Breast Cancer (cont.)
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Breast cancer facts
- What is breast cancer?
- What are the different types of breast cancer?
- What causes breast cancer?
- What are breast cancer risk factors?
- What are breast cancer symptoms and signs?
- How is breast cancer diagnosed?
- How is breast cancer staging determined?
- What is the treatment for breast cancer?
- What is the prognosis of breast cancer?
- Can breast cancer be prevented?
- What research is being done on breast cancer? Should I participate in a clinical trial?
- I may have breast cancer. What questions should I ask my doctor?
- Is the doctor sure I have breast cancer?
- What type of breast cancer do I have?
- What difference does a precise diagnosis make?
- What has been done to exclude cancer in other areas of the same breast or in my other breast?
- What type of medical team do I need for the most accurate diagnosis?
- Is my family history relevant to my breast cancer diagnosis?
- What other studies should be done on my tissue biopsy?
- How urgent is it that I make decisions and begin treatment?
- Should I stop taking hormone therapy (HT)?
- Even though my breast tumor does not have hormone receptors, should I take tamoxifen to reduce the risk of a new tumor?
- I have a ductal carcinoma in situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?
- Should I start chemotherapy before surgery?
- If I am advised to have a mastectomy, what are the risks and benefits of immediate breast reconstruction?
- Should my lymph nodes be removed?
- What is a sentinel lymph node biopsy and what are its benefits and risks?
- Are there any other questions I should ask my doctor?
- Breast Cancer FAQs
- Find a local Oncologist in your town
What difference does a precise diagnosis make?
The importance of an accurate diagnosis cannot be overstated. It is the precise diagnosis that determines the recommended treatment. Treatment must be specifically tailored to the specific type of breast cancer as well as to the individual patient.
Your doctor should be able to give you a clear description of your type of breast cancer along with the treatment options that are appropriate to your case.
What has been done to exclude cancer in other areas of the same breast or in my other breast?
Unfortunately, there are some patients who may have more than one area of malignancy in the same breast or even an additional malignancy in the other breast. If this does occur, it can greatly change the recommendations for treatment.
Therefore, it is critically important that your doctors carefully investigate beyond the immediate site of the tumor to make certain there are no other areas with possible malignancy.
Sometimes discovering these "secondary" areas requires careful review of your mammograms. It may also require the addition of special views from different angles and specialized examination of your breasts by ultrasound, MRI, or other imaging techniques. Sometimes imaging techniques will be used to evaluate the rest of your body as well.
What type of medical team do I need for the most accurate diagnosis?
A well-coordinated team which includes input from the pathologist, surgeon, and radiologist is usually the best way to approach treatment decisions. Advice from the entire team must be available during biopsies and any tumor-clearing surgery to ensure the best chance of a favorable outcome for the patient.
How important is the role of the pathologist reading my slides?
The pathologist evaluating the slides made from fine-needle aspiration biopsies, core biopsies, and tissue slides of the breast must have a great deal of experience and special training. It is important that the pathologist reliably determine the presence or absence of cancer and distinguish cancer from other conditions such as hyperplasia with atypia (an overgrowth with unusual-looking but benign cells). The pathologist also orders and interprets special studies (see below) on your cancer tissue to determine the precise characteristics of the cancer cells, such as whether the cancer expresses hormone receptors. These results are used to further specify the type of breast cancer and optimize treatment decisions. The remainder of the treatment will be based on the pathologist's diagnosis.
Have my slides been reviewed by more than one pathologist?
A review by more than one pathologist is optimal. There are many subtleties which can be overlooked when reviewing microscope slides. These can lead to both over-reading (making a false-positive diagnosis) and under-reading (making a false-negative diagnosis). When slides are read a second time by another pathologist followed by a discussion of the conclusions, most diagnostic problems are resolved.
There are almost always several pathologists available who can review the pathology of your slides (this is termed a "double reading"). The added safeguard of double reading may not be necessary in most cases of breast cancers but can be a critical factor in some cases.
Can I have my biopsy reviewed by a pathologist at another diagnostic center?
It should always be possible to send slides from your biopsy to a pathologist at another diagnostic center. First of all, there should not be a rush to treatment; breast cancer is almost never an emergency. Developing the best treatment plan depends on a good, thorough pