Breast Cancer (cont.)

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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 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 that 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 to develop cancer cells 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.

Medically Reviewed by a Doctor on 9/25/2013

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