There is legislation in California (SB 112) that mandates patients be given their treatment options prior to a physician performing a breast biopsy or treatment for breast cancer (surgical and/or adjuvant). The booklet, A Woman's Guide to Breast Cancer Diagnosis and Treatment was developed under the mandate of SB 112. The booklet is available to physicians by writing to Breast Cancer Treatment Options, Medical Board of California, 1426 Howe Ave., Suite 54, Sacramento, CA 95825. Requests can also be faxed to (916) 263-2479. The treatment descriptions below have been adapted from the booklet.
 

Doctors used to believe that it was best to biopsy a woman's lump and remove her breast in the same operation if cancer was found. A woman went into surgery for a biopsy not knowing whether she would wake up with her breast. This rarely happens today.

• You have time to make a decision after your diagnosis. This will allow you to:

• Read more and think through the information.
• Obtain pathology report findings.
• Consult with your healthcare team.
• Get a second opinion.
• Contact WIN ABC for more information.
• Talk to other women who have had breast cancer.
• Have a complete study of your breast tissue, and, if needed, of other parts of your body.
• Prepare yourself and loved ones for your treatment.

Primary and Adjuvant Treatment Options for Breast Cancer

There are three basic forms of therapy that are utilized in the management of breast cancer:

1. Surgical procedures to establish the diagnosis (biopsy), to remove the local disease in the breast (lumpectomy, mastectomy) and to estimate the extent of the disease.
2. Radiation therapy to control local disease in the breast or to treat specific sites of spread.
3. Chemotherapy and hormone therapy to treat cancer in the breast, to reduce likelihood of recurrence and to treat known spread of breast cancer to other body sites.

In most situations, effective therapy involves use of more than one form of treatment.

Surgical Options (synopsis - details)

Most women who have breast cancer today are diagnosed with Stage 0, I, or II breast cancer. Many of these women will live a  long life. Most of these women can choose Lumpectomy and radiation therapy, OR Mastectomy. Studies show that both options provide the same long-term survival rates. However, neither option gives you a 100% guarantee that cancer will not return at the treated site.

Whichever choice you make, you will still need medical follow-up and monthly breast self-exams for the rest of your life. And whether you have a lumpectomy or mastectomy, your surgeon will usually remove some of the lymph nodes under your armpit. This procedure (an axillary node dissection) is most often done at the same time as the breast surgery. If cancer is found in the lymph nodes, your doctor will talk to you about additional treatments. 

Sentinel Node Biopsy is a technique developed to help avoid removal of a large sampling of lymph nodes from the underarm (axilla) area that may lead to swelling (lymphedema) in the arm. This procedure is performed by injecting a small amount of blue dye and/or a radioactive material around the breast tumor. The surgeon observes the dye as it travels along the lymph channel that connects the breast to the axillary lymph nodes. The first lymph node that turns blue - the "sentinel node" or "gatekeeper" - is removed and examined for tumor cells by a pathologist. If no tumor cells are found, it can be safely assumed that no tumor cells have spread into other lymph nodes. (This procedure should only be performed by surgeons who are experienced with it.) These additional therapies are designed to control and kill cancer cells that could be in other parts of your body. The advantage: Finding out the stage of your cancer. 

Radiation Therapy (synopsis - details)

In most cases, a lumpectomy is followed by radiation therapy. High-energy radiation is used to kill cancer cells that might still be present in the breast tissue. There are times when radiation will be suggested after a mastectomy. Thoughts to remember about radiation therapy: 

1. You often will be alone in a room, but your radiation therapist can hear you and see you on a television screen.

2. The treatment lasts a few minutes. You will not feel anything. 

3. The radiation is delivered to a small area - your treated breast. 

4. You are NOT radioactive during or after your therapy.

5. You CAN hug, kiss, or make love as you did before your therapy. 

Chemotherapy and Hormone Therapy (synopsis - details)

Research suggests that - even when your lump is small - cancer cells may have spread beyond your breast. Most of these cells are killed naturally by your body's immune system. When the growth of cancer cells is large enough to be detected, it means that your immune system is having difficulty fighting the cancer and needs additional help. 

Help in killing cancer cells comes from two other forms of therapy - chemotherapy and hormone therapy. The drug, Herceptin, is a relatively new breakthrough in the treatment of breast cancer. Herceptin can be effective for patients that have an overabundance in their tumor cells of a gene called HER-2/neu. About 30% of women with breast cancer fall into that category. It is the first successful treatment (Gene Therapy) that targets a specific genetic alteration. Herceptin avoids the serious side effects associated with traditional chemotherapy, such as hair loss and significant drops in blood counts. Herceptin has been approved by the FDA for treatment in metastatic breast cancer. However, clinical trials have begun to test Herceptin as a first time treatment for early stage cancer. A pathologist can determine if the patient is positive for HER-2/neu when a biopsy is performed, and the tumor submitted for a test called Herceptest. 

Now, more than ever before, these treatments are chosen for your individual case: your age, whether you are still having periods, and how willing and able you are to cope with the possible side effects. 

Questions to ask your doctor: Do I need chemotherapy? What drugs do you recommend? How successful is this treatment for the type of cancer I have? How long will I need chemotherapy? Can I work while I'm having chemotherapy? What are the benefits and risks? 

Breast Reconstruction (synopsis - details)

Breast reconstruction - surgery to "rebuild" a breast - is a routine option for any woman who has lost a breast because of cancer. California law requires that group health insurers pay for reconstruction and for surgery to the other breast to obtain a good match. Reconstruction will not give you back your breast. The rebuilt breast will not have natural feelings. But the surgery can give you a result that looks like a breast. If you are thinking about reconstruction, discuss this option with a plastic surgeon before your mastectomy. Ask your surgeon for a referral to an experienced plastic surgeon. Some women start reconstruction at the same time as their mastectomy; others wait several months or even years. Your body type, age, and cancer treatment will determine which reconstruction will give you the best result. 

It is normal to have trouble coping with a diagnosis of breast cancer. And it is normal to ask questions about it. As you go through the diagnosis and treatment processes, you may find it helpful to write out questions before you meet with your doctor. Some of them might even be right here. Most important, never be afraid to have information repeated and to ask questions. There is no "dumb" question when you are faced with cancer. To help you further, you may want to tape record information that is given to you, and consider asking a friend or family member to come with you during health care appointments. For more information, contact WIN ABC. 

Last Updated: 06/01/2004

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