Diagnosed with Breast Cancer

If you have been diagnosed with breast cancer, you are not alone. Nearly 200,000 American women are diagnosed with breast cancer annually. The most important thing for you to remember is that it is NOT a hopeless condition. Thanks to the medical advances over the past 30 years, today's breast cancer survival rates can be as high as 98%!  Early detection and modern therapy with a combination of surgery, radiation, drugs, or hormones can help many patients.

Ultimately, your long-term survival depends on you taking an active role in your treatment strategy. As an active participant in your care, it is important that you:

  • Know your medical team
  • Understand your diagnosis
  • Understand what your insurance will and will not cover

Know Your Medical Team

The doctor who diagnosed your cancer will be one of many medical professionals that will become part of your team. Your oncologist is the member of your team that organizes your treatment plan. He or she may work with an oncology nurse who helps you manage treatment side effects, gives more information about the treatment you will be receiving, and schedules your next diagnostic procedure. It’s important that you know the role of each member of your medical team. Other medical professionals and a description of their roles are listed below:

Medical Oncologists - Provide chemotherapy and other non-radiation and non-surgical treatments. Medical oncologists often serve as the coordinating physician for adults with cancer.

Radiation Oncologists - Specialize in treating cancer by destroying cancer cells with radiation therapies such as x-rays, electrons and gamma rays.

Pathologists - Exam tissues and cells under the microscope in order to arrive at a diagnosis. A pathological diagnosis is the gold standard that indicates the presence or absence of cancer, the type of cancer, and its classification.

Surgeons - Perform surgical biopsies, tumor removal (mastectomy and lumpectomy) and reconstructive surgeries. Although there is no board certification specifically for breast cancer surgery, the surgeon performing these procedures should be board certified in general surgery. That certification indicates that he or she has the basic skills needed to perform breast surgery.

Plastic Surgeons – Perform reconstructive surgery to repair damage done to the breast during tumor removal surgeries i.e. mastectomy and lumpectomy.

Find out whether your doctor is board certified in his or her specialty. Board certification is a sign that a doctor is highly trained in his or her field. Several field related to cancer have national boards that are responsible for setting standards that doctors must meet in order to be certified. However, board certification does not exist for some of the specialties that are important in cancer treatment.

Social workers, hospice workers and even family members are also crucial parts of your medical team.

Last but not least, always get a second opinion about your diagnosis and treatment plan from another qualified professional. Don't be afraid to ask your doctor for your pathology report and other medical records to share with the doctor providing the second opinion. Qualified medical professionals will NOT be insulted if you decide to get a second opinion. It is a common request.

 Understand Your Diagnosis

Because all breast cancers are not alike, it is important that you know the specifics about your cancer diagnosis.  The tumor size, grade and cancer stage all affect your treatment options.   Ask your doctor the following questions about your cancer diagnosis:

What is your tumor size?  - Generally, the smaller the tumor, the better your prognosis (chance of survival). The best way to measure the size of the tumor is after it has been removed during surgery. However, healthcare professionals can estimate the size by touch or through ultrasound and mammography images. Even a biopsy by a pathologist provides clues about the size of the tumor.

What is your lymph node status? - Lymph nodes are small, bean-shaped groups of immune system cells (cells that fight infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.  Most lymph vessels of the breast lead to lymph nodes under the arm. Healthy_Breast

If none of your lymph nodes are found to be cancerous, your prognosis (chances of long-term survival) is good.  Your prognosis worsens with each cancerous lymph node detected.

What is your tumor type? characteristics?Ask your doctor or other health professional whether the tumor is invasive or non-invasive, whether it originates in the breast lobules or ducts, or whether it has positive or negative hormone receptors. These are a few of the tumor characteristics that can affect your prognosis and treatment options. For more information about various cancer types click on the following link. Tumor_Types

What is the grade of the tumor? Under a microscope a pathologist can examine a portion of your tumor (removed during a biopsy) to determine how closely the cells resemble normal cells. The more similar the cells are to normal cells, the lower the tumor grade and the better the prognosis. 

Has the cancer metastasized (spread to other organs)?About five percent of women in the US have distant metastases when they are first diagnosed with breast cancer [1].  While the 5 year survival rate is worse for patients with metastatic breast cancer compared to those diagnosed with early stages of breast cancer, survival is not hopeless.  Advances in medical treatment make it possible for patients to live longer, normal lives than what was expected in the past.  Your involvement is key to your long-term survival.

 What is the stage of cancer? Once you have been diagnosed with breast cancer, additional testing must be done to determine whether the cancer has spread. That process is called staging the cancer. As shown on the table to the right [2], the predicted survival rate is different for each stage of breast cancer. Early stage cancer (stages I or II) has a better prognosis than later stage cancer (stage III and IV). Also, cancer that stays in the breast has a better prognosis than cancer that has spread beyond the breast to the lymph nodes. The worst prognosis is for metastatic breast cancer, where the cancer has spread beyond the lymph nodes to the other parts of the body.

For a  detailed_list_of_questions that you should ask your doctor after your diagnosis, click on the following link to the American Cancer Society.

 

Understand what your insurance will and will not cover

Only when faced with a medical crisis do many people learn how their HMO, other health coverage or entitlements work, what services are covered, and what reimbursement procedures to follow. To anticipate any problems, use the toll-free number provided by your health insurance carrier. Find out whom you should call in your doctor’s office or hospital when your insurance company has a question about a procedure or specific charge for medications or tests.

If you do not have health insurance there are a number of resources that offer financial assistance for women diagnosed with breast cancer.  One example is CancerCare, which offers financial help for diagnostic work-up, transportation to and from treatment and childcare when a parent is having tests or treatment.  They also provide information about specific prescription drug assistance programs. 800-813-HOPE OR (800 813-4673) www.cancercare.org  

REFERENCES
[1] Ries LAG, Eisner MP and Kosary CL. SEER Cancer Statistics Review, 1973-1998, National Cancer Institute. http://seer.cancer.gov/csr/1973_1998/, 2001
[2] Source: National Cancer Data Base and American Cancer Society, 2005 Note: Data reflect pre-2003 staging classifications, which do not include a stage IIIc  Breast cancer. American College of Surgeons and American Cancer Society, 2005

Last Medical Review: August 2010