Step Four: Getting the News
Ask your doctor how and when the office will contact you. Think twice about giving your cell number. You don't want to be driving or in the grocery checkout line if you find out it is cancer. Be specific about whether or not the office can leave a message. Doctor’s offices are very careful about how you health information is disseminated.
Recruit a friend or family member to go with you if you're getting your results in person. (Many centers want you to come in for results, even if the diagnosis is not cancer.) Whether the results are negative or positive, you'll need to note some important details of your diagnosis.
If it's negative:
Get a photocopy of your pathology reports for your files.
Have your doctor carefully explain the results. There's a whole range of benign, from truly nothing to conditions such as atypical hyperplasia, which put you at risk for future cancer. Understand the symptoms you should watch for, your timetable for any follow-up visits, and when you should schedule your next mammogram. If the biopsy diagnosis is a benign condition that can be associated with a more significant pathology, your doctor may still recommend removing the lump with an excisional biopsy.
If it's cancer:
Once you've gotten the diagnosis, ask your doctor for the following.
* A photocopy of the pathology report for your files.
* Answers to the following questions:
What type of cancer is it? Invasive or non-invasive? (For help reading a pathology report, go to breastcancer.org's online guide.)
Did it begin in the ducts or in the lobules?
How large is it?
What is the clinical stage (the stage the doctor can assess with a physical exam)?
Is there evidence of invasion into blood vessels or lymphatic vessels?
What additional tests are required before treatment begins? (MRI, CXR, Bone scan, PET? CT? These will vary based upon the type of cancer and clinical stage.)
How does the doctor perform sentinel node evaluation?
Ask for a referral to a plastic/reconstructive surgeon and a radiation oncologist to help in your decision process.
Can the doctor connect you with a support group?
Is my tumor estrogen-receptor positive or negative? Progesterone positive or negative? Her2neu positive or negative?
Ask if you are a candidate for genetic testing for the BRCA I and II gene. (Risk factors include diagnosis under 40 or 50, Ashkenazi Jewish heritage, family history of ovarian cancer, Hx bilateral breast cancers, premenopausal breast cancers, male relatives with breast cancer.)
Today many women with early-stage breast cancer should request that the biopsied tissue be genetically analyzed. One test, Oncotype DX, examines tumor genes and predicts risk of future recurrence. This crucial knowledge can drive your treatment decisions. This test should only be ordered after your lymph nodes are examined and found not to have tumor cells in them.
Beth B DuPree, MD, FACS, is chair of the Board of Advocates of the American Society of Breast Surgeons and the medical director of the Breast Health Program at Holy Redeemer Hospital in Meadowbrook, Pennsylvania.
Also see: "How to Get a Second Opinion Fast"
MORE's profile of Dr. Beth DuPree, "The Good Doctor"
A former patient writes "How Dr. Beth DuPree Saved My Life"
Originally published in MORE magazine, October 2007.
Updated October, 2009.
