to work so hard to understand and remember everything."

Recent reports have shown that diagnosing very early stages of breast cancer is not always easy, with the result that some women have undergone surgery for a cancer they never had in the first place. Make sure your pathologist — the doctor who will be looking at your breast tissue under the microscope — is experienced in diagnosing breast cancer. If you live in a small town, you may want to send your tissue slides to a big hospital with a lot of staff expertise in diagnosing and treating breast cancers. Even if your pathologist has a lot of experience, don’t be afraid to get a second opinion.

With very young women or those with a significant family history of the disease, cancer doctors are likely to consider a blood test for the breast cancer genes BRCA1 and BRCA2. “We like to incorporate this assessment at the time of diagnosis, because if the patient is found to have a mutation in the BRCA1 or BRCA2 gene, it might impact … choice of treatment,” says Dr. Banu Arun, co-medical director of the Clinical Cancer Genetics Program at the MD Anderson Cancer Center at the University of Texas in Houston.

Once your health team has defined your cancer, your two top questions will become:

  • How will I get rid of it?
  • How will I prevent it from coming back?

 

Although much has changed in recent years in terms of our understanding of breast cancers, the answers still involve some form of surgery, usually in combination with radiation and/or drugs, including hormone therapy, immune therapy and chemotherapy.

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