First, Don't Panic: Take Enough Time to Make Smart Decisions
You’ve just been diagnosed with breast cancer, and you’re in shock. But don’t act out of panic; you DO have the time to make responsible, well-researched decisions around critical treatments.
When you hear the word “cancer,” your reaction is visceral. You imagine something ugly and dangerous growing in your breast, and you feel repulsed – both emotionally and physically. You want that demon out NOW.
But hold on. Most women have already had cancer for 5 to 6 years by the time they’re finally diagnosed; and for some with slow-growing tumors, the timeframe is more like 8 years.
How is that possible? Isn’t the definition of cancer wildly uncontrolled cell growth?
Breast cancer can begin very quickly – or start off slowly
Some women are diagnosed with aggressive breast cancer, one that develops quickly: think inflammatory breast cancer (IBC). For these women, it’s imperative that treatment begins as soon as possible; because of their very nature, aggressive cancers are quick to metastasize: to travel to other parts of the body, which is when breast cancer – any breast cancer – becomes deadly.
But for many women diagnosed with breast cancer, the journey began years before with an overgrowth of cells called DCIS (ductal carcinoma in situ).
When the first atypical DCIS cells are born, they may just lie dormant for long periods of time. The cells are abnormal, but not invasive; they don’t leave the breast’s milk ducts.
Though most women with DCIS will never develop invasive breast cancer, some will – often years down the road. And while DCIS can evolve to invasive cancer, by their very nature the cells remain slow-growing – more a trickling stream than a raging river.
So while it’s only natural to want treatment to start IMMEDIATELY, it’s probably not necessary.
Making treatment decisions
Once you get a breast cancer diagnosis, the treatment clock starts ticking. Typically you’ll begin with surgery to remove the tumor; based on the tumor’s projected size, you’ll be given the option of breast conservation surgery (lumpectomy), or breast removal (mastectomy).
Then, based on the tumor’s pathology and whether or not cancer cells are found in the underarm lymph nodes, your oncologist will recommend a course of follow-up treatment: radiation, chemotherapy, and/or hormone therapy.
Make no mistake, decisions around all of these treatments are major ones, ones that can permanently affect your health and lifestyle. Thus it’s imperative that you have your wits about you as you ponder the best course, acting not out of fear – which, with cancer, can be irrational – but reason.
Waiting is stressful – and often inevitable
Don’t be surprised if the time between your initial diagnosis and the start of treatment stretches into weeks. Your doctor has enough information from the biopsy to gauge how quickly you need to get into the system. Women with larger/more aggressive cancers are seen first; those whose cancer appears small and relatively dormant stand in line.
While it’s stressful to wait for surgery and follow-up treatment, it’s simply a fact of life. Doctors and surgeons are busy; schedules need to be coordinated. It’s their job to treat you as effectively as possible, and the medical staff – not you – is best equipped to determine how and when treatment begins.
That said, don’t put up with bureaucratic ineptitude. If the surgery scheduler says s/he’ll call back by Wednesday and you don’t hear anything, pick up the phone first thing Thursday morning and find out what’s up. No news isn’t necessarily good news; it can signal a breakdown in the system. As an empowered patient, it’s up to you to be the “squeaky wheel.”
Collect and consider data
Your doctor will provide you with all kinds of statistics around 5-year survival rates (a.k.a. chance of recurrence). For instance, if you have a lumpectomy followed by radiation, your risk of recurrence within 5 years is X percent; if you have a mastectomy, your risk is Y percent.
In this scenario many women, acting out of panic, will choose what seems like the most aggressive treatment: mastectomy. After all, won’t you more effectively obliterate cancer if you cut off your whole breast, rather than just part of it?
Surprisingly, there’s no difference in survival rates for women who choose mastectomy vs. those who opt for the less aggressive course: lumpectomy followed by radiation.
And mastectomy comes with some serious after-effects: the need to consider breast reconstruction; and an increased risk of other health issues, including lymphedema and shoulder problems.
So before you tell your doctor to “just cut it all off” – understand what that means, both as far as your 5-year survival rate, and your long-term overall health.
Make a thoughtful decision
Similar statistics exist around every treatment you’ll be offered. Get past the “do everything” mindset, and really examine the data.
If having chemotherapy will reduce your risk of recurrence from 60 percent to 20 percent, then clearly you opt for chemo. But if the reduction is more like 10 percent to 6 percent, think hard: chemotherapy after-effects are serious, and they can plague you for the rest of your life.
When planning your breast cancer journey, take the time to look hard at survival statistics and the potential after-effects of each treatment. The best treatment plan isn’t always the fastest and most outwardly aggressive – it’s the plan that works best for YOU.
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Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.