Breast Cancer Questions To Ask The Doctor (cont.)
In this Article
How urgent is it that I make decisions and begin
treatment?
It is extremely rare that a patient must be rushed into
treatment. The biology of breast tumors is established fairly early
in their development, and by the time the tumors are detectable, most
have been growing undetected for considerably more than a year. This
means that if you take a few weeks to complete a thorough evaluation,
obtain appropriate consultations, understand the situation, discuss
the alternatives and initiate a treatment plan, it is not likely to
add any
significant risk. This time frame, however, should allow the facts
of your
case to be carefully sorted out and errors to be minimized. Your treatment team should be able to help you in this process and specifically advise you on the urgency to start certain treatments.
Are there controversies in the recommended treatments among
reputable experts?
Doctors may differ in their recommendations
if
they weigh the risks differently. There will always be
uncertainties in any given case. These issues are rarely "right
versus
wrong." They can be compared with decisions such as "how do I
balance my desire to have the largest and safest care with the need to
have convenience and economy?" There are tradeoffs. For example,
certain breast-cancer treatment options may favor cosmetic appearance
but slightly increase the risk of recurrence in the affected breast. If you have concerns, a second opinion by a different treatment team can often be helpful.
How might my treatment affect future risks and follow-up
treatment?
There are often indirect consequences of treatment decisions. For
example, breast-conservation therapy achieves, as its goal, treatment
of the breast cancer along with preservation of the breast. This is
clearly a highly desirable objective. However, in doing so, it
leaves
the possibility that cancer may recur in that breast. The risk is
small but is definitely there. Most of the time, the recurrence
will be
recognized and the new tumor treated early but not always.
These risks mean that a patient choosing breast-conservation
therapy must have the treated side (and the other breast
as well) carefully monitored with regular examinations and imaging
tests. Occasionally,
tissue
abnormalities develop which may suggest a new or recurrent cancer,
thereby
necessitating further evaluation with more tests or even another
biopsy.
The majority of these abnormalities turn out to be benign, perhaps
caused by benign breast disease or changes from the surgery and
radiation therapy. But the psychological impact of having to repeat
such an
evaluation may be very upsetting to some patients. Breast conservation is not appropriate for every breast-cancer patient or breast-cancer type.
There are similar considerations in each treatment plan which have
to be understood and carefully evaluated before committing to a
particular method of therapy. You should discuss these issues
thoroughly with your doctor.
Should genetic testing be part of the treatment decision
process?
The majority of breast cancers occur as unconnected (sporadic)
cases and
are not caused by an inherited genetic abnormality (mutation) passed
from parent to child. However, if you have close family members,
such
as
a mother or sister, who have had the disease, especially if it
occurred at a young age, then the possibility of a genetic
predisposition should be investigated. In these situations, genetic
testing may provide valuable information. The test results may
affect not only recommendations for your therapy but may also have
major
implications for other family members as well. Gene testing should
only be done after careful genetic counseling so that everyone has a
thorough understanding of the potential value and also the
limitations
of these tests.
Next: Should I stop taking hormone replacement therapy
(HRT)? »
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