Though most women may know the basics, like the percentage diagnosed with breast cancer over their lifetime, they may not know how to ensure they’re in good hands during screening or after diagnosis.

Are you at risk?

Breast cancer isn’t one kind of cancer; it is many different types. Knowing that it is ductal or lobular carcinoma is no longer enough. Within its cell structure are many specific features informing scientists that breast cancer is made up of hundreds of different types of breast cancer. This also helps scientists better understand why it has been so hard to cure and prevent.

Know your risk factors: Family history of breast or ovarian cancer, taking HRT, drinking alcohol, smoking, obesity, having atypical cells on a breast biopsy. Don’t have any risk factors? Well, being female is technically a risk factor, however 85 percent of women diagnosed don’t have the risk factors listed above. One in 8 women will be diagnosed with breast cancer in their lifetime, meaning by the age of 85.

Know the geography of your breasts. You should know your breasts better than anyone. Even though they may be lumpy and bumpy, those lumps and bumps are “your normal” and you should be checking your breasts monthly, at the same time of the month, to see if there is a change.

Take an active role in reducing your risk. Follow lifestyle behaviors such as regular exercise, maintaining a normal weight, avoiding smoking, limiting alcohol and adhering to a healthy, well-balanced diet that’s rich in green and orange veggies.

Facing a diagnosis

An accurate diagnosis leads to the right treatment plan. There are various types of breast cancer, as well as various types of mutated cells that can mimic a cancer cell. Make sure the pathologist reading the breast biopsy specimen slides as well as the pathology slides from breast surgery specializes in breast cancer. If the pathology is wrong then the treatment will also be wrong.

"Women should only give breast cancer the time it requires to get rid of it. It doesn’t deserve to take away her social time, personal time, work time or family time."

Digital mammography is 28 percent more accurate than analog (X-Ray film) mammograms. Tomosynthesis, which is a 3-D mammogram, now available at most breast imaging facilities, is even better at detecting breast cancer early. Also, inquire to ensure the radiologist reading the mammogram is a dedicated breast imaging radiologist and not a general radiologist.

Once diagnosed with breast cancer, be sure to be in the hands of breast specialists; that means breast surgical oncologists, breast medical oncologists, breast radiation oncologists, breast genetics experts, breast pathologists, breast cancer rehabilitation therapists and breast nurse navigators. Survival rates have been proven to be higher, no matter what the stage of breast cancer it is, when you are cared for by those dedicated to the treatment of this disease.

Survival and beyond

The goals of treatment today should no longer be limited to just survival. Women deserve to also have their life goals preserved—fertility preservation, staying on track for the next promotion, becoming a concert pianist. If the treatment team doesn’t know what these life goals are, treatments given to the patient may cause her to forfeit these life goals. That means cancer has stolen away even more of her life than it should.
 

Women need to speak up and make their doctor aware of what these life goals are and request that they be factored into the decision making about treatment options. Women should only give breast cancer the time it requires to get rid of it. It doesn’t deserve to take away her social time, personal time, work time or family time.

Speaking of working, most breast cancer patients can work during their treatment too. Scheduling chemotherapy so that if side effects occurred they would happen when she is off from work rather than occurring in the middle of the week.

A personalized approach

There are more treatments for breast cancer than ever before. Personalized medicine and targeted therapies are resulting in more long-term survivors. Though 80 percent of women diagnosed today are candidates for lumpectomy surgery, many are choosing to do mastectomy and even bilateral mastectomies. Doing a bigger surgery however doesn’t result necessarily in a higher survival rate.

Breast reconstruction is more sophisticated than ever. Implants are still an option but transferring body fat from one location (tummy, buttocks, inner thigh) has become a popular choice. Reconstruction for those diagnosed with breast cancer is required to be covered by private insurance too.

Though the vast majority of women diagnosed today will become long-term survivors, there continue to be about 39,000 who are forced to succumb to this disease annually. These individuals dealing with stage 4 breast cancer report feeling isolated and misunderstood. Society assumes that they have neglected their health resulting in breast cancer spreading to other organs within their body, which is rarely the case.

On a positive note, more women with metastatic disease are living longer—even decades—thanks to improvements in treatments. They too have life goals they want to fulfill. Some may need to be fulfilled in alternative ways, such as having cards for their children when they reach specific milestones in their lives. What does she want to tell them on that special day?

Do no harm

Physicians are embracing the Hippocratic oath. For elderly women diagnosed with breast cancer, doctors are looking more compassionately to determine what treatments really are needed and which ones are not. Treatment for treatment sake is bad treatment. So if someone has severe cardiac disease, is also a diabetic and is 89 years old and living in an assisted living facility, her treatment for an early stage breast cancer may be limited to just taking a pill or, if slow-growing, even no treatment at all.

Some side effects can occur months or even years after treatment is completed—some are known, many are not. Research is focused on learning what they are but this takes decades of study. So being mindful of one’s body is important. If a new symptom arises, the survivor should get it checked out.

Genetics and genomics

There are more genes that have been identified in the last few years that are linked to causing breast cancer. There are also sophisticated pathology tests done by specialty labs that can provide more information about one’s breast cancer, what treatments are most appropriate to receive and who is most likely to have a recurrence. Such information can be really helpful in determining the treatment plan.

"Cancer survivorship doesn't start at the end of treatment; it starts at the moment of diagnosis. That means keeping a woman on track for her life goals, and dovetailing those goals with her treatment plan."

Due to a growing shortage of oncology specialists, it is no longer rational to be followed by an oncologist in the long term. At some point after completion of acute treatment, the breast cancer survivor needs to be transitioned back into the arms of their community PCP and gynecologist. And ideally, these two community providers should remain aware and involved in her care while she is receiving her treatment, thus following a shared care model.

The survivor needs to be on top of her schedule so that she knows when she is due for an exam, a cancer screening of any kind, living a healthy lifestyle to reduce risk of occurrence and risk of another new cancer of a different kind.

The new normal

Women are commonly told after treatment is completed to go “find their new normal” or “adjust to their new normal.” But it is better to “create your new normal” beginning with remaining on track for your life goals, taking charge of your health and finding opportunities to make a difference in this world. And for women with metastatic disease whose new normal is constantly evolving, they need to know their purpose for living and what legacy they want to leave that is not monetary in its intent.

Cancer survivorship doesn't start at the end of treatment; it starts at the moment of diagnosis. That means keeping a woman on track for her life goals, and dovetailing those goals with her treatment plan. No one should sacrifice their future goals to this disease if they don't have to. This means fertility preservation before chemotherapy for women hoping to start or expand their family in the future; cancer rehabilitation to prevent fatigue and other side effects; and creating a flexible work schedule with a treatment plan to enable her career to remain on track.