Breast Cancer Diagnosis and Treatment

By OBOS Common Medical Conditions Contributors | October 15, 2011
Last Revised on May 1, 2014

Shock, disbelief, fear, anger. All are common reactions to learning you have breast cancer. The most important thing to remember is that a diagnosis of breast cancer is usually not a medical emergency. This means that you have time to seek out opinions about the best way to proceed and to choose physicians with whom you feel comfortable. You have the right to have all of your questions answered and to understand your treatment options fully before deciding what to do.

Doing whatever your doctor suggests may be appealing, but it does not always result in the best care. Although most doctors have good intentions, they tend to offer only the treatment they know best. It’s wise to get a second opinion before committing yourself to a plan, even if you feel confident with your first doctor. This is especially true if your physician has not fully explained your surgical treatment options.

Lumpectomy and radiation therapy (also called breast-conserving therapy) when compared with mastectomy (removal of the entire breast) has the same survival rates. If your surgeon is not explaining this to you, then you should definitely seek a second opinion. While in some circumstances a mastectomy may be recommended and be better for keeping the cancer from spreading, you should fully understand why your doctor is recommending it.

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Some physicians may be slow to accept new therapies until there’s more experience with them; some may be unwilling or unable to discuss all available treatments. Some states, including Massachusetts, California and Minnesota, have laws that require patients to be informed of all medical options.

Lumpectomy and radiation therapy (also called breast-conserving therapy) when compared with mastectomy (removal of the entire breast) has the same survival rates; that is, the same percentage of women who don’t die of breast cancer. If your surgeon is not explaining this to you, then you should definitely seek a second opinion. While in some circumstances a mastectomy may be recommended and be better for keeping the cancer from spreading, you should fully understand why your doctor is recommending it. Some physicians may be slow to accept new therapies until there’s more experience with them; some may be unwilling or unable to discuss all available treatments. Some states, including Massachusetts, California, and Minnesota, have laws that require patients to be informed of all medical options.

Even though you may have a good relationship with your health care provider, if you live in a small town you should strongly consider going to the nearest large city with a research-oriented or university hospital. These institutions generally keep up with ongoing studies, use a team approach, and may be more flexible about treatment. A local women’s health center, the National Cancer Institute or the American College of Surgeons can help you find appropriate cancer centers and specialists.

Cancer centers usually have special breast cancer centers. The advantage of getting a second opinion or of being treated at a breast cancer center is that a team of specialists—medical, surgical, and radiation oncologists—will be involved with your care from the beginning. Private oncologists may not practice in teams, making coordination of your care more difficult. Certain breast cancer centers offer more treatment choices, including clinical trials testing new therapies.

If you meet income guidelines and were diagnosed under a federally funded screening program for uninsured or underinsured women, Medicaid will cover treatment for breast cancer. Some communities have local support groups for women with cancer, where you may be able to get help with transportation to medical appointments and with child care, as well as encouragement from other women who have had or are having similar experiences.

Surgery is usually recommended within six to eight weeks of the biopsy, so it’s okay to take time to adjust, ask questions, and find out about your options. In some cases, chemotherapy is used over several weeks or months to reduce the size of the tumor prior to surgery (this is called neoadjuvant chemotherapy).

When you are trying to decide about treatment, the most pressing question is likely to be “How can I maximize my chances of disease-free survival?” But you will also want to understand the long-term effects of cancer therapy. To decide on the best treatment, you also need to know the size of the tumor, whether or not there is cancer in the lymph nodes, the hormone status of your tumor (called ER/PR), and what the HER-2/ neu* status of your tumor is. (*HER-2/neu stands for “human epidermal growth factor receptor 2.” It is overexpressed in 20 to 30 percent of breast cancer tumors and is associated with more aggressive disease.) These factors are specific for each woman’s cancer, and these tumor markers can help individualize and optimize your therapy.

Most of this information is available after the biopsy, and it is used to recommend systemic therapies (endocrine/hormone therapy or chemotherapy) and/or radiation. Usually the medical oncologist is the one who discusses appropriate treatment options based on the biopsy or surgery results.

It is important to learn about all the available options. The entire field of breast cancer medicine is changing rapidly. Old, established theories and treatments are being questioned, while newer techniques have not been used long enough to be completely evaluated.

To find reliable information on breast cancer treatment as well as important current research, see:

  • Dr. Susan Love’s Breast Book and her website contain up‑to-date and credible information on breast cancer treatment.
  • The National Breast Cancer Coalition website takes an activist approach. Getting balanced information on the pros and cons of various treatment options will help with knowing what questions to ask and how best to proceed with your care.
  • What You Need To Know About Breast Cancer is an online booklet from the National Cancer Institute that covers types and stages of breast cancer, tests that may help guide treatment, and treatment options.