Why should I talk to my doctor about breast cancer?

Breast cancer is the most common cause of cancer in women (aside from the non-melanoma skin cancers) and the second leading cause of cancer deaths in women (behind lung cancer). According to the American Cancer Society, women in the U.S. have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 35 chance of dying of breast cancer. While these figures may paint a bleak scene, there are things you can do to reduce your risk of dying from this disease. Foremost among these is talking to your doctor about breast cancer. Even if you are young and unlikely to develop breast cancer soon, you can discuss the risk factors for the disease with your doctor and learn how you can reduce your own risk. No matter your level of risk for developing the disease, regular checkups and breast cancer screening are the best way to identify the disease early. When you participate in breast cancer screening, if cancer does develop, your chances of catching it while it is still easily treatable are much higher. If breast cancer is diagnosed in stage 0 or I, the five year survival rate is nearly 100%, while if the cancer has progressed to stage IV, the five year rate is around 20%.

If you do find out that you have breast cancer, many treatments are available to help you fight the disease. In addition, there are many resources and advocacy groups for breast cancer patients and survivors: perhaps no other disease has such an extensive and public support system. There are hundreds of thousands of amazing women just in America who have bravely fought this disease and many get great joy out of helping others through the same experience.

How do I talk to my doctor about breast cancer?

Some doctors may not bring up the topic of breast cancer with their patients until the patient approaches an age when the disease becomes more common. That doesn’t mean you can’t ask questions about your own concerns about the disease and the risk factors you may have long before you approach menopause. If you are getting to the age where breast cancer is more common and your doctor hasn’t discussed it with you, you can ask him or her about it.

As with any medical matter the best thing you can do is to be prepared with a list of the questions you want to ask and with answers for the questions that the doctor may ask of you. Especially if you are seeing a new doctor, you should bring a list of any medications you are taking (including both prescription and non-prescription drugs). You may be asked to provide a medical history, including any past illnesses, surgeries, and treatments (including mental health treatment) so knowing the dates of these is helpful.

If you have had symptoms such as pain or tenderness in the breast or if you found a lump, try to give your doctor as much information as possible about it: when did you first notice it, has it gotten better, worse, or stayed the same? Keeping a journal of your symptoms may help you talk about them with your doctor.

It is a good idea to take notes, bring a tape recorder, or ask a friend or family member to come with you to help you remember what your doctor tells you. Medical information can be overwhelming, especially when you are faced with a lot of it all at once.

Make sure you understand any diagnoses the doctor gives you and any tests ordered or treatments prescribed. Ask your doctor to explain if he or she says something that you do not understand. Speak up. Let your doctor know if he or she has not answered your question or addressed your concern. Tell your doctor if a treatment is not working or if you are having side effects. He or she may prescribe a different treatment that might work better for you.

If you are asked to come back for more tests or to consult with the doctor about test results, you may want to bring someone along for support. Even if the outlook is very good, hearing your doctor say you have cancer can be quite an emotional experience.

What questions will the doctor ask me to help determine if I have breast cancer?

If you have found a lump or other irregularity in your breast, you can help your doctor by coming to your appointment prepared to answer questions about the symptoms you have experienced and about any breast cancer risk factors you may have. A doctor may ask if you have had any of the common symptoms of breast cancer, which mostly include changes in the breast or nipple. Your doctor will likely ask you about when you first noticed a change in your breast and if the symptoms have changed at all since then.

Your doctor will also want to know about your known risk factors for breast cancer. You can be prepare for your appointment by figuring out if you have any of risk factors and being ready to discuss them with your doctor. He or she may ask if you have any of the following risk factors:

• age
• family history of breast or ovarian cancer
• personal history of breast cancer
• genetic predisposition
• obesity
• radiation exposure
• early menarche or late menopause
• late first pregnancy
• hormone replacement therapy (HRT)
• birth control pill use
• alcohol use
• precancerous breast conditions
• dense breasts

If you come prepared to answer these questions you can help the doctor accurately assess your risk and decide what steps to take next.

If you already know that you are at high risk for developing breast cancer - such as if you have more than one close relative with the disease, you have had a precancerous condition that predisposes you to breast cancer, you have tested positive for BRCA1 or BRCA2, or you have had breast cancer before - you should make sure your doctor knows you are in a high risk group. Ask your doctor what extra screening measures you should take to increase the likelihood of detecting cancer early.

What questions should I ask my doctor about screening and mammography?

Whether you have several risk factors for breast cancer or very low risk, you should talk to your doctor and ask about how to increase the chances of detecting breast cancer early. You can ask him or her about what screening techniques they recommend and how often you should be screened, as well as measures you can take on your own to reduce your risk of developing the disease. Questions you can ask include:

• How often should I schedule appointments with you or another doctor and what types of exams should I have (physicals, breast exams, checkups, etc.)?
• What cancer screening tests (e.g., mammography) should I have and how often?
• Is there anything in my personal or family history that indicates I should have mammograms more often than the usual recommendations?
• Where should I have my mammograms?
• Is there anything I should do to prepare for my mammogram?
• What will the mammogram show?
• Who gets the report of my mammogram? Can it also be sent to my other doctors?
• How long will it take to receive the mammography report?
• What happens next if my mammogram detects a problem?
• How often should I perform breast self-exams? Can you show me how?
• How can I tell which lumps are not normal?

