My Breast Cancer Team
It cannot be stressed enough – having a team of doctors who work together on a regular basis can have a tremendous impact on your experience and outcomes in breast cancer. Breast cancer teams are assembled for good reason. A breast cancer team meets together often to discuss women newly diagnosed and are able to formulate a treatment plan from every aspect (genetics, surgery, chemotherapy, radiation, and reconstruction). The best teams, able to provide state-of-the-art breast cancer care, are part of the National Accreditation Program for Breast Centers (NAPBC) in your community.
Primary Care Gynecology
Your primary care doctor or gynecologist is often the first person you will see. They are often the ones doing your annual breast exam and/or order your screening mammogram.
Previously surgeons were the ones to diagnose breast cancer. But with the evolution of medicine, the doctors performing and reading mammograms are now the ones to make the diagnosis. When an abnormality is found on a mammogram, the next step is often an ultrasound and a biopsy. Sometimes an MRI is needed to get additional views prior to biopsy. With one of these imaging options, a needle is inserted into the suspicious area (often with multiple passes) to obtain tissue for evaluation. Pathologists then look at the tissue samples under a microscope and determine if the breast tissue has cancer within. If cancer is found in the biopsy specimen, the radiologist is then the first to call you and give you the results whether benign or malignant.
Breast Health Navigator
Part of your breast cancer team is a person called the navigator. They are invaluable in helping women traverse the medical maze associated with cancer treatment. Your navigator will help guide you through the entire process, from diagnosis to treatment and on to survivorship. They often help coordinate all of your doctor visits, making sure you see every player on the team and that nothing goes uncovered.
At some stage you will meet with a breast surgeon, often called an oncologic surgeon. He or she will discuss with you what your biopsy results mean and what surgical options are available to you. Discussions will include lumpectomy versus mastectomy and the timing of surgery, either before or after other modalities like chemotherapy. All of your questions about what to expect with each type of surgery, the risk of recurrence and contralateral disease, and what your results should look like will all be covered in your consultation with your general surgeon. They are often the ones to recommend a reconstructive surgery consultation and can guide you with referrals.
As an important part of your breast cancer team, your reconstructive surgeon’s role is to educate you on the options available to make you as a whole as possible and to look as good as possible. Almost every woman has options to help lessen the deformities after breast cancer treatment. For lumpectomies, often a breast lift or reduction is possible to lessen the effects of the radiation you will have after lumpectomy. For mastectomy, there are options to build your new breasts with the use of implants, your own tissue, or a combination of both. Options for reconstruction often can be performed at the time of your cancer removal, but sometimes must be done after other treatments like chemotherapy or radiation therapy have been completed. Even after cancer has been treated, and no reconstruction was done initially, there are often options to improve your symmetry or appearance.
As part of your breast cancer team, these doctors are the ones who will make recommendations with regards to chemotherapy. There are many forms of chemotherapy now, and consultation will inform you as to what types will address your cancer, what the benefits and risks of those chemotherapies will be, and at what time and for how long these therapies should be continued. Medical oncologists will evaluate your body for the spread of cancer with CT scans or PET scans, and will also monitor you for years after your cancer has been treated.
In some cases, when cancer is aggressive and large or when it involves lymph nodes, radiation may be necessary. Your radiation oncologist will explain why radiation is necessary, the benefits and risks of radiation in general, and what to expect during and after treatments.
Research has proven that breast cancer has a genetic component in some cases. We now have genetic markers that can be tested for and their results can help guide women in making educated decisions regarding their breasts, ovaries and uterus, and the potential risks for future cancer. The geneticist will gather lots of information regarding your family history and order tests necessary to evaluate the potential for any future cancer.
Cancer Support Community
As an important part of your breast cancer team, fellow breast cancer patients are the greatest resources for each other. There are groups who gather in your area to talk about any and all sorts of issues related to breast cancer and its treatments. Most women find these groups a useful place to get information and also of tremendous emotional support. Often your navigator will have a list of these groups and their meeting times and locations. Find one in your area!