Entering the world of breast cancer treatment can be confusing, scary, and overwhelming. The first thing you need to know is that the type of treatment you will need is determined by your diagnosis. This means it is important to understand what your doctors have found.
To do this, you will need to ask your doctor for a copy of the pathology report from your needle/core biopsy, lumpectomy, or mastectomy for your records. If the doctor doesn’t give it to you, call the pathology department in the hospital where you had the procedure and ask for a copy.
With this information in hand, you will be able to understand your full range of treatment options.
Targeting Cancer Cells & Their Environment
Treatment for breast cancer involves removing cells, killing cells and controlling cells by changing their neighborhood or environment.
- Surgery removes all the cells, good and bad, from a defined location. This changes the environment by causing the inflammatory reaction needed to heal.
- Radiation therapy kills whatever dividing healthy and malignant cells are in its path. It takes advantage of the fact that most healthy cells are usually capable of recovering from the damage of radiation and/or grow back, leaving the irradiated breast intact. Like surgery, it changes the environment by causing the inflammatory reaction needed to heal.
- Chemotherapy kills cancer cells in many different ways, among them by causing fatal mutations in the cell’s DNA. In general, the effects of chemotherapy are quite similar to those of radiation therapy, both interfere with the cancer cell’s growth.
- Hormone therapy, whether it is tamoxifen, an aromatase inhibitor, or even ovarian ablation (removing or blocking the ovaries) targets specific cancer cells, altering cell functions needed for survival and/or cell growth. At the same time, it also changes the environment. Thus it causes a different hormonal milieu in the whole body, including the breast and the neighborhood directly around the tumor.
- Targeted therapies alter one of several key processes necessary for the cancer cell’s growth and/or survival and probably changes the environment in ways not yet fully understood.
- Immunotherapy changes the response of the body’s defense systems by removing the block some cancers have put on them, much like removing a roadblock to allow first responders through. This lets the immune system attack the cancer or make the neighborhood less conducive to its growth.
- Complementary and lifestyle approaches, like stress reduction, weight loss, or increased physical activity have been shown to help reduce the risk of recurrence. This may be because they change the environment of the body, reduce inflammation, and thus help keep cancer cells in a more dormant state.
It Takes a Team
Once you have received a diagnosis, it is important to assemble a team. The place you are being treated may have pre-existing multidisciplinary teams with all specialists represented. Or, you may need to assemble your own team. In the past, your surgeon gave you your diagnosis and then chose an intervention (lumpectomy, mastectomy, and so on) to prevent breast cancer from recurring. After that, you were passed on to a radiation therapist and then an oncologist for some chemotherapy. Now this sequence has been reversed. Often the first step is chemotherapy or hormone therapy, followed by surgery, and ending with radiation. As a result, depending on the kind of tumor you have and whether you have chosen to participate in a clinical trial, you may receive chemotherapy, hormone therapy, and/or targeted therapy first.
Treatment choices are based on three primary decisions.
- What are you going to do to treat any cancer cells that may already be in the rest of your body? Systemic therapies—chemotherapy, hormone therapy, and targeted therapies—are used for this purpose.
- How are you going to treat what we call the local area, which is the breast and lymph nodes under your arm? Choices for this are usually combinations of local therapies including surgery and radiation.
- How are you going to prevent the cancer from coming back? Your options here usually involve lifestyle changes such as losing weight, exercising, and reducing stress.
None of these are simple, cut-and-dry decisions. While this can be intimidating, it is important to remember you are the patient and have to make the choices that work the best for you, not your doctor or team. There is no right or wrong answer. This is why it often can be a good idea to get a second opinion.
It’s always wise to consider getting a second opinion, no matter how much you trust the advice of your surgeon or oncologist. The preference for a treatment is always somewhat subjective, and you’re entitled to consult with more than one expert. Furthermore, special kinds of cancer may require different approaches than your doctor’s, and different institutions may be involved in different research with new treatments that may be appropriate for you.
Several breast centers in the country have multidisciplinary programs, in which you can meet with all the specialists involved in your care at the same place. There are also the NCI Comprehensive Cancer Centers. In most of them you can self-refer—you don’t have to be referred by a doctor.
If looking to a multidisciplinary program for a second opinion doesn’t sound optimal for you, look for a breast cancer expert who is knowledgeable in the field . Breast surgeons and medical oncologists specializing in breast cancer are more likely to be able to talk to you about chemotherapy and radiation therapy than a general surgeon.
And don’t be afraid of hurting your original doctor’s feelings. Most doctors welcome another point of view—and if yours doesn’t, you should probably be looking for another doctor anyway.