Next Steps

If polyps are found during the colonoscopy, the specialist would have removed and sent it for microscopic examination - biopsy.

If the biopsy shows that the polyp

1. is cancerous- you may need surgery to remove the portion of the colon where the polyp was removed.
2. is precancerous - (all variety of adenomas) - you will need a periodic colonoscopy at a a regular interval depending on the number of other risk factors you may have -such as family history of colon cancer, number & size polyps you had & how "bad" the precancerous polyps were on biopsies.
3. Hyperplastic- usually of no concern. However, this subject has become a debate point lately & some scientists do believe that these polyps too may be a sign that you are at a risk of developing precancerous polyps later on.

There are other rare types too but that subject is beyond the discussion in this forum. If polyps are found during the colonoscopy, the specialist would have removed and sent it for microscopic examination - biopsy.

If the biopsy shows that the polyp

1. is cancerous- you may need surgery to remove the portion of the colon where the polyp was removed.
2. is precancerous - (all variety of adenomas) - you will need a periodic colonoscopy at a a regular interval depending on the number of other risk factors you may have -such as family history of colon cancer, number & size polyps you had & how "bad" the precancerous polyps were on biopsies.
3. Hyperplastic- usually of no concern. However, this subject has become a debate point lately & some scientists do believe that these polyps too may be a sign that you are at a risk of developing precancerous polyps later on.

There are other rare types too but that subject is beyond the discussion in this forum.

One can think of the answer to this question in terms of heightened surveillance, chemoprevention and intervention such as prophylactic surgery. Surveillance: annual mammography, breast exam by a health care provider every 6 months, and annual breast MRI. The American Cancer Society recommends annual MRI for patients with a lifetime risk of breast cancer of 20% or greater. Various models exist to calculate lifetime risk, the most commonly used being the modified Gail model. Often I will recommend staggering the mammogram and MRI so that breast imaging is done every 6 months. The very least one would do for a high risk patient is increase surveillance.
Chemoprevention: NSABP P-01 compared tamoxifen to placebo for risk reduction in women with a 5 year risk of breast cancer of 1.67% or greater. Women 35 years of age and older were enrolled. This study included both pre- and post-menopausal women. There were 50% fewer cancers in the tamoxifen arm. NSABP P-02 (STAR) trial compared tamoxifen to raloxifene (Evista) in high risk post-menopausal women 35 years of age and older. Risk of invasive breast cancer was reduced equally well by tamoxifen and raloxifene, although tamoxifen also reduced the number of non-invasive (in situ) cancers. Evista had a better safety profile, with fewer DVTs and pulmonary emboli in the Evista arm. In the June 23rd 2011 NEJM results were published for the use of exemestane (Aromasin) for breast cancer prevention in post-menopausal women 35 years of age and older, with a 5 year risk of breast cancer greater than 1.66%, N Engl J Med 2011; 364:2381-2391. With a median follow up of 3 years, risk reduction was 65% in women taking Aromasin.
Prophylactic mastectomy: The study from the Mayo Clinic by Hartmann and others N Engl J Med. 1999 Jan 14;340(2):77-84, showed the risk reduction associated with prophylactic mastectomy to be at least 90%. Breast cancer surgical techniques are always in evolution. Skin-sparing mastectomy is well-established; nipple-sparing mastectomy is an option for appropriate candidates.
These options are discussed with high risk patients. Which option is chosen will likely depend on why you are at high risk, atypia on a biopsy versus carrying a deleterious mutation of BRCA 1 or 2. One can think of the answer to this question in terms of heightened surveillance, chemoprevention and intervention such as prophylactic surgery. Surveillance: annual mammography, breast exam by a health care provider every 6 months, and annual breast MRI. The American Cancer Society recommends annual MRI for patients with a lifetime risk of breast cancer of 20% or greater. Various models exist to calculate lifetime risk, the most commonly used being the modified Gail model. Often I will recommend staggering the mammogram and MRI so that breast imaging is done every 6 months. The very least one would do for a high risk patient is increase surveillance.
Chemoprevention: NSABP P-01 compared tamoxifen to placebo for risk reduction in women with a 5 year risk of breast cancer of 1.67% or greater. Women 35 years of age and older were enrolled. This study included both pre- and post-menopausal women. There were 50% fewer cancers in the tamoxifen arm. NSABP P-02 (STAR) trial compared tamoxifen to raloxifene (Evista) in high risk post-menopausal women 35 years of age and older. Risk of invasive breast cancer was reduced equally well by tamoxifen and raloxifene, although tamoxifen also reduced the number of non-invasive (in situ) cancers. Evista had a better safety profile, with fewer DVTs and pulmonary emboli in the Evista arm. In the June 23rd 2011 NEJM results were published for the use of exemestane (Aromasin) for breast cancer prevention in post-menopausal women 35 years of age and older, with a 5 year risk of breast cancer greater than 1.66%, N Engl J Med 2011; 364:2381-2391. With a median follow up of 3 years, risk reduction was 65% in women taking Aromasin.
Prophylactic mastectomy: The study from the Mayo Clinic by Hartmann and others N Engl J Med. 1999 Jan 14;340(2):77-84, showed the risk reduction associated with prophylactic mastectomy to be at least 90%. Breast cancer surgical techniques are always in evolution. Skin-sparing mastectomy is well-established; nipple-sparing mastectomy is an option for appropriate candidates.
These options are discussed with high risk patients. Which option is chosen will likely depend on why you are at high risk, atypia on a biopsy versus carrying a deleterious mutation of BRCA 1 or 2.

