What are the most important questions to ask your breast surgeon when you are first diagnosed with breast cancer?

Expert Answers

SeanTCanaleMD (Physician - Surgery - Breast (Verified) ) - 05 / 22 / 2012

Once a diagnosis is made, the breast surgeon will sit down with the patient and discuss the diagnosis, what is known at that point, what additional information needs to be gathered, and most importantly start working with the patient to formulate a comprehensive treatment plan. This information will include the type of cancer and a clinical stage. It will also usually include the grade of the cancer and several marker results (ER, PR, Her2) although these may come back a couple of days after the initial diagnosis. Local treatment option should be covered including breast conservation (i.e. lumpectomy) and mastectomy. Basics of radiation therapy and the role this may play may be included. Other testing such as an "in breast" staging MRI and genetic testing may be discussed in pertinent cases where they will impact care. Moving from clinical staging to pathologic staging should be covered including the role of nodal staging. This may be achieved via ultrasound guided axillary node fine needle aspiration (FNA) if a suspicious node is seen on axillary ultrasound or via sentinel node biopsy. The basics of systemic therapy including cytotoxic chemotherapy, hormonal therapy, and biologic therapy may be covered as well as how staging and genomic profiling may impact systemic therapy recommendations. The final piece of the puzzle is to put together a plan and timeline including the order of anticipated therapies can be covered. If appropriate, the concept of neoadjuvant therapy can be presented as well.

Comprehensive breast cancer care today is multidisciplinary/multimodality each of which is covered by a different subspecialty. The role of the breast surgeon is the local regional specialist - performing the biopsy to make the intial diagnosis, mapping and biopsying lymph nodes as part of the staging process, and providing the major local therapy via breast conservation or a mastectomy. A medical oncologist plays the predominant role in systemic therapy (treatment of cancer cells away from the breast). The radiation oncologist's role is local/regional similar to the breast surgeon adding radiation to lumpectomy in breast conservation or when indicated after mastectomy. The breast surgeon will generally help the patient assemble this team of experts to recommend and provide the necessary comprehensive care. This team may also include a plastic surgeon for reconstruction after mastectomy.

It is important that a patient understands and is able to participate in the decisions regarding their care. The breast surgeon will make medical/technical recommendations but often there may be other impacting factors for an individual patient. Peace of mind is always huge. Similarly, it is important that the patient is comfortable with the choices they are making, that they have all the information/answers they need (particularly in the areas above), and with the doctors with whom they will be working.
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