Who, What, When, and Where

We’ve already talked about selecting your medical team (see Chapter 4, “Taking Their
Word for It”). Now, assuming your surgeon and/or doctors are in place, your next de-
cision is choosing what treatment is best for you. With breast cancer, “treatment” is
usually plural, involving at least one kind of therapy and perhaps as many as three or
four. Depending on the type of cancer you have and how advanced it is, you may
have one or all of the following:
➤ Local therapy treats the tumor with surgery and/or radiation
➤ Systemic therapy uses chemicals or hormonal therapy traveling through the
bloodstream to attack the tumor
➤ Adjuvant therapy is a systemic therapy used when your doctor suspects cancer
cells may have escaped into other parts of the body even though no detectable
cancer remains after surgery
The usual routine is for your surgeon to recommend a surgical treatment and,
after the pathologist’s report is in, send you on to oncology specialists who recom-
mend the rest. In either case, though, you may be given two or even three choices.
How do you think this through?
Recommendation, Please
Starting with first things first, let’s consider the surgical decision. Refer to the note-
book you began earlier (see Chapter 3, “Learning a New Vocabulary”) and review
what your biopsy showed:
➤ What type of breast cancer do I have?
➤ Is it in situ or infiltrating?
➤ Has it metastasized?
➤ What stage is my cancer?
These are the bare-bones facts on which you’ll flesh out answers to lots of questions.
Remember, breast cancer comes in many shapes and styles, and what was right for
your sister or best friend may not be right for you. Know your diagnosis.
Until you’ve had some kind of surgery—a surgical biopsy, lumpectomy, or mastectomy
(and we’ll talk about these options in detail)—there are some unknowns. For in-
stance, you won’t know about lymph node involvement or the results of any hormone
receptor tests (another topic we’ll take up at some length later in the book). Without
that information, no one can confidently recommend any local or systemic therapy.
So your first decision may be whether to have a lumpectomy, mastectomy, or bilateral
mastectomy. Without going into the details now (we will in Chapters 7, “Taking Your
Lumps: Lumpectomy,” and 8, “When They Take It All: Mastectomy”), we can still
weigh the pros and cons.
Ask your surgeon two questions:
➤ What is the usual surgical treatment for my kind of breast cancer at my stage?
➤ Is there anything about my case that would suggest something different from
the usual?
Ask for explanations, and then compare the sur-
geon’s recommendations with the chart later in
this chapter, compiled from recommendations
from the American Cancer Society (ACS) and
the National Comprehensive Cancer Network
(NCCN).