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Expert Q&A: Getting the Best Breast Cancer Treatment

An interview with Duke University Surgeon Lee Gravatt Wilke, MD
By
WebMD Feature
Reviewed by Louise Chang, MD

Each year in the United States, close to 250,000 women learn they have breast cancer. As they deal with their diagnosis, they are also asked to make daunting decisions about how to best fight their disease.

New patients facing treatment need to understand their options, and that means learning all they can about their cancer, says breast cancer surgeon Lee Gravatt Wilke, MD.

Breast Cancer: Me & the Girls

When breast cancer hits home, it's personal. WebMD shares stories and advice from women who know what breast cancer is like firsthand.

  • Zunilda Guzman, 39, had both breasts and ovaries removed after learning she had breast cancer and a high-risk gene.
  • Pamela Cerceo, 51, had both breasts removed even though she didn’t have breast cancer.
  • Diane Morgan, 71, offers advice on what friends should and shouldn't do when someone has breast cancer.
  • Jenee Bobbora, 39, chose not to have breast reconstruction after her mastectomy.
  • Tammy Joyner, 49, talks about telling her sons she had breast cancer.

Read more stories: 

 

Wilke, who is an assistant professor of surgery at Duke University Health System and a board member of the NavigateCancer Foundation, shares with WebMD some of the things breast cancer patients need to know.

Q: What are the questions you recommend all breast cancer patients ask their doctor?

A new patient may be referred to a surgeon or in some programs they may see a team of providers that will help them understand their treatment options.

Some basic questions to ask are:

  • What type of cancer do I have? Is it ductal or lobular or a different variant?
  • What stage is my tumor and how big is it? Is my cancer localized to the breast (in situ) or has it spread to my lymph nodes?
  • What are the characteristics of my tumor? Is it fueled by estrogen (estrogen-receptor positive) and is it HER2-positive. About 25% of breast cancer patients have HER2+ tumors, which tend to be more aggressive.
  • Should I be tested for a BRCA mutation? A treatment consultation should always include questions about family cancer history. A woman with close relatives who have had breast or ovarian cancer or had cancer at an early age may want to be tested.
  • What are my surgical options? Many patients are candidates for either breast-conserving surgery with radiation or mastectomy, in which the breast is removed.
  • Should I see other providers, such as an oncologist or radiologist?

As soon as someone learns they have breast cancer, they should start learning about the condition; and it is the doctor’s job to help you learn.

Q: I’m anxious to start treatment, but I need more time to consider my diagnosis and treatment options. How long do I have to decide on a treatment course?

Ideally, we like to have a treatment plan within two to three weeks of diagnosis, but if a patient is going for second opinions and needs more time, that is usually OK. I tell most of my patients they shouldn’t wait longer than a few months to start treatment, though, because cancers do grow in that time.

Q: When should I seek a second opinion?

A second opinion is important for a patient who doesn’t feel she understands her treatment options.  With some late-stage cancers there aren’t a lot of options, but with most early stage cancers there are. The patient should be the driver. If the patient doesn’t understand the treatments being proposed or wants to hear about them in a different way, a second opinion is important.

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