What questions should I ask my doctor about breast cancer if I am diagnosed?

If you find a lump you should visit your doctor prepared to ask informed questions about what will happen in the event that you do need further tests. If you are diagnosed with breast cancer, some questions you can ask about your cancer and include:

• Do I really have breast cancer? Have you ruled out other possible causes for my symptoms?
• What kind of breast cancer do I have? What stage? What effect does this have on my prognosis?
• Has the cancer spread?
• Do any lymph nodes show signs of cancer?
• What is my prognosis for recovery?
• How precise is the diagnosis? What difference does a precise diagnosis make?
• Do you know what caused my cancer? Did it start in the breast?
• Can I have my biopsy reviewed by another pathologist for a second opinion?
• Have you ruled out any other cancer elsewhere in the same breast or in my other breast?
• How urgent is it that I make decisions and begin treatment?
• Is my family history relevant to my diagnosis?
• Should I stop taking hormone replacement therapy (HRT)?
• Should genetic testing be part of the treatment decision process?
• What did other lab tests show? What did the hormone receptor test show?
• Should I take tamoxifen to reduce the risk of a new tumor?
• Will I need to have a mastectomy?
• Will I need to take chemotherapy?
• Is hormone therapy right for me?

What questions should I ask my doctor about treatment?

Before you start treatment for breast cancer, you should make sure that you understand the treatment plan, the potential risks and side effects, and the rationale for each treatment you will receive. Getting a second opinion from another doctor about your diagnosis and treatment plan can help you feel more secure that you are doing the right thing. This may take some time so it is not always possible: some cancers warrant immediate treatment.

Asking questions about your treatment can help demystify an otherwise scary process and also help you know what to expect. Some questions you can ask are:

• What is the goal of my treatment?
• What are my treatment options?
• What treatment or treatments do you recommend? Why?
• Are there controversies in the recommended treatments among reputable experts?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment? How can side effects be managed?
• How can I get a second opinion about my treatment?
• Who are the members of my treatment team? Can I talk to each of them?
• How might my treatment affect my future risk of cancer?
• What can I do to prepare for treatment?
• Will I need to stay in the hospital? If so, for how long?
• How much will treatment cost? Will my insurance cover the cost?
• How will treatment affect my normal activities?
• If I am advised to have a mastectomy, what are the risks and benefits of immediate breast reconstruction?
• Should my lymph nodes be removed?
• Should I start chemotherapy before surgery?
• Will I have normal sensation in my breasts after my treatment?
• Should I follow a special diet or make other lifestyle changes to help my recovery?
• What are the chances my cancer will come back with the treatment programs we have discussed? What would we do if that happens?
• Are new treatments under study? Am I eligible for any clinical trials?
• Can I continue my usual activities while I’m undergoing treatment?
• Will the treatment affect my fertility? What if I want to have children later?
• How do I explain my condition to my family, friends, and colleagues?
• Are there foods, over-the-counter drugs, or supplements I should use or avoid?
• Can you recommend support groups or counseling?
• Are there some alternative breast cancer therapies I can use along with conventional treatment?

What questions should I ask about surgery?

If your doctor recommends surgery as a part of your treatment, you may want to ask him or her these questions before the surgery:

• Which operation do you recommend for me? Why?
• Will I have to have radiation?
• Should I start chemotherapy before the surgery? Should I take it afterwards?
• Is breast-sparing surgery an option for me?
• Will my lymph nodes be removed? How many? Why?
• How will I feel after the operation? How long will I have to stay in the hospital?
• What will I look like afterwards?
• How effective will breast reconstruction surgery be if I want it? What other options are there?
• Can you suggest a plastic surgeon for me to contact?
• Will I have to do any special exercises or physical therapy to help my recovery?
• Can you put me in contact with someone who has had the same surgery?

What questions should I ask about radiation treatment?

These are some questions you can ask your doctor before beginning radiation therapy:

• How will my radiation be administered?
• How long will I have to undergo treatment? How often? How long will each session last?
• How will I feel during treatment? Will I be able to drive myself to and from treatment?
• When will we know if the treatment is working?
• What can I do to take care of myself before, during, and after treatment?
• How will I look afterward?
• What are the side effects?
• What are the long-term effects?
• How often will I need checkups?

What questions can I ask my doctor about systemic therapy?

If your doctor recommends any type of systemic therapy (chemotherapy, hormone therapy, or biological therapy) you can ask the following questions about what to expect:

• What drugs will I be taking? What will they do?
• If I need hormone treatment, would you recommend drugs or surgery to remove my ovaries? Am I eligible for surgery?
• How long will treatment last? How often will I have to undergo treatments?
• Where will I go for treatment? Do I need to bring someone with me to take me home?
• What can I do to take care of myself during treatment?
• What are the side effects? Is there anything I can do about them?
• Will there be long-term effects?