What Breast Cancer Treatment Is Right for You?

Breast Cancer, Featured Article
on October 1, 2013
Woman in doctor's office frowning

MOST WOMEN WHO’VE HAD BREAST CANCER want to do whatever it takes to avoid its return. And who can blame them? Yet new research suggests that some patients—and doctors—may be opting for more treatment than necessary.

A study at the Humanitas Cancer Center in Milan, Italy, for instance, followed 749 women at 11 centers in Italy after surgery alone or surgery plus radiation. The women were ages 55 to 75 and had tumors 2.5 cm or less that had not spread. The study found no significant difference in the return rate of cancer among the women in the two groups after nine years.

A 2012 study at the University of Michigan of 1,446 women treated for breast cancer found that about 70 percent of women who had both breasts removed after a breast cancer diagnosis did so despite a very low risk of getting cancer in the healthy breast. The researchers said that in most cases the decision was driven by fear of recurrence.

While the idea that less treatment may be just as effective in eradicating breast cancer is undoubtedly good news, it does make an already tough decision more complicated. Under such scary circumstances, getting answers to the following questions should help you decide when less aggressive breast cancer treatment is the right choice for you.

1. Should I get a second opinion? “If you’re troubled by feeling a decision is all up to you, get a second opinion,” says Dr. Mary Jane Massie, attending psychiatrist at Memorial Sloan- Kettering Cancer Center in New York City, who counsels women through these decisions every day. “But go in with an open mind. If you want someone to agree with your preconceived notion, you can probably find someone who will— whether it’s minimal treatment or three buckets of treatment.”

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Getting a second opinion doesn’t mean abandoning the first doctor, says Massie: “It may help clarify your decision. But remember that 23 opinions are never useful.”

2. What are my feelings about each option and why? “If a woman is offered the choice between mastectomy plus reconstruction versus limited surgery and radiation, some might say, ‘I’ve seen many women I love die from breast cancer, so for me, the best option is a mastectomy,’” says Massie. “But another woman might say, ‘I’m young, I had hoped for a partner and to nurse my children, so for me the limited surgery and radiation is best.’ It depends where a person is in life.” Going over those feelings with your doctor will help him guide you and also help clarify your feelings.

3. Are the options equal or is one preferable to another? “Many women aren’t given an optional choice by their doctor,” says Massie. “The doctor may say, ‘This is my recommendation, period.’ But sometimes a doctor says these are equal choices. That’s when your personal preferences come into play.” Ask about the risks and benefits of each option, says Massie: “And ask, ‘If I do nothing, what is the chance I will die?’ ‘If I do x, what is the likelihood that the cancer will recur?’ That’s when the trust in your doctor comes into your decision.”

Once you have made a decision based on the best information from your doctor and your own research, try to avoid second- guessing yourself, says Mary Dev, a social work counselor at MD Anderson Cancer Center in Houston.

“Nothing is 100 percent guaranteed,” she says. “You have to make the best decision for yourself given the options you’re presented with.”

4. Should I consult with a cancer psychologist or psychiatrist about my decision? Most decisions about cancer treatment don’t have to be made in a rush, says Massie. “Comprehensive cancer centers have mental health professionals who realize how over- whelming these decisions are,” she says. “Meeting with a psychologist or psychiatrist can help you prioritize your questions, and sort through what is trivial versus what is important.” Such discussions can help both you and the counselor understand how you’ve made decisions in the past, which can help you decide what is right now.