Standard or Not?

If your surgeon recommends something dramati-
cally different from the so-called standard, ask for
reasons behind his or her decision. At the same
time, however, remember there’s no such thing as
“standard breast cancer,” so “standard treatment”
is only a set of averages. Every woman’s case car-
ries a unique set of details, and your surgeon and
doctors have all these details in mind when they
offer recommendations. My point? You won’t be
comfortable with any regimen unless you under-
stand and accept it. So ask. Be an informed con-
sumer. Then decide.
What if your surgeon gives you a choice between a
lumpectomy and a mastectomy? Or between a mas-
tectomy and a bilateral mastectomy? How do you
decide? By learning everything you can about your
diagnosis, what it means, and what the options are.
But you have to read—and you’re on your way by
reading this book—and then ask questions. Lots of
them. Start by comparing the chart later in this chap-
ter with your diagnosis, and then formulate a list of
questions for your surgeon:
➤ What are the advantages of each kind of
surgery?
➤ What are the disadvantages of each kind of
surgery?
➤ Why would you recommend one over the
other?
➤ What are my percentages for regaining full
health with each procedure?
➤ What typical radiation and/or systemic and/or
adjuvant therapies are recommended with each
procedure?
Make note of the answers in your notebook. Then, to digest what you’ve been told,
make a list. Put the advantages in one column and disadvantages in another. Then,
call a hotline again. Read, check the Internet, and talk. Talk to survivors. Talk to fam-
ily and friends. Keep track of their comments, suggestions, and observations, revising
your advantages-disadvantages list as you go.
Finally, after you’ve done enough reading, studying, and talking, when you look at
your list, the fog around your decision will lift. Take your list with you to your ap-
pointment with the surgeon to discuss your final decision. Then, if you have made a
decision based on misinformation or misinterpretations, your surgeon can point out
the error before you make a serious mistake.
Later, after you get the pathologist’s report from whatever surgical procedure you
have, you’ll use the same process to make decisions about radiation, systemic, and/or
adjuvant therapy. For instance, if your medical oncologist recommends a stem cell
rescue (sometimes called a bone marrow transplant), you’ll want to ask the informed-
consumer questions to find out why. It’s a fairly drastic measure used to treat ad-
vanced stages of breast cancer with such high doses of chemo that, without the
rescue, would be fatal. A somewhat controversial treatment, it involves removing
bone marrow prior to treatment and regenerating it through stem cell support or
transplant. Still, it’s saved lots of lives.