Breast Cancer Diagnosis: Addressing Questions and Concerns
Nadine M. Tung, M.D.: So, Kristin, what are some of the common questions that patients with newly diagnosed breast cancer ask you?
Kristin E. Fleischmann-Rose, NP: The patients want to know, if possible, about the stage of their disease, which basically translates to how much disease they might have. They want to know the grade of the cancer, another way of saying how aggressive it might be. Patients want to know what their treatment is going to be and if they have any options for treatment. For example, they might ask if they’re a candidate for a lumpectomy. They might ask if they could consider bilateral mastectomy: that’s having both breasts removed. They might ask how long radiation would be. They might ask if we think that they’ll need chemotherapy.
Nadine M. Tung, M.D.: Another question that I’m often asked by patients who haven’t had breast cancer is how breast cancer is diagnosed. A lot of women want to know if it’s painful. Breast cancer is usually not painful. It’s usually diagnosed as a result of an abnormality on a mammogram or because a patient or their health care provider felt a lump. So that usually leads to a biopsy. The diagnosis of breast cancer is made, and then that sample of tissue, the breast cancer, is taken and stained for those three receptors that we spoke about at the beginning that classify the breast cancer into one of those three groups. They’re stained for the HER2 [human epidermal growth factor receptor 2] receptor, the estrogen receptor, and the progesterone receptor. Occasionally, to determine the HER2 status, the tumor sample needs to be sent for a more specialized test called FISH [fluorescence in situ hybridization] in which the test is really looking at how many HER2 receptor copies there are inside the cancer cell.
Kristin E. Fleischmann-Rose, NP: What do you tell patients about how their stage impacts their treatment goals and the decisions around that?
Nadine M. Tung, M.D.: That’s an important question. So stage 1, stage 2, and stage 3 are all considered local breast cancer, which means breast cancer that has not spread beyond the breast or the regional lymph nodes. And that’s important because the purpose of treatment for patients with stage 1, 2, and 3 disease is curative, and therefore the treatment often does entail combinations of more toxic therapy and for a limited time period. Chemotherapy might be for two months or for four months, and that’s in contrast to patients who have metastatic disease or stage 4 disease. In that scenario, the intention of treatment is really not for cure. It certainly is to prolong life, but it is to try to control the disease with good quality of life. And it’s important to remember that the treatments will probably be continuous for the rest of a woman’s life. We really want to choose therapies that are less toxic. They’re effective but less toxic. So let me ask you, Kristin, what advice do you give to a newly diagnosed patient?
Kristin E. Fleischmann-Rose, NP: One of the most important things I encourage patients to do is to not Google their disease. The reason is that somebody else’s experience will not be a blueprint for our patients’ experience. Patients will have a care team and that care team — their providers, their nurse practitioners — will provide them with a detailed plan of care. And also these are resources to whom they can ask questions.
Nadine M. Tung, M.D.: So, Kristin, how do you address the individual concerns of patients and what advice do you have for newly diagnosed patients?
Kristin E. Fleischmann-Rose, NP: I always allow time for questions, which is one of the most important things. I provide plans in writing, so that patients can reference them later. We strive to provide culturally appropriate care and instructions at an appropriate educational level. In terms of advice, I discourage most patients from Googling their diagnosis. The reason for this is that another patient’s experience is not going to be a blueprint for their own. Every patient, of course, is going to have a provider team, including doctors, nurse practitioners, and nurses. These providers are going to provide patients with a detailed plan of care, and these are resources that patients have for answering questions. At our institution, we will sometimes encourage patients to get a second opinion if they need one. This helps them to understand what their treatment options are and feel empowered by their choices.
Nadine M. Tung, M.D.: And are there any other resources available to patients that you recommend?
Kristin E. Fleischmann-Rose, NP: At our institution, we’re very fortunate to have three oncology social workers. These social workers provide support for the patients themselves and for their family members. They can help patients deliver the news to family, friends and children. We’re also lucky enough to have a resource specialist who can help patients with rides, hotel stays and some financial resources like gift cards. In terms of websites, we like the National Cancer Institute and the American Cancer Society web pages. We feel that these are the best online resources for providing answers to many of the questions patients might have about their diagnosis and treatment.