First, you need to slow down by using deep breathing techniques, buy some meditation tapes and get a journal to keep track of your feelings and what you are going through.
That being said, there are number if factors that will determine what your treatment options are, for example:
What stage _____ are you; What grade _____ are you? Have you had your biopsy yet and, if so, did you have clear margins, were any lymph nodes involved, etc. If you need a list of questions to ask your oncologist, please e-mail me and I will send you a list.
I am a two time cancer survivor and a Certified Professional Cancer Coach, just like Elyn. I also work with cancer patients with the goal to get them through this journey and come out the other side thriving and surviving.
Susan Mayer-McHugh
susan@helpyouhealcoaching.com


This is such a complex question, and there is no one answer. An excellent resource is http://ww5.komen.org/. The first link on the top of the page is "Understanding Breast Cancer." There are several choices in the drop-down menu, including Questions to Ask Your Doctor. That is divided into sections every step of the way.

Ask your doctor if there is a "Breast Cancer Navigator" or a "Peer Navigator Program" at your hospital, or call the local cancer center. You can also Google "Peer Navigator Program" to find one near you. There are women there who can help guide you through each step and provide resources to help you sift through the decisions you will face.

As you go to your upcoming medical and testing visits, it's helpful to take a list of questions, a notebook to write answers, as well as a supportive friend, spouse or family member with you as a second set of ears.

If there is just one piece of advice I can give you, it is to always have an advocate with you at appointments...a spouse, friend, relative or a coach. When faced with a cancer dianosis even the most brilliant and medically knowledgable person can become overwhelmed with the information given.
Today cancer patients have many options. It is critical that you find the best treatment plan and team for you and your cancer. I have written a few blogs on this and if you can, please view:
http://elynjacobs.blogspot.com/2011/05/empowerment-is-key-to-successful.html
http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html The first thing that needs to happen is a series of tests and analyses, and potentially biopsy and surgery to learn more about the breast cancer. Breast cancer is different for everyone, and as much information as possible must be gathered in order to determine treatment options. These tests likely will take a week or two to perform and analyze the results. In the meantime, do whatever works for you to relax and not worry, whether that is pampering yourself, taking a trip, exercising, shopping, etc.

When you receive the results of the tests, make sure that you have copies of all your medical records (mammograms, test results and pathology slides, etc.) so you can have them for future consultations and appointments. You can get this information at any time, all you need to do is ask for it.

It is also recommended that you get a second opinion, or even a third or fourth, to help you feel more comfortable with your options. This will also help you to begin selecting your medical team. You will get a feel for the physicians that are the best fit for you and that will listen and spend time with you.

After you evaluate the test results and discuss your options with your medical team, the next step will be to decide on your treatment plan. The good news is that there will more than likely be quite a few options to choose from. There will be a lot of information to understand. The medical team and your personal support team will be helpful during this process. Make sure to ask a lot of questions.

Your course of action and options first and foremost depend on whether you have been diagnosed with breast cancer or not. When you had the BRCA screening your physician or genetic counselor should have explained the implications of having a BRCA mutation. It's best to discuss this complicated question with a health professional so I'd advise you to set up an appointment with somebody who can explain BRCA mutation risks and recommended courses of action based on your situation. Your course of action and options first and foremost depend on whether you have been diagnosed with breast cancer or not. When you had the BRCA screening your physician or genetic counselor should have explained the implications of having a BRCA mutation. It's best to discuss this complicated question with a health professional so I'd advise you to set up an appointment with somebody who can explain BRCA mutation risks and recommended courses of action based on your situation.