Receiving a diagnosis of breast cancer is a fear shared by millions of women. It doesn't matter their age, race, ethnicity, or other factors; this is something all women have in common.
Once told these scary words, how do you go about ensuring that you are in the best medical hands to treat you and restore you to a status of breast wellness again? This question and seeking the
answer to it can more paralyzing and cause more nights of lost sleep than the actual diagnosis. Here's some guidelines to follow so you can help ensure you are in good hands:
1. Seek a comprehensive breast center that is part of an academic teaching hospital. Any body and any facility can call themselves a breast center (there are currently no regulations to dictate or
oversee who is and isn't a reputable Breast Center unfortunately.) A breast center that is an integral part of a large academic medical center however provides a strong probability that within its doors will be faculty and staff who specialize in breast cancer, see and treat large volumes of women with this disease, and can offer state of the art treatment modalities.
2. Seek a second opinion. You have the right to talk to more than one doctor or group of doctors at the same facility. Have your pathology slides and mammograms re-reviewed as part of the second opinion consultation too. Meet with a breast surgical oncologist. The first portion of your treatment will more than likely be breast surgery. It can be quite difficult for a medical oncologist to render an opinion about system treatment for you (chemotherapy and/or hormonal therapy or targeted biologic therapy) until the tumor is out and the prognostic factors from pathology are known.
3. Select a team that provides multidisciplinary approach to your breast cancer treatment. It would be rare for the only treatment you would need to be solely surgery. Having an integrated team (breast surgical oncology, medical oncology, radiation oncology, pathology, breast imaging radiology, breast reconstruction, breast genetics evaluation) provides you a higher assurance of coordination of care. The last thing you want to have to be doing right now is making sure that the various doctors involved in your treatment are communicating with one another effectively on your behalf.
4. Get the numbers. You want doctors who take care of hundreds and hundreds of women with breast cancer. The more they do, usually the better they are at doing it. Survival rates have even been shown to be higher for physicians who specialize in breast cancer and see and treat a large volume. For example, when seeing the breast surgeon, ask how many breast cancer operations he/she does a year. NOT breast biopsies. These don't count. Breast CANCER surgeries. You want someone who does at least 100 a year.
5. Look for proof of state of the art equipment and techniques. Perhaps the best example of breast reconstruction. There are a variety of ways today to rebuild a breast after mastectomy surgery. Skin sparing mastectomy is the preferred way, assuming there is no medical reason (like inflammatory breast cancer) to do this. DIEP flap and S-GAPs are more sophisticated ways to do breast reconstruction today, taking body fat from elsewhere for no muscle, reducing the recovery time, and maintaining muscle integrity. Plastic surgeons who do large volumes of breast reconstructions and are passionate about restoring a woman's silhouette should have taken the time and gotten the training to do these types of microvascular procedures. If a plastic surgeon tells you that TRAM flap is as good as DIEP flap, leave the room and don't return. TRAM flap reconstruction sacrifices your abdominal muscles and places you at high risk of hernia and bulge while limiting your lifting (for life) to no more than 20 lbs. A 4 month old grandchild weighs that much. Don't allow a decision made in haste to result in a lifetime of daily reminders that you had this disease.
6. Innovation is your new best friend. A breast center that provides you access to clinical trials is worth pursuing. There is a tendency to think of a clinical trial as experimentation. Actually, by the time a clinical trial reaches the bedside, a great deal of research has been already completed. The outcomes of women participating in breast cancer clinical trials today results in setting the new treatment options of the future. Sentinel node biopsy was born from clinical trials. In the past, the surgeon had to remove all of the axillary lymph nodes in order to determine if there was cancer that had spread from the breast to the lymphatic system. Today he/she only needs to remove one node. The sentinel node, also known as the guard node. If it is cancer free then we have faith that the rest of the nodes are free of cancer cells too. This dramatically reduces the risk of developing lymphedema in the future. Such a standard of care now available world wide was made possible by women before you participating in the sentinel node biopsy clinical trials.
If you feel like you have to take action against this disease immediately, relax. You actually have time to make good decisions and ensure you are in good hands that you feel confident handling your care. Most breast cancers that are found even at a very early stage have been growing, slowly, for several years. Take a few weeks (but not months) to select your team is very acceptable and should be encouraged. Knowing you are in good hands will give you peace of mind. For more information about breast cancer visit me at www.hopkinsbreastcenter.org