There are few things in life that can shake a woman at her very core, the way a diagnosis of breast cancer can. Even before a formal diagnosis, the stress surrounding the uncertainty and fear a woman is feeling can make it difficult to face the decisions that may lie ahead. Education and supportive care can go a long way toward helping a woman deal with the many issues and emotions she is feeling.
In this issue of Well-Being, we have tried to focus on breast cancer in a comprehensive way, addressing all aspects of the experience from exercise during and after treatment, to making your way through the healthcare system, to nutrition and even dealing with your changing self-image. While each cancer and each cancer patient is different, what women have in common is the need for reliable sources of information, emotional support, and assistance with everything from clinical issues to problems of daily life. Fortunately, there are numerous sources of help throughout the process. Knowing about it and accessing it is part of the challenge. We spoke to a number of professionals, each of whom plays an important role in helping women navigate the difficult journey that is…breast cancer.
Once a suspicious “lump” has been discovered in a woman’s breast, the next step is a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The tissue sample, is removed during the biopsy and is analyzed by a pathologist. There are different types of biopsies, classified by the technique and/or size of needle used to collect the tissue sample. Your physician will discuss these options with you and determine which method is best for your individual case.
If all of this seems overwhelming and difficult to absorb, you are not alone. It is important for you to talk freely and candidly with your doctor about how you are feeling and ask for clarification if there is something you don’t understand. It is a good idea to have a friend or loved one go with you to appointments to help you remember what your doctor says. It’s often hard for a patient to comprehend everything that is being communicated. Think of it as a circuit that is overloaded with all of the thoughts and feelings that you are experiencing.
According to Adrienne Russell, Breast Health Navigator at Baptist Health System’s Center for Breast Health, she often gets involved with patients even before the biopsy.
“I try to help patients understand what to expect during the biopsy and answer questions they have about the procedure and what the results might mean for them,” notes Russell. “I remind the patient that most biopsy’s are benign, and that they should not become overly concerned…but of course that is something that is much easier said than done. If the biopsy reveals that cancer is present, I counsel with the patient and help them realize they will need to work through the stages of accepting the diagnosis and coming to grips with what lies ahead, taking it one day at a time.”
Staging is a way of describing where your cancer is located, how much the cancer has grown, and if it has spread. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all the tests are finished. Knowing the stage of your cancer helps your doctor decide what kind of treatment is best for you and can help predict your prognosis (chance of recovery).
The most commonly used tool to describe a tumor stage is the TNM system. This system judges three factors: the size of the tumor itself, the presence of cancer in the lymph nodes where the cancer cells often first travel, and whether the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. In breast cancer, there are five stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (one through four), which are used for invasive breast cancer. The stage provides a common way of describing the cancer so doctors can work together with the patient to plan the best treatments.
The biology and behavior of a breast cancer affects which course of action your physician will recommend for your treatment. Some tumors are small but grow fast, while others are large and grow slowly. Treatment options and recommendations depend on several factors, including:
• The stage and grade of the tumor
• The tumor’s hormone receptor status
• The patient’s age, general health, and preferences
• The patient’s menopausal status
• The presence of known mutations in inherited breast cancer genes (BRCA1 or BRCA2)
Even though the doctor will specifically tailor the treatment for each patient and their breast cancer, there are some general steps for treating breast cancer. Your treatment may include surgery, chemotherapy or radiation therapy, or a combination of two or more of these treatments.
Well-Being spoke with Phillip Ley, MD, FACS, fellowship trained Surgical Oncologist with Mississippi Breast Center, about some of the most difficult aspects of helping his patients weigh their treatment options.
“Today, there are a number of options that we can look at in terms of surgical approaches, and we try to walk our patients through these and help them understand the choices they have,” explains Dr. Ley. “The hardest thing is for patients to tune out all of the preconceived ideas they have and the advice and pressure from friends and family, and to realize that every case is different. Education is a big part of what we do. We want our patients to understand that while the #1 goal of their treatment is survival, there may be more than one way to accomplish the same result, often including breast conservation.”
Questions for Your Doctor
Because breast cancer treatment can be multifaceted, and very confusing, having a list of questions for your doctor when you go in for a pre-treatment consultation, can help you be prepared to get the information you need to help you make the decisions you are facing. Your doctor will help guide you through the process and explain what you can expect. Some common questions you might ask follow.
• What type of breast cancer do I have? How does this affect my treatment options and prognosis?
