more questions to ask your doctor
Few women (or men) are truly prepared to receive a breast cancer diagnosis. Knowing what to ask your doctor is a challenge for the newly diagnosed. The challenge is made even greater by ongoing improvements in how we manage breast cancer. The following list of questions will help you get off to a great start with your doctors.
- What is the hormone receptor status of my tumors? Tumor receptors play a major role in determining how your individual breast cancer will be managed. Tumor receptors are proteins on the surface of or inside the cells of your breast cancer that help doctors determine how your cancer should be treated medically and which types of drugs to use. The three most important breast cancer tumor receptors are estrogen receptors, progesterone receptors, and HER2/neu receptors. These tumor receptors are routinely measured in the biopsy sample and should be listed on your pathology report.
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Should tumor profiling testing be done on my tumor? Tumor profiling tests help determine the benefit of using chemotherapy in addition to hormone therapy to treat some estrogen receptor-positive (ER-positive) breast cancers. Traditionally, tumor stage, patient age, and lymph node status were the main determinants of the need for chemotherapy. However, tumor profiling tests may identify patients with larger or lymph node positive breast cancers that do not require chemotherapy, while also identifying some patients with smaller, lymph node-negative breast cancers that would benefit from chemotherapy. Ultimately, tumor profiling testing helps to ensure that chemotherapy is offered to women who truly benefit from its use.
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Should I consider chemotherapy before surgery? For women requiring chemotherapy, historically, chemotherapy was given only after the patient recovered from surgery. However, women with larger tumors or positive lymph nodes may benefit from chemotherapy prior to surgery. Chemotherapy given prior to surgery, also called neoadjuvant chemotherapy, can often reduce the size of a large breast tumor to make it possible to perform lumpectomy when mastectomy might have previously been required. Chemotherapy prior to surgery can also convert some lymph node positive patients to node-negative status, thereby possibly reducing the need for extensive lymph node surgery.
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Is lymph node surgery required? The practice of lymph node surgery is constantly evolving with the overall goal of reducing the extent and side effects of lymph node surgery, or by eliminating the need for lymph node surgery altogether. For example, most women undergoing lumpectomy and whole breast radiation therapy do not require complete lymph node surgery even if their lymph nodes are positive. Furthermore, the Society of Surgical Oncology now recommends selective use of lymph node surgery for women age 70 and older with estrogen receptor-positive invasive breast cancer treated with lumpectomy and anti-estrogen medications.
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Am I eligible for a clinical trial? A clinical trial is a research study involving people that aims to test news ways to prevent, detect or treat a medical condition. The most advanced and innovative breast cancer treatments are first only accessible via clinical trials. Participants in clinical trials are also monitored more closely than non-trial patients and clinical trial treatments are often available at no additional cost to the patient, although some may experience some out-of-pocket expenses.
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Should I undergo genetic testing? The indications for genetic testing are steadily changing. In the recent past, genetic testing was recommended only for women under 50 years of age or for those with a strong family history of breast or ovarian cancer. However, more recent guidelines have expanded to include others who may benefit from genetic counseling and testing.
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Am I eligible for a shorter course of breast radiation? Breast radiation after lumpectomy traditionally consists of a 30-35-day course of daily doses, to the entire breast over a six week-period after recovering from lumpectomy. However, recent clinical trials show equal cancer control with shorter courses of breast radiation therapy that have the added benefit of greatly reducing the inconvenience of the longer course of therapy. The most common alterative to the six-week course of radiation is an accelerated 16-day course administered over only three to four weeks or partial breast radiation approaches that reduce the duration of radiation to five days or as little as one day.
These seven questions provide only a partial list of the important questions you should ask your doctors. For additional questions to ask your doctors, please visit Understanding Your Diagnosis.
* The opinions and guidance contained in this article are those of the author and not of Susan G. Komen.
