Your top questions about breast cancer treatment, answered

When you find out you have breast cancer, it’s natural to have a lot of questions about what lies ahead. There’s a lot of information out there. And not all of it may be accurate or reflect the most current approaches to treatment.

One thing we know: Breast cancer treatment continues to evolve and save lives. “We treated pretty much everyone the same 20 years ago,” says Timothy Pluard, M.D. He’s the medical director at the Saint Luke’s Koontz Center for Advanced Breast Cancer in Kansas City, Missouri. Now doctors can customize treatments for each patient. “And as options continue to become more personalized, the survival rate can only increase,” he says.

Here are some key questions to ask your doctor (or your entire cancer care team, once you have one in place).

1. Which type of breast cancer do I have?

Your cancer type will determine which treatments will work best for you. Most breast cancers are invasive. That means they have spread outside of the milk glands and ducts into surrounding tissues, according to the American Society of Clinical Oncology (ASCO).

There are multiple types of breast cancer, including:

Ductal carcinoma. This is the most common type of breast cancer. It can either be contained in one area of the breast or it can spread.

• Ductal carcinoma in situ (DCIS). This is a noninvasive cancer. It’s found only in the duct, meaning it hasn’t spread beyond it.
• Invasive or infiltrating ductal carcinoma. This breast cancer has spread outside the ducts or lobules to other tissue in the breast. It is the most common type of ductal carcinoma.

Invasive lobular carcinoma. This type of breast cancer has spread outside of the ducts or lobules. It is the second most common type of breast cancer.

Other breast cancers. Less common types of breast cancer include inflammatory breast cancer, medullary, papillary, and more.

Cancer is diagnosed in stages 0 through 4. The higher the number, the more the cancer has spread.

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2. What kinds of experts will treat me?

Your cancer team will include more than one doctor. There will likely be several medical professionals who will take care of you during your breast cancer treatment. That group is known as a cancer care team. The doctors on your team will depend on your cancer type, stage, and treatment. Members could include:

• A breast cancer surgeon or surgical oncologist. This specialist treats cancer by performing surgery to remove cancerous tumors and cells. Surgery is a key treatment for breast cancer in stages 1 through 3, according to the American Cancer Society (ACS).
   
• A medical oncologist. This doctor treats cancer with medicine. Many options can be effective in breast cancer treatment. They include chemotherapy and immunotherapy. This specialist can help guide your cancer treatment. They can be by your side from your diagnosis until after your treatments end.
   
• A mental health professional. Having cancer is a stressful experience. That’s why it can be helpful to have the assistance of a mental health expert throughout your journey. You could see any one of the following:
  • Psychiatrist
  • Psychologist
  • Oncology social worker
  • Psychiatric nurse
  • Licensed counselor
  • Pastoral counselor

A radiation oncologist. This doctor treats cancer with radiation. Radiation therapy targets cancerous cells and is an important treatment for breast cancer. It can also lower the risk of breast cancer coming back.

A reconstructive surgeon. This doctor is a plastic surgeon experienced in breast reconstruction. If surgery is part of your treatment plan, you may want to consider having reconstructive surgery to rebuild the shape of your breast. It’s best to talk to your doctors about your options before you have surgery to remove your tumor, says the ACS.

3. What are my treatment options?

There are many different ways that doctors treat breast cancer. All of them involve some side effects. But with the survival rate high for early detection and treatment, the upside of treatment outweighs the cons. Your treatment could include one or more of the following:

Surgery. A surgical procedure removes the breast cancer tumor and any affected tissue.

“For newly diagnosed breast cancer patients, surgery is usually the first step, but not always,” Dr. Pluard says. Women with certain types of breast cancer will receive chemotherapy before they have surgery.

The two types of breast cancer surgery are:

• Lumpectomy. This surgery removes only part of the breast and a small amount of healthy tissue around the tumor. It’s also sometimes called breast-conserving surgery or a partial mastectomy.
• Mastectomy. This surgery removes the whole breast, and there are different types. You can have a mastectomy that saves the breast skin or the nipples. The size of the tumor compared to the size of your breast can impact what type of mastectomy you have.

Radiation therapy. This treatment uses high-energy x-rays to stop cancer cell growth. The most common is external-beam radiation therapy, according to ASCO. This is given from a machine outside your body. Treatment can happen over several weeks or several days.

There are other types of radiation therapy. Intra-operative radiation therapy is done with a probe. Brachytherapy places radioactive sources inside your tumor for a short period of time. Partial breast irradiation, also called PBI, is common after a lumpectomy.

Medication. There are a lot of different drugs that are used for breast cancer treatment. You may be given just one of these medications or a combination of them. They can also be paired with surgery and/or radiation therapy.

• Chemotherapy. These drugs stop cancer cells from growing and spreading. But they can also harm healthy cells. Common side effects include vomiting, nausea, and hair loss. This treatment is highly effective, and it is often the first medication used for breast cancer.
   
• Immunotherapy. This newer drug type improves the immune system’s ability to stop cancer cells, according to the ACS. Side effects include diarrhea, skin issues, flu-like symptoms, thyroid problems, and weight changes.
   
• Targeted therapy. These medications are more focused than chemotherapy. They aim to block the growth and spread of cancer cells without harming healthy cells. Potential side effects include a rash or other skin changes, per the ACS. There is also a small risk of heart problems.
   
• Hormone therapy. This treatment targets tumors that are sensitive to your body’s female hormones. The drugs stop hormones from fueling the growth of cancer cells. Some hormone therapy is taken for years. It can cause side effects such as hot flashes, night sweats, and vaginal dryness, according to the National Cancer Institute.

4. Do any other factors impact my treatment options?

Breast cancer treatment can be different for different patients. That’s not just because of the type of breast cancer that you have. Your care team will also consider the factors below to tailor a plan that’s right for you:

• The stage of your tumor
• Any genetic mutations
• Your overall health
• If you have gone through menopause or not
• Your age
• Your preferences

5. Should I get a second opinion?

Are you unsure about which treatment to choose? Or maybe you wonder if a different doctor would suggest other treatment options. Getting a second opinion can help you better understand your diagnosis and treatment plan options, according to ACS. It’s a common request, so you should feel comfortable asking your doctor about it.

Other reasons to seek a second opinion: If your hospital doesn’t have a specialist in breast cancer treatment. Or you and your doctor don’t seem to be communicating well.

You will likely have many other questions about your breast cancer treatment. You may wonder how it will affect your mental health or your fertility, for example. If you don’t understand something, ask your doctor or a nurse to explain it more clearly. Your care team will be there to answer your questions every step of the way.

Additional sources:
Types of breast cancer: American Society of Clinical Oncology
Stages of breast cancer: American Cancer Society
Medical oncologist: National Cancer Institute
Breast cancer treatment: American Society for Clinical Oncology
Reconstructive surgery: American Cancer Society
Hormonal therapy: National Cancer Institute
Immunotherapy: American Cancer Society
Seeking second opinion: American Cancer Society

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.