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.
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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
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
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
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
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.