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Your Guide to Making Breast Cancer Treatment Decisions


Breast Cancer image

When you are first diagnosed, you may feel as if you will do anything to get rid of the cancer – the sooner the better. Although prompt treatment is important, breast cancer usually is not a medical emergency. It is critical to take time to understand the type of breast cancer you have. Then you can select the treatments that are most likely to benefit you.

Making treatment decisions does not happen overnight: it is a process that involves you, key relatives or friends, and your treatment team. It may take a couple of weeks to gather enough information about the breast cancer to consider all your options.

Changes in How We Understand Breast Cancer
Just 30 or 40 years ago, breast cancer was viewed as a single disease. Treatment choices were limited, and doctors usually told women what to do without talking about individual options or preferences

Now, that has all changed. We know there are many different types of breast cancer, each with its own features. New breakthroughs in breast cancer research have helped doctors learn more about who will or will not benefit from certain treatments. That is why you could have a relative, a friend, and a colleague with breast cancer, and all four of you could have different treatment plans

Creating “Individualized” Treatment Plans
Today, treatment plans are tailored to meet each woman’s needs. Medical tests performed on the breast tumor tissue and underarm lymph nodes are done to understand how the cancer grows and behaves. This information creates a “profile” of the cancer, which can guide you and your treatment team in selecting the best ways to treat it

In some cases, the best course of treatment for breast cancer is very clear. In others, deciding among a few good options may be a matter of what makes sense for you.

Some of these tests look at the activity of the cancer cells’ genes. Genes “express” proteins that control the behavior of all our body’s cells. When certain proteins are present, absent, or not working properly, the cancer is likely to behave in a certain way – and may be more likely to respond to certain treatments. Selecting treatments based on these biological traits is called personalized medicine

In some cases, the best course of treatment for breast cancer is very clear. In others, deciding among a few good options may be a matter of what makes sense for you. If different treatments work equally well, how do you choose? Talk to your treatment team about the quality of life you want to lead during your treatment. Are there side effects that concern you? Is traveling for treatment an issue? Do you want to time your treatments around any special events? Voice your concerns and let your team know what is important to you

Gathering Information to Create a “Cancer Profile”
Breast cancer is diagnosed from a biopsy, a procedure that removes some suspicious breast tissue with a needle or through an incision. A doctor called a pathologist looks at the tissue under a microscope, makes a diagnosis, and may decide to run more tests. These results come back to you in an initial pathology report. This first report can help guide decisions about surgical treatment

The complete pathology report will not be ready until you have surgery to take out all the breast cancer and one or more of the underarm lymph nodes (to check for possible signs of cancer there). Over several days to a couple of weeks, this tissue is tested to create that final report.

Your report starts with a brief history of your present condition, where the tissue was removed, and the size and appearance of the samples. More important in planning treatment is the information about the cancer itself, such as the size, how the cancer cells look and behave, and whether any lymph nodes contain cancer. The report also should tell you whether cancer was found in one area or many areas of the breast, and whether any cancer cells made their way to the skin or nipple. Often, the results are summed up in a final section called “Impression,” “Final Diagnosis,” or “Summary.”

If you have stage I or II breast cancer that (1) is not in the lymph nodes, and (2) is hormone receptor-positive, then you likely are eligible for a test called a genomic assay. Genomic assays look at groups of genes in cancer cells and whether they are present, absent, or too active, which influences how a cancer is likely to grow and respond to treatment. A cancer with lots of abnormal activity can be treated differently than a cancer with lower levels of such activity.

Putting It All Together with Your Treatment Team
You and your treatment team will review your pathology report and possibly genomic assay results to better understand your particular type of breast cancer. This cancer profile will become the foundation for making decisions about treatment.

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To read more, visit Living Beyond Breast Cancer at to download or order a free copy of the Guide to Understanding Treatment Decisions.

Reprinted with permission from Living Beyond Breast Cancer’s Guide to Understanding Treatment Decisions, copyright © 2009 Living Beyond Breast Cancer, All rights reserved.

This article was published in Coping® with Cancer magazine, September/October 2010.