Questions to Ask Your Doctor to Prepare You for Your Breast-cancer Journey

SPRINGFIELD — How many times have you gone to the doctor, then returned home only to realize you forgot to ask several important questions? Do you known the right questions to ask after getting a diagnosis of breast cancer, so that you can better understand your diagnosis, treatment plan, and overall care?

A Baystate Health breast surgeon and breast medical oncologist offer their insight during Breast Cancer Awareness Month on questions to ask your doctor to prepare you for your breast-cancer journey.

“Patients come to us understandably very nervous; some may be angry, but I think most are generally overwhelmed by their diagnosis. Some are upset and have not done any research beforehand, and others have done some reading. For those who have done research, it is important for me to understand what they have read,” said Dr. Holly Mason, Section Chief for Breast Surgery at Baystate Health. “For any patient, it is important that I help them to understand the diagnosis and the various parts of breast-cancer treatment. It is also important for me to learn the patient’s preferences and how they view the options that I present so that, in the end, they feel comfortable with the surgical plan.”

Mason noted there is a lot of information for breast-cancer patients to consume.

“We help our patients to get through it all, explaining everything so it hopefully makes sense to them, and talking to them about how different treatments accomplish different goals. We also discuss the support systems we have available from social workers to nurse navigators to help them through what may be the most challenging time in their lives.”

According to the Baystate breast surgeon, before undergoing any type of surgery, it is important to feel comfortable with and have the utmost confidence in both your surgeon and your treatment plan. It is reasonable to ask your surgeon their level of expertise in taking care of breast-cancer patients or what percent of their practice is breast surgery.

The question Mason is most often asked by her patients is simply, ‘am I going to survive?’

“Today, the five-year relative survival rate for localized breast cancer in the United States is excellent,” she said, noting there are more than 3.8 million breast-cancer survivors in the U.S., including those currently being treated.

Here are just some of the many important questions to ask your surgeon beforehand:

• What type of breast cancer do I have, how large is the tumor, how aggressive is the cancer, does it use hormones as a fuel source, and does it have the HER2 growth factor?

• Has all my imaging been done, or will I need other tests before surgery?

• Will I be able to have a lumpectomy, or will I need a mastectomy?

• Is there any difference in the cancer coming back in the breast or chest and in my overall survival in choosing between a lumpectomy or mastectomy?

• Is breast reconstruction a possibility?

• Will the lymph nodes in my underarm need to be removed? What about lymphedema and other possible side effects?

• Will I need radiation therapy after surgery, and will that affect reconstruction options?

• Will I need radiation even after a mastectomy?

• What are the risks and possible complications of the surgery?

• Should I consider genetic testing?

“Many patients want to know if they will need chemotherapy,” Mason said. “For some patients, we know the answer at the very beginning based upon the type of cancer they have. For other patients, the answer may not be known until after surgery is completed and they have seen the medical oncologist.”

According to Dr. Prarthna Bhardwaj, senior medical oncology fellow with special interest in breast oncology at the Baystate Regional Cancer Program, breast-cancer patients are normally seen after their surgery to discuss further treatment options such as chemotherapy or hormonal therapy.

“Other times, we may see them prior to surgery when it is determined that upfront chemotherapy may be beneficial to shrink the tumor, thus making the surgery less extensive,” she added. “This is dependent on the stage of the cancer and type of receptors your breast-cancer cells have, including hormone receptors and HER2 receptors that are responsible for the growth of the cancer.”

Asking and knowing the stage of your cancer and if it is invasive or not (ductal carcinoma in situ DCIS) is very important because that will determine treatment. Nearly 85% of breast cancers are hormone-receptor-positive and can be treated with hormonal therapy to decrease the recurrence of these cancers after curative surgery, Bhardwaj noted.

“Early-stage breast cancers are usually curable with a combination of surgery with or without chemotherapy, with or without radiation, and with or without hormonal therapy. What combination of treatments we use, and the sequence, is dependent upon the type of cancer you have that is determined upfront at the time of your biopsy,” she explained. “We have a high-functioning, multi-disciplinary team of radiologists, pathologists, medical oncologists, breast surgeons, and radiation oncologists who discuss the appropriate sequence of care for several of our patients.”

The Baystate medical oncologist also noted that, if your surgeon hasn’t already discussed genetic testing with you, you should ask about the possibility.

“The National Comprehensive Cancer Network has specific guidelines for genetic testing for which you may qualify, information which can be used to determine what kind of surgery or therapy you will get, especially if you have a hereditary cancer syndrome, for example, the BRCA gene,” Bhardwaj said.

Additional questions to ask your breast medical oncologist include:

• What will the side effects of all my treatments be, and how can they be addressed?

• What is the additional benefit of the treatment I am undergoing?

• What is my overall prognosis?

• Will treatment affect my sexual health and fertility?

• Are there any clinical trials available to me?

• Should I undergo any scans to determine if there is cancer elsewhere in my body?

• What lifestyle changes should I be making to decrease the risk of breast-cancer recurrence?

• Are there any supplements I should be taking?

For a more comprehensive list of breast-cancer questions to ask the health care team, visit the American Society of Clinical Oncology at www.cancer.net/cancer-types/breast-cancer/questions-ask-health-care-team.

And, so you don’t forget to ask anything, make a list of questions you want to discuss at your appointment and bring them with you, whether on a piece of paper, your phone, or a tablet.