Being diagnosed with breast cancer is incredibly scary and stressful, regardless of the prognosis.
For those receiving the news, it’s a challenging, overwhelming time, says Dr. Taiwo Adesoye, 38, a breast surgical oncologist and assistant professor of breast medical oncology at the University of Texas MD Anderson Cancer Center.
dr. Adesoye says patients should focus on the positive first: You’ll be surrounded by a whole team to help and support you on this journey.
“It is important for patients to understand that they are not alone,” says Dr. Adesoye. “They have their entire treatment team to rely on.”
dr. Maggie DiNome, chief of breast surgery at Duke University Hospital, echoes Dr. Adesoye and points out that “the outlook is really very positive” for most breast cancer patients.
“We’ve come so far in breast cancer treatment,” she says. “We have excellent cure rates for most women with breast cancer. Most cancers are curable, especially when caught in the early stages. Things are only going to get better in the future. I tell patients that they should hope that they’re going to be OK – and when they’re done with this , we expect them to be able to return to their normal lives.”
But even knowing all that, those first few days will be disorienting and you’ll need a guide to help you make the most of your first appointment. PEOPLE spoke with experts across the country to ask, “What are the top 5 questions you should ask your doctor when you’re diagnosed with breast cancer?”
Write them down before you meet with your oncologist, advises Dr. Adesoye: “You think you’re going to remember, and you sit down and kind of forget everything.”
Having these questions at hand can help you on your road to recovery.
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What type of breast cancer do I have – and what stage is it?
“Breast cancer is not one disease,” says Dr. Amy Comander, 49, a breast oncologist, medical director, Mass General Cancer Center in Waltham, also director of Breast Oncology and Survivorship, Mass General Cancer Center in Waltham and Newton Wellesley. “There are many different subspecies.”
Because there are different types of cancer and different types of treatment, your treatment will be tailored to your cancer.
“This may explain why your treatment is different from your friend Susie’s,” explains Dr. Adesoye.
Breast cancer can be classified as invasive or non-invasive. Non-invasive breast cancer, explains Dr. Adeosye, means that the cancer cells are confined to the milk ducts and have not spread to the surrounding tissue. Invasive breast cancer means that the cells have started to spread to the surrounding breast tissue.
Ask your doctor: Is your cancer localized or metastatic? (Localized means confined to the breast or lymph nodes in the pit under the arm, while metastatic means it has started to spread to other parts of the body.)
Also ask what stage your cancer is in, to help determine treatment options, Dr. Comander says; stage 3 cancer has a much higher risk of recurrence than stage 1 cancer.
What treatment will I need?
Will you need surgery? Will you need radiation? Will you need chemotherapy? Or a combination? And in which order?
dr. Comander explains to patients that it has a multidisciplinary approach to breast cancer treatment.
“This can include surgery, chemotherapy, radiation therapy, hormone therapy, targeted therapies. There are many different treatments that can be used to treat breast cancer with the goal of curing breast cancer,” says Dr. Comander.
Experts say you will likely need surgery if you are diagnosed with breast cancer.
“Breast surgery is almost universal for any patient who has breast cancer—unless it has spread to other parts of the body,” explains Dr. Adesoye.
Surgery can mean either a lumpectomy (where part of the breast tissue is removed along with a very small amount of healthy surrounding tissue) or a mastectomy (which removes the entire breast tissue).
“Most patients do well with either approach,” says Dr. Adesoye.
Your doctor may also suggest that you start chemotherapy before surgery or continue with radiation after – all depending on the type of cancer you have.
After discussing your treatment plan, Dr. Comander suggests asking yourself, “Why do I need this treatment? What is my risk of relapse? And how will these treatments reduce my risk?”
Also be sure to talk to your doctor about the short- and long-term side effects of different treatment options, says Dr. Comander.
Picture of a doctor and a patient with breast cancer. Getty
Should I go for genetic testing?
Genetic testing can also help choose the treatment you should receive, says Dr. Adesoye: “It helps us decide whether an individual has a higher risk of developing different types of cancer.”
For example, if you have a genetic mutation, your doctor may recommend removing both breasts to reduce your risk of developing breast cancer in the future. (These mutations may also indicate that you have a higher risk of colon cancer and should start screening earlier, or that you have a higher risk of ovarian cancer and should consider an ovarian transplant.)
In addition, some genetic mutations make people respond better to certain treatments, says Dr. Adesoye.
Plus, it’s good information for your relatives, adds Dr. Adesoye: “It can give people information they can share with their family members, so they can understand their own breast cancer risk.”
If you do not have a particular mutation, it is also useful information for your doctors and children, who will be asked about family history at the doctor’s office.
Is there a clinical trial?
Ask your doctor if there is a clinical trial that is relevant to your cancer.
“Everything we know about breast cancer has been learned through these rigorous clinical trials, and it has shaped our approach to treatment and helped us deliver the right treatment to the right patient at the right time,” says Dr. Adesoye. “It’s a personal decision, but I always encourage patients to ask questions if something isn’t clear about a clinical trial they’re presented with and help them decide if it’s the right step for them.”
Participating in a clinical trial can not only help your own treatment, it can help improve the treatment of other women.
“All of our advances in cancer treatment are the result of testing,” says Dr. Comander. “These are research studies that help us identify new approaches, new approaches for radiation treatment, new approaches for chemotherapy, hormone therapy, all the other treatments to recommend. Many patients really benefit from being tested, obviously to help themselves, but also to help the next group of women who come through.”
What can I do to reduce the risk of this cancer coming back?
When you’re diagnosed with breast cancer and faced with a ton of decisions, many patients feel like many things are out of their control, says Dr. DiNome.
So at the end of the first appointments, Dr. DiNome likes to put patients back in control and discuss ways to reduce risk in the future.
Although “for breast cancer, we don’t have a silver bullet like we do for lung cancer: If you stop smoking, you’ll lower your risk,” says Dr. DiNome, but there are things people can strive for, such as maintaining a healthy weight.
Many types of breast cancer are triggered by estrogen, and fat cells have enzymes that make estrogen, Dr. DiNome explains. “When you are overweight and have excess body fat, you produce more estrogen. And estrogen is the culprit that makes breast cells grow, multiply, divide and replicate.”
He also recommends reducing the amount of alcohol you drink, as alcohol can increase the production of estrogen in fat cells. (“We’re not necessarily saying you have to be completely abstinent,” she says, recommending three to five glasses a week, rather than every day.)
Exercise has also been shown to be beneficial, as have dietary changes such as cutting down on red meat, eating less artificial sugars and cutting down on refined sugar, focusing instead on fresh fruit and vegetables.
“It’s important to give patients goals and things they can do to try to be proactive and I think they’ll get their life back on track after treatment ends,” she says.
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Source: HIS Education