What do I do if I've been diagnosed with breast cancer?

Again it is important to keep breathing! Find your support system. Realize that life has changed but not ended! A diagnosis of breast cancer is not a death sentence and it is not an emergency. A woman has time to find out as much as she wants to know about her diagnosis. I tell women it is like going back to school in a class you never wanted to take but you will pass. I would first recommend that a woman or her partner find the nearest Breast Center — most cities or universities now have one, if not several. These centers, however, need to be more than imaging centers and should have multidisciplinary teams of breast surgeons, oncologists and radiation specialists. www.breastcare.org. If you are unable to find a breast center it is important that you have confidence in your surgeon, usually the person that first diagnosed you, and that she/he has contacts with medical and radiation oncologists. There are websites of breast surgeons also — www.breastsurgeons.org . However, some people choose not to belong, or cannot afford the membership fees to all these organizations, so the fact that your surgeon does not belong does not mean that she/he is not good. However, all surgeons should be board certified. Many surgeons are now choosing to specialize in breast and have practices where they only do breast surgery. If you want this type of care you should be able to find it.

www.womensurgeons.org/CDR/Breast.htm

There are several websites that cover the basics and overview of breast cancer treatment options. Here are my favorites —

There is a lot of information on these sites, and many diagrams and search functions. Some of the sites also have subscription newsletters and links to other sites.

Also, now there are many books on the topic. My favorite still remains one of the first — Dr. Susan Love's Breast Book. A Breast Center should also have a library of information, pamphlets, brochures, videos and check lists — www.educareinc.com/patient .

A woman is usually referred first to a surgeon. Again, most general surgeons are trained in breast surgery, but there is a growing specialty of breast surgeons who see and operate only on breasts. Many women prefer to see a specialist. A woman, however, should feel comfortable with her surgeon and get as many opinions as she wants to find this person who often is the "captain" of her team.

A woman and her support team should be provided with the "standard of care" for breast cancer. This standard usually includes surgery, radiation and some type of systemic or total body care.

Surgery in 2003 should include a choice between a lumpectomy and mastectomy. Women should understand that both types of surgery can offer the same long term survival. www.healthandage.com. Both usually are accompanied by a relatively new procedure called sentinel node biopsy. www.cancernews.com/. Sentinel node biopsies in breast cancer have become standard-of-care in 2003, and a woman should request that it be done. There are only very few cases where it cannot be done. Sentinel node biopsies reduce the time of surgery and most of the post operative complications for many women. The surgical experience can be made into a very positive one instead of a frightening trip if one wants to use some new techniques. www.healfaster.com

The important thing to me is that women feel that they have received as much information as they want, and they understand their options. Different women have different priorities and these concerns also need to play into the equation. Some women would truly rather die than have their breasts removed; others want their breasts removed even when they don't have cancer. However most women fall somewhere in between and just need to take time to come to a decision. Women are obviously not children and can make their own choices. A woman should never feel like she was railroaded into a decision. I see too many women who are told they had to have a mastectomy because "it" was better.

If a woman chooses to have a lumpectomy she will be recommended to have 6 to 7 weeks of radiation treatments. These treatments last about 5 minutes, but a woman has to go everyday — Monday to Friday. Most women have no problems. Some get very tired toward the end, however I've found that acupuncture helps this a lot. Some women are very sensitive to radiation and need to detox their bodies during and after. I usually recommend that women use some seaweed or kelp products. The breast skin can get severely burnt and women are encouraged to use aloe by mouth or on the skin. Most women's white cell counts will be depressed for some time after radiation. I haven't found a simple antidote for this. Radiation is recommended to decrease the chance of reoccurrence — found to be at least 30% in major studies. There does not seem to be any improvement in survival from the radiation. Radiation is considered standard of care but is not mandatory. New techniques are being developed to deliver radiation during surgery.

Breast cancer is now considered a systemic (affecting the total body) disease and treated as such. Surgeons once thought that they could cure breast cancer with the knife. This has been proved wrong except perhaps in very small cancers. Therefore, now more and more women are encouraged to see a medical oncologist to have some sort of adjuvant (additional) therapy, usually chemotherapy and/or hormonal therapy. Most of the information about the benefits and risks from these treatments can be found on the websites above. Unfortunately we do not have the magic pill to cure or prevent breast cancer YET. Systemic therapies can usually stop the cancer from returning for some years and for many women, for life. However they don't work for all women and some women are probably getting them unnecessarily. They are probably the best we have at this time, but keep tuned for newer ongoing research into vaccines, teleomerases, and tumor profiling. Again, a woman should feel she has been presented with the facts and statistics regarding the benefits and side effects. For some women even a 1 to 2% advantage is enough to do everything, for others the thought of chemo-brain is enough to outweigh any benefit. We are all different. Get as many opinions as you want and find a support team to bring with you!!!

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