• Has my cancer spread to lymph nodes or internal organs?
• What is the stage of my cancer and how does it affect my treatment options and outlook?
• What treatments are appropriate for me? What do you recommend? Why?
• What are the risks and side effects that I should expect?
• How effective will breast reconstruction surgery be if I need or want it?
• What are the pros and cons of having it done right away or waiting until later?
• What will my breasts look and feel like after my treatment? Will I have normal sensation in them?
• How long will treatment last? What will it involve? Where will it be done?
• What should I do to get ready for treatment?
• Should I follow a special diet or make other lifestyle changes?
• What are the chances my cancer will come back with the treatment programs we have discussed? What would we do if that happens?
• Will I go through menopause as a result of the treatment?
• Will I be able to have children after my treatment?
• What type of follow-up will I need after treatment?
Your Healthcare Team
Once you have been diagnosed with breast cancer, you will find that there is not just one healthcare provider following your case, but a whole team of professionals, each bringing different training and expertise to your overall plan of care. Your team may include a surgical oncologist, a medical oncologist, a radiation oncologist, a patient navigator, a nurse navigator, a social worker, a nutritionist, and one or more oncology rehabilitation therapists.
Breast Cancer Nurse Navigator at the University of Mississippi Medical Center, Vicki Stout helps patients navigate the system and access the resources and services that are available to them.
“I meet with recently diagnosed breast cancer patients and educate them about their diagnosis, help them manage the complexities of scheduling and juggling treatment appointments, and make sure they are communicating with their physicians and care team,” notes Stout. “Many of my patients come from medically underserved communities and may not have health insurance, so I help them apply for financial assistance. We do everything we can to prevent unnecessary delays in treatment that could have serious consequences,” Stout adds. “Basically, I try to make sure patients get the help they need, including interfacing with nutritionists about their dietary requirements and coordinating with physicians to arrange for home care for patients who are eligible. I advocate for the patient. Cancer treatment can be complicated. I try to make it as easy as possible for our patients.”
Ms. Stout works along with Beth Feisel, who is the American Cancer Society Patient Navigator at the University of Mississippi Medical Center, to identify any barriers to care. Beth’s job, which is funded by AstraZeneca, is completely free to her patients.
“Each patient comes to me with a different set of needs,” says Feisel. “Going through breast cancer is difficult even under the best circumstances, but many of my patients need help with a myriad of problems that can directly or indirectly effect their treatment and recovery. We help with everything from patient education, to finding financial resources to assist with medications, housing, energy, transportation, and more. We also help patients who are undergoing chemotherapy select wigs and head coverings, and we help mastectomy patients find properly fitting bras and prostheses.”
The Wrap Up
Dr. Barbara Craft, Medical Oncologist at the University of Mississippi Medical Center spoke to Well-Being about the changes she is seeing in breast cancer patients.
“Overall, the number of patients presenting with breast cancer has not changed over the past few years, but what we are seeing is an increase in younger patients who do not have a family history of the disease,” notes Dr. Craft. “We know that early detection is the key to more successful treatment and improved survival rates. If there is anything I can say to women that I hope they will take to heart, I would encourage them to live a healthy lifestyle, to exercise daily, to eat a nutrient rich diet, to limit their alcohol consumption, and to get routine screenings starting at age 40. There are more reasons today than ever before for women to survive breast cancer and live long productive lives.”
Wherever you are undergoing your breast cancer treatment, there are resources and specialists available to help you through the maze of appointments, services, follow-up care and more. Talk to your doctor about your concerns and inquire about assistance that may be available through social services, patient advocacy professionals and other hospital departments. Another invaluable resource is the American Cancer Society, www.cancer.com. For reliable, oncologist- approved information about all aspects of breast cancer including diagnosis and treatment options visit www.cancer.net provided by the American Society of Clinical Oncology.
American Cancer Society Programs and Support for Breast Cancer Patients
*All programs and services are available free of charge.
Information and Resources 24/7/365: 800-227-2345 is available day and night to help anyone who has questions about cancer or needs help.
Reach to Recovery: http://www.cancer.org/treatment/supportprogramsservices/reach-to-recovery Through face-to-face visits or by phone, Reach to Recovery volunteers (breast cancer survivors) give support to newly diagnosed patients.
Road to Recovery: http://www.cancer.org/treatment/supportprogramsservices/road-to-recovery Road to Recovery program provides transportation to and from treatment for people who have cancer who do not have a ride or are unable to drive themselves.