Breast Cancer Diagnosis and Treatment Questions to Ask Your Doctors

If you have received a positive or possible diagnosis of breast cancer, there are a number of questions that you can ask your doctor. This outline is designed to provide a framework to help you and your family make certain that most of the important questions in breast cancer diagnosis and treatment have been addressed. Each individual case is different, so not all questions will apply in every instance. The answers you receive to these questions should give you a better understanding of your specific diagnosis and the corresponding treatment. In addition, your doctor's ability to address your questions will give you some assessment as to the quality of care to be provided.

Biopsy and Pathology

> What kind of biopsy am I having? (fine needle aspiration, core biopsy, surgical excision) How will this be performed (with ultrasound or mammographic/stereotactic guidance or by palpation)? Will this be done in the office or in the operating room? What sort of anesthesia will I be having? Why?

>What kind of tests will be performed on the tissue?
> How soon will I get the results?
> What is the importance of the pathology report? Have your surgeon explain your pathology report and make sure to get a written copy. 
> Have my slides been reviewed by more than one pathologist? Does this pathologist review a large number of breast cases?
> Should any other tests be performed on my tissue biopsy? Are there any tests that have been done on the tissue that are still pending?

Diagnosis

> What kind of breast cancer do I have?
> Is it invasive cancer, or in situ?
> What is the size of the tumor?
> Has my cancer spread to lymph nodes? If so, how many were positive? Should there be tests performed to evaluate possible spread to internal organs?
> What is the stage of my cancer? What does that mean regarding prognosis and treatment options?
> What are the other characteristics of my cancer:

• How aggressive are the cells (nuclear grade)?
• Were cancer cells found in the blood vessels/lymphatic system? How does this affect my treatment options?
• Were the cells estrogen and progesterone positive or negative and to what extent? HER2 positive?
• What is the S phase (how many cells are dividing)?
• Did you get clear margins?

>Do I need any additional tests and why do you recommend them?
> What treatment choices do I have? What do you recommend? Why?
> What are the risks or side effects of different treatments?
> What are the chances of my cancer coming back with the treatment you suggest?
> Am I eligible for any clinical trials?
> Is my family history relevant to my recommended treatment?
> Should genetic testing be part of the treatment decision process?
> Do you work as part of a breast cancer treatment team? Who are the other members? Which specialists should be part of my team?
> How urgent is it that I make decisions and begin treatment?
> What are my chances of survival, based on my cancer as you see it?

[Get a second opinion. If possible, select a doctor who is not associated with the same hospital as your first doctor.]

About Surgery

> What are the options of surgical treatment and what do you recommend? 
> What are the advantages and disadvantages of each choice? 
> Does your practice include only breast surgery or general surgery? How many operations of each type have you performed? 
> Am I a candidate for sentinel node biopsy? Please explain what that procedure entails. Do you test the node(s) in the operating room by frozen section or touch prep? What will happen if my node is negative? Positive? 
> How long will it be before I have surgery? 
> Do you recommend chemotherapy before surgery (neo-adjuvant) or surgery and then chemo (adjuvant)? Why? 
> What is the recovery period from my surgery? 
> What side effects might I experience? Any physical limitations? How long will they last? 
> Do I need to arrange to have help at home? Should I arrange for a private duty nurse on the night of surgery? 
> Will I have normal feeling in my breast after treatment?

Listen to this podcast regarding pre-op and post-op care:   https://directory.libsyn.com/episode/index/show/diepcjourney/id/21329339

Reconstruction

> If I am advised to have a mastectomy, what kinds of breast reconstruction are possible in my case?
> If I do not choose reconstruction, what prostheses or breast forms are available?
> What are the issues with silicone vs. saline implants?
> What are the risks and benefits of immediate breast reconstruction?
> How many operations are needed? How long a hospital stay is necessary for each?
[Before making a decision, ask your surgeon to show you photographs of a full range of results – not just "showcase" chests.]

Adjuvant Therapies

(Radiation, Chemotherapy, Hormonal Treatments, Alternative Treatments)
> Is neo-adjuvant or adjuvant therapy recommended for me? If so, what kind?
> If more than one, in what order?
> Will I go through menopause as a result of my treatment?
> Will I lose my hair? If so, what can I do about it?
> How often will I be given this treatment?
> How long will each course of treatment last?
> Will I need a port and where will it be inserted?
> Will I be able to drive myself home after treatment or will I need help?
> Will I be out of work? If so, for how long?
> Will I be able to have children after my treatment?
> Please explain any long-term risks from this treatment.
> Even though my breast tumor does not have hormone receptors, should I take tamoxifen or another drug to reduce the risk of a new tumor?

Insurance

Find out what is covered under your policies and any pre-approvals required.
> Are there certain hospitals or doctors I must use?
> Will the proposed treatment be covered?
> What part of the payment will I be responsible for?
> What is the maximum payment allowed? Is a second opinion covered? Required?

Other Points

Bring a friend/relative with you to your doctor visits especially when you expect to receive your diagnosis so you have a second set of ears to hear what is discussed with you. Your doctors should be able to explain to you and your companion your diagnosis and treatment options so you can understand them. If they cannot, you should see another doctor! Your doctor should be responsive to follow up discussions by phone/email or in person.