Just Got a Breast Cancer Diagnosis? Here Are 5 Questions to Ask Your Doctor
It can be difficult to know where to start when you're facing challenging health news — but this list will prepare you for your next conversation
Being diagnosed with breast cancer is incredibly scary and stressful, no matter the prognosis.
For those who receive the news, it's a challenging, overwhelming time, says Dr. Taiwo Adesoye, 38, a breast surgical oncologist and assistant professor of breast medical oncology at The University of Texas MD Anderson Cancer Center.
Dr. Adesoye says patients should first focus on the positive: You will be surrounded by an entire team who will help you and support you on this journey.
“It’s important for patients to understand that they’re not alone,” Dr. Adesoye says. “They have their entire treatment team to lean on.”
Dr. Maggie DiNome, Chief of Breast Surgery at Duke University Hospital, echoes Dr. Adesoye and points out that "the outlook really is very positive" for most breast cancer patients.
“We've come so far in terms of treating breast cancer,” she says. "We have excellent cure rates for the majority of women with breast cancer. Most cancers are curable, especially when they’re found at early stages. Things are only going to get better in the future. I tell patients they should be very hopeful that they’re going to be fine — and that when they’re done with this we have every expectation that they’re going to be able to get back into resuming their normal lives."
But even knowing all that, those first few days will be disorienting and you'll want a guide to help you make the most out of your first appointment. PEOPLE spoke to experts across the country to ask, "What are the top 5 questions you should ask your doctor when you have received a breast cancer diagnosis?"
Write them down before you meet with your oncologist, advises Dr. Adesoye: "You think you’re going to remember, and you sit there and you sort of forget everything."
Having these questions handy can help as you face your road to recovery.
Related: Stars Who Have Had Breast Cancer and Shared Their Stories
What type of breast cancer do I have – and what stage is it?
“Breast cancer is not one disease,” says Dr. Amy Comander, 49-year-old breast oncologist Medical Director, Mass General Cancer Center in Waltham, also Director of Breast Oncology and Survivorship, Mass General Cancer Center in Waltham and at Newton Wellesley. “There are many different subtypes.”
Since there are different types of cancer and different types of treatment, your treatment will be custom-tailored to your cancer.
“That can explain why your treatment is different from your friend Susie’s treatment,” says Dr. Adesoye explains.
Breast cancer can be classified as either invasive or non-invasive. Non-invasive breast cancer, Dr. Adeosye explains, means that the cancer cells are confined to the milk ducts and haven’t spread to surrounding tissue. Invasive breast cancer means the cells have started to spread to surrounding tissue in the breast.
Ask your doctor: Is your cancer localized or metastatic? (Localized means confined to the breast or the lymph nodes in the arm pit, whereas metastatic means that it has begun to spread to other parts of the body.)
Also ask what stage your cancer is, to help determine treatment options, Dr. Comander says; a stage 3 cancer has a much higher risk of recurrence than a stage 1 cancer.
What kind of treatment will I need?
Will you need surgery? Will you need radiation? Will you need chemotherapy? Or a combination? And in what order?
Dr. Comander explains to patients that she takes a multidisciplinary approach to breast cancer treatment.
“That may involve surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapies. There's many different treatments that may be used to treat a breast cancer with the goal to cure the breast cancer,” Dr. Comander says.
Experts say you likely will need surgery if you are diagnosed with breast cancer.
“Breast surgery is almost universal to any patient who has breast cancer – unless it’s spread to other parts of their body,” Dr. Adesoye explains.
Surgery could mean either a lumpectomy (where a portion of the breast tissue is removed along with a very small amount of the healthy surrounding tissue) or a mastectomy (which removes all the breast tissue).
“Most patients do well with either approach,” Dr. Adesoye says.
Your doctor also might suggest you start chemotherapy before surgery, or pursue radiation after — all depending on the type of cancer you have.
Once you discuss your treatment plan, Dr. Comander suggests asking: “Why do I need this treatment? What is my risk of recurrence? And how are these treatments going to reduce my risk?"
Also be sure to talk to your physician about the short-term and long-term side effects of the different treatment options, Dr. Comander says.
Should I get genetic testing?
Genetic testing can also help guide what treatment you should get, says Dr. Adesoye: “It helps us decide if an individual has a higher risk of developing different cancers."
For example, if you have a genetic mutation, a doctor may recommend removing both breasts to reduce the risk of developing future breast cancer. (These mutations might also show that you're at higher risk for colon cancer and should start screenings earlier, or that you're at a higher risk for ovarian cancer so you should consider moving your ovaries.)
Plus, some genetic mutations make people respond better to certain treatments, Dr. Adesoye says.
Additionally, it's good information for your relatives, Dr. Adesoye adds: “It can give people information to share with their family members, so they can understand their own risk for breast cancer.”
If you do not have a specific mutation, that's also useful information for your doctors and children, who will be asked about family medical history at their doctor's.
Is there a clinical trial?
Ask your doctor if there is a clinical trial that is relevant to your cancer.
“Everything we know about breast cancer, we have learned it through these rigorous clinical trials, and it's shaped our treatment approach and helped us to deliver the right treatment to the right patient at the right time,” Dr. Adesoye says. “It is a personal decision, but I always encourage patients to ask questions if something is not clear about a clinical trial that they're presented with, and to help them decide if it is the right step for them.”
Participating in a clinical trial can not only help your own treatment, but can help improve treatment for other women.
“All of our advances in cancer treatment are because of trials," Dr. Comander says. "These are research studies that help us identify new approaches, new approaches for radiation treatment, new approaches for chemotherapy, hormonal therapy, all the other treatments we recommend. Many patients really derive benefit from being on a trial, obviously to help themselves, but also to help the next group of women coming through."
What can I do to reduce my risk of this cancer coming back?
When you’re diagnosed with breast cancer and facing a ton of decisions, many patients feel like a lot of things are out of their control, says Dr. DiNome.
So at the end of initial meetings, Dr. DiNome likes to give patients back the control and talk about ways to reduce risk in the future.
Ever though "for breast cancer, we don’t have a silver bullet, like we do for lung cancer: You stop smoking, you’re going to reduce your risk,” Dr. DiNome says, there are things people can strive for, such as maintaining a healthy body weight.
Many breast cancers are estrogen driven and fat cells have enzymes which make estrogen, Dr. DiNome explains. “When you have more weight on you, and you have excess body fat, you are making more estrogen. And estrogen is the culprit that drives breast cells to grow, multiply, divide and replicate.”
She also recommends decreasing the amount of alcohol you drink, because alcohol can increase estrogen production by fat cells. (“We don’t necessarily say you have to be completely abstinent,” she says, recommending three to five glasses a week, instead of every day.)
Exercise has also been shown to be beneficial, as has dietary changes like cutting back on red meat, eating less artificial sugars and cutting back on refined sugar, focusing instead on fresh fruits and vegetables.
“It's important to kind of give patients goals and things that they can do to try to be proactive and I think get their life back on track again after treatment is over,” she says.
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