When your doctor breaks the news that you have breast cancer, chances are a lot is going through your mind: You may be shocked, scared, dismayed, overwhelmed, determined to fight, or a combination of all of those and more. While you can’t control your diagnosis, you do have a say in your treatment and what to do next. To make the best and most informed decision about your breast cancer care, here are crucial questions to ask your doctor after a breast cancer diagnosis—from breast cancer surgeons, doctors, and survivors themselves.
Questions to Ask Your Doctor After a Breast Cancer Diagnosis
1. What type of breast cancer do I have?
Hackensack University Medical Center breast surgeon Dr. Tara Balija tells Parade that questions around the specifics of your breast cancer diagnosis are key to understanding what’s right for you and your individual health needs. Dr. Balija explains, “There are several different types of breast cancer. It is important to know which you are being diagnosed with to choose the right course of treatment.”
2. What stage of breast cancer do I have?
According to Dr. Balija, the stage, not just the type of cancer, will dictate your treatment plan, as well as provide a better idea of potential survival rates.
3. Do I have hormone receptor-positive cancer?
This is an important and often overlooked question for patients with breast cancer diagnoses, largely because they simply don’t know to ask it. “Hormone receptor-positive (or hormone-positive) breast cancer cells have either estrogen (ER) or progesterone (PR) receptors or both,” Dr. Balija says. “This is important to ask about because breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors.”
4. What is my Oncotype?
“The Oncotype test gives the score that determines whether or not a patient needs chemotherapy,” Dr. Balija explained. “The Oncotype test looks at the DNA in cancer and based on those genes, it lets you know the likelihood of the cancer recurring. The test results also help medical oncologists determine whether the patient needs chemotherapy or not. The test can help the patient and the doctor make a treatment plan that’s right for the patient.”
5. Can I have genetic or genomic testing?
Genetic testing can help you find specific genes that may predict your likelihood of certain cancers, while genomic testing may give a better look at your specific cancer case right now and provide a better idea of how your breast cancer may manifest. Dr. Balija told us, “A genomic test looks more widely at what’s called your genome—your full set of genetic ‘code.’ It checks for gene mutations in your cancer to predict how it might act. A genomic test could help your doctor tell how fast-growing your cancer might be and how likely it is to spread.” Certified breast surgeon at OhioHealth in Columbus, Ohio, Dr. Deepa Halaharvi, DO, FACOS, concurs that this is a great question to ask your doctors, noting, “While a cancer diagnosis can be overwhelming and scary, genomic testing can provide patients with personalized insights about their cancer diagnosis to allow them to make treatment decisions with a greater degree of confidence.”
6. Do my lymph nodes need to be biopsied?
A biopsy of your lymph nodes can help your medical team see if your cancer has spread to other organs or is contained to your breast, Dr. Balija notes.
Questions to Ask Your Doctor About Breast Cancer Treatment
7. What course of treatment do you recommend?Should I pursue complementary therapies?
Breast cancer treatment options include surgery, radiation, chemotherapy, hormone therapy, and any number of combinations thereof. Your specific treatment plan can vary and will likely be unique to your own individual needs depending on the type and stage of your breast cancer. Dr. Halaharvi—herself a breast cancer survivor—knows how important it is to tailor your treatment to you. “Breast cancer treatment is no longer a one-size-fits-all approach,” Dr. Halaharvi told Parade. “As not all patients and tumors are the same, these are important questions to ask your doctor to enable personalized treatment decisions. Personalized medicine, or tailoring treatment to the biology of each patient’s individual tumor, can potentially spare some women the time, expense and harmful side effects that can be associated with chemotherapy.” Dr. Jean L. Wright, MD, director of the breast cancer program and the director of safety and quality for Johns Hopkins Medicine’s Department of Radiation Oncology and Molecular Radiation Sciences, explains, “Breast cancer is really a spectrum of diseases, and the treatment is highly variable depending on your specific diagnosis. It may be difficult to anticipate the full plan of care at the beginning because sometimes a treatment recommendation will depend on the outcome of an earlier step. Most treatments will include some combination of surgery, systemic therapy (chemotherapy, targeted therapy, and/or hormone therapy) and radiation. Yet for many patients, the uncertainty around the treatment plan can be very stressful.” As such, Dr. Wright recommends also asking what order your treatments will be in, noting that treatment plans can evolve over time depending on how your body responds to them. Also ask your doctor whether complementary therapies, like acupuncture, may be beneficial to your care, Dr. Bajia advises. Different doctors will have different opinions based on your specific case and diagnosis, so it’s important to consult with your care team before pursuing any of these avenues on your own.
