Breast cancer affects 1 in 8 women. The statistics are reassuring when you are asked to return for further evaluation of an abnormal screening mammogram. The statistics are also in your favor when a breast biopsy is recommended. Unfortunately, statistics are just that: statistics. The truth is that although the statistics are reassuring, there is always a chance that the abnormality being evaluated is in fact cancer. The breast radiologist’s job is to determine the breast cancer likelihood for each patient depending on the imaging findings, and if present, the breast symptoms (i.e. palpable lumps, nipple discharge). Based on the BI-RADS lexicon a biopsy should be recommended if the radiologist feels there is a 4-100% chance the imaging abnormality may be cancer. The biopsy recommendations absolutely err on the side of caution, but I hope you can agree that it is best to fully evaluate any abnormality that has even a remote chance of being cancer.
You can find more information related to ultrasound-guided, stereotactic-guided, and MRI-guided breast biopsies in the linked articles. The purpose of any breast biopsy is to provide the pathologist with a reasonable amount of tissue from the area of concern. The pathologist runs multiple tests to arrive at a final diagnosis referred to as a tissue diagnosis.
It can take 3-5 business days for the pathologist to run the necessary tests and arrive at a final tissue diagnosis. At our facilities, the breast patient navigator contacts most patients with biopsy results, with the caveat that a few primary care providers have specifically asked to call patients with results themselves.
If breast cancer is the diagnosis, the next couple of weeks will feel like a whirlwind. Many patients believe that certain steps must be followed after a breast cancer diagnosis because a family member underwent a specific treatment protocol for a different type of cancer. No one cancer is like another, and each type of cancer has a different protocol for treatment. We encourage you not to compare the treatment protocol for other types of cancer including colon, liver, kidney, etc. to the treatment protocol for breast cancer. This is like comparing apples and oranges and will just lead to frustration on your part. In fact, even comparing the treatment protocol of those who have had breast cancer is not helpful because treatment protocols vary greatly depending on a number of factors.
The first priority after a breast cancer diagnosis is to establish care with a breast surgeon. The breast surgeon will discuss the pathology results with you and examine your breasts. The breast surgeon may or may not require a breast MRI depending on multiple variables. Once all imaging is complete the breast surgeon will discuss your surgical options. In most cases, surgery is the first step in breast cancer treatment. The surgical options will vary based on the size of the tumor, the location of the tumor, the size of your breasts, your age, if there is more than one cancer in the breast, and if there is cancer in both breasts. Every case is different and the decision between a lumpectomy (taking a small portion of the breast that contains cancer) and mastectomy (removal of the entire breast) must be made based on all these variables, as well as considering your personal desires and technical input from the breast surgeon. Sometimes your personal desires are not technically feasible, but the breast surgeon is the best physician with which to thoroughly discuss this to come to a final decision.
As stated above, most patients will undergo surgery first. However, breast cancer treatment is not always a cookie cutter protocol and there is a subset of breast cancer patients who will benefit from undergoing chemotherapy or hormone therapy (referred to as neoadjuvant therapy) prior to surgery. If your breast surgeon believes this is the case in your specific situation, they will help you establish a relationship with a medical oncologist prior to undergoing surgery. In this situation, the medical oncologist will be responsible for your neoadjuvant treatment. After the oncologist feels that the neoadjuvant therapy is complete, the breast surgeon will then discuss your surgical options with you.
After the initial surgery, many variables come into play, and it is difficult to give you a definitive roadmap of possible treatments. The breast surgeon plays a central role in guiding you to your next steps in treatment.
- If breast reconstruction is desired, consult with your breast cancer specialists to refer you to a board-certified plastic surgeon. There are multiple reconstruction options available, and you will want to know which one is the best fit for your current situation and lifestyle.
- All patients will need to meet with a medical oncologist following surgery even if neoadjuvant therapy was given prior to surgery. Some breast cancer patients will be eligible for hormone therapy while others will require chemotherapy. These decisions are based on the pathology results of the lumpectomy or mastectomy.
- Some patients will be eligible for radiation therapy. The breast surgeon and/or medical oncologist will tell you if this will be necessary and will help with establishing care with a radiation oncologist.
- Non-physician appointments may also be necessary, including physical therapy and genetic counseling.
A new breast cancer diagnosis is quite overwhelming and the number of steps necessary to treat breast cancer is staggering. You are not alone in this diagnosis. Know that there are many facilities where all of these breast cancer specialists work together to ensure the most seamless treatment plan possible. When in doubt ask questions. Make lists of anything that crosses your mind– there are truly no dumb questions when facing a new breast cancer diagnosis. We all understand this is overwhelming and as physicians, we want to help you navigate the waters of breast cancer treatment as smoothly as possible.