15 Things to Know Before Breast Cancer Surgery
Questions to Ask Before Making Your Treatment Decision
Sassy Survivor Breast Health Alliance
Sassy Survivor Breast Health Alliance
An interactive guide designed to help you understand the questions you may want to ask before making your treatment decision.
Questions to Ask Before Making Your Treatment Decision
A breast cancer diagnosis can feel overwhelming. You may hear unfamiliar words, meet several doctors and feel pressure to make decisions quickly. Remember: you are an important member of your healthcare team. Ask questions. Take notes. Bring someone you trust with you. And make sure you understand your options before making a decision.
Not every recommendation on this list will apply to every person. Breast cancer treatment should be based on your specific cancer, your overall health and your personal preferences.
Hearing the words “You have breast cancer” can be frightening. Your first reaction may be, “Get it out of me as quickly as possible.” That feeling is understandable.
But before surgery, ask your doctors to explain exactly what has been found and what your treatment options are. Unless your medical team tells you there is an urgent reason to begin treatment immediately, use the time available to gather information and make an informed decision.
The first treatment decision can affect the treatments available to you later. Understanding your diagnosis before moving forward can help you make choices that are right for you.
If you are having a lumpectomy, ask your surgeon how they will determine whether all of the cancer has been removed and what happens if cancer cells are found at or near the edge of the removed tissue.
Sometimes another operation is necessary after a lumpectomy. Modern surgical techniques and updated guidelines about surgical margins can help reduce unnecessary repeat surgery.
You have the right to get another medical opinion before beginning treatment.
You might ask another breast surgeon, medical oncologist, radiation oncologist or pathologist to review your case—especially if you have questions about your diagnosis or treatment choices.
A second opinion may confirm the original recommendation or give you another option to consider. Most importantly, it can help you feel more confident about your treatment decision.
In most situations, breast cancer should be diagnosed with a needle biopsy before definitive breast cancer surgery.
Ask:
A biopsy does more than tell doctors whether cancer is present. The tissue can provide important information about the cancer that may help determine whether surgery—or another treatment—should come first.
If you are having a lumpectomy, ask whether oncoplastic surgery is appropriate for you. It combines cancer surgery with plastic-surgery techniques to help preserve or restore the breast's shape.
If you are having a mastectomy, ask about all of your choices, including reconstruction with implants, reconstruction using your own tissue, delayed reconstruction and aesthetic flat closure.
Removing the cancer is the priority, but your quality of life and how you feel about your body after treatment matter too. You deserve to understand your options before surgery.
Instead of simply asking the surgeon to “take a wide margin,” ask:
More tissue is not always better. Modern breast cancer guidelines define adequate margins differently depending on whether the cancer is invasive or DCIS and the treatment being given. Removing more healthy breast tissue than necessary may not improve the outcome and can affect the appearance of the breast.
Ask:
And if cancer is found in a sentinel node, ask:
Years ago, removing many lymph nodes under the arm was common. Today, some patients can safely have only a few sentinel lymph nodes removed—and some carefully selected patients may be able to avoid sentinel-node surgery altogether. Less lymph-node surgery may reduce the risk of lymphedema, numbness, pain and limited arm movement.
Instead of automatically requesting an MRI, ask:
MRI can be very helpful for certain patients, including some people with difficult-to-evaluate findings. But not everyone needs one. MRI can also find abnormalities that are not cancer and lead to additional biopsies or testing.
If radiation may be part of your treatment, ask about today's options.
Ask:
Radiation treatment has changed considerably. Some eligible patients can now receive radiation over a much shorter period than the traditional several weeks. The best approach depends on the cancer, surgery and individual risk factors.
Ask your medical team:
You can also ask about trials at other cancer centers if none are available where you are being treated.
Today's standard treatments exist because patients participated in yesterday's clinical trials. A clinical trial may provide access to promising approaches while helping researchers improve breast cancer care for future generations.
Breast cancer is not one single disease.
Ask your doctor to explain your pathology report, including:
Then ask:
Two people can have tumors of the same size and still need very different treatments. The biology of your cancer helps doctors determine which treatments are most likely to work.
Surgery does not always have to be the first treatment.
Ask:
This is called neoadjuvant therapy.
For certain breast cancers—including some HER2-positive, triple-negative, larger or lymph-node-positive cancers—treatment before surgery may shrink the cancer, make breast-conserving surgery possible and show doctors how well the cancer responds to treatment.
The response to treatment can also help guide what treatment may be needed after surgery.
Ask:
Testing may include genes such as BRCA1, BRCA2, PALB2 and others, depending on your personal and family history and current testing guidelines.
An inherited genetic mutation may affect your risk for future cancers, your surgical choices, certain treatment decisions and potentially the health of your relatives.
If genetic information could change your surgical decision, it may be especially helpful to have the results before surgery.
Genetic testing and genomic testing are not the same thing.
Genetic testing can look for inherited changes you were born with.
Genomic tumor tests—such as Oncotype DX and other validated tests—study characteristics of the cancer itself and are used only in certain types of breast cancer.
Ask:
For appropriate patients, genomic testing can provide additional information about the cancer's behavior and help guide decisions about treatment. It is not needed or useful for every type of breast cancer.
Don't wait until after surgery to learn about lymphedema.
Ask:
Lymphedema is swelling that can develop after lymph nodes are removed or treated with radiation. Knowing your baseline and recognizing early changes may allow problems to be addressed sooner.
Before leaving the doctor's office, ask:
And remember:
Your breast cancer diagnosis is more than the size of the lump.
Your treatment plan may depend on the type and biology of the cancer, its size and location, lymph-node involvement, imaging, genetic information when appropriate, your age and menopausal status, other health conditions—and your personal goals and preferences.
If having children in the future is important to you, ask about fertility preservation before beginning chemotherapy or certain other treatments.
Don't assume it is too late, and don't assume someone else will bring it up. Ask the question.
You have permission to:
Educational information only. This guide is not a substitute for individualized medical advice. Treatment recommendations should be discussed with your breast cancer care team.