8. What is the difference between a lumpectomy and a mastectomy? Which one is right for me?
This is a two-pronged question that can significantly impact your breast cancer treatment, as well as your life following it. “A lumpectomy is viewed as breast-conserving surgery. The goal of a lumpectomy procedure is to remove the cancer and some of the surrounding normal breast tissue but leave the breast intact,” Dr. Balija says. “A mastectomy, on the other hand, removes the entire breast.” Your doctor will be able to determine which will work best for you, and it’s important to have your own voice heard in this respect too: For better or worse, your breasts are part of you, and you may have different feelings about whether or not you want to keep them or remove them entirely. It can be an emotionally-charged decision for many women, especially in terms of self-esteem and intimacy after treatment, and what’s right for you may not be right for someone else. Making an informed choice while also honoring your own desires is key. You may also want to ask about potential reconstructive surgery if you think you’ll be self-conscious about removing all or part of your breast.
9. What type of radiation do you recommend, and why?
Dr. Wright explains that there are different types of radiation and your specific treatment plan should be explained thoroughly to make sure you understand it. “Answers may range from 3-D conformal treatment to intensity-modulated treatment to proton treatment,” she told us. “There is no one best type of radiation therapy; the optimal type should be tailored to each patient’s unique situation, but hearing a clear explanation of why a particular type of radiation is chosen can be helpful.” She recommends asking the following more specific questions about radiation treatment:
How many treatments will I receive per week?How will the radiation therapy be given?Will it be an external beam or brachytherapy?What do the treatments feel like?How does your team ensure that the treatment is delivered safely and accurately? What safety checks are in place? What kind of imaging is done on the treatment machine to make sure the treatment is being delivered correctly?Does your radiation oncologist participate in a “peer review” program where other physicians evaluate the treatment plan to optimize safety?What do you do to protect my heart during radiation treatment? Again, there is no single right answer, and the best approach will depend on your situation, but hearing a clear explanation may be helpful.How urgent is it to start my treatment? Most patients are understandably eager to start treatment quickly once a diagnosis is made, but additional tests are often recommended and that may take time to accomplish. Each case is unique, and generally, it is best to get the most information you can before starting treatment. Talking to your doctor about this can also help alleviate stress.
10. If I have surgery, what type of surgeon will I have?
Dr. Balija says it’s important to ask if your surgeon will be a breast surgeon or a general surgeon. If they’re a general surgeon, ask how often they handle breast cancer patients. Having these answers may help give you peace of mind before going under the knife.
11. Does my breast cancer care team work together in a multidisciplinary fashion? Is it a team-based approach to my care?
It’s important to know that all of your doctors, from oncologists to surgeons and beyond, are on the same page and communicating effectively about your breast cancer care. Dr. Wright advises to also ask if the physicians on your team participate in multidisciplinary care conferences or “tumor boards,” as well as to ask if all of your cancer care team members are on the same medical record system. If they aren’t, ask how they share information with one another.
12. What ancillary services are available in the system where I am receiving care?
Dr. Wright recommends asking about nutrition, physical therapy, and genetics to start. Your care team will be able to determine the best course of action for you and your specific needs.
13. What psychological and emotional support is available to me during my breast cancer treatment?
Obviously, a breast cancer diagnosis and subsequent treatment is likely to be a hugely emotional time for you. Dr. Wright and Dr. Bajia recommend asking what social work and support groups may be available to you, whether through your care team directly or if they can simply refer you to others that they may recommend. You may also ask for referrals for therapists and other mental health professionals to see what emotional and mental support is available.
14. How should I physically prepare for my treatment and its side effects?
It’s crucial to check with your care team on how you can prepare for your breast cancer treatments of any kind, as well as what side effects—both short and long term—that you can expect to have from them. Also be sure to ask your cancer care team to whom to report the side effects of each of your breast cancer treatments, as well as how long and how frequently you’re expected to undergo each treatment, so you can make necessary arrangements for transportation and help at home as needed.
15. How should I financially prepare for breast cancer treatment?
In an ideal—and currently, in most of the rest of the developed world—you wouldn’t have to worry about choosing between life-saving medical treatment and potential bankruptcy, but unfortunately, that’s where we are right now. Consult with your care team to see what your insurance (if you have it) will and won’t cover and to determine potential payment plans and financial arrangements if you need to make them. If you need financial help with your medical bills (one of the overall largest causes of debt in the United States), please check out these resources to see what’s available to you:
American Cancer Society Hope LodgeAmerican Cancer Society Road To RecoveryBreast Cancer Assistance FundCancerCareCancerCare’s Linking A.R.M.S.Compassionate AllowanceGenevieve’s Helping HandsThe Gift of HopeThe Healthwell FoundationHope for Young Adults with CancerKomen Financial Assistance ProgramPartnership for Prescription AssistancePatient Advocate Foundation Co-Pay ReliefThe Pink FundRXAssistThe Sisters NetworkBreast Cancer Assistance ProgramStupid CancerSupplemental Security Income (SSI)Social Security Disability Insurance (SSDI)United Way’s 2-1-1 Program
Next, what is CHEK2? Here’s everything you need to know about the breast cancer gene no one’s talking about.
Sources
Dr. Tara BalijaDr. Deepa Halaharvi, DO, FACOSDr. Jean L. Wright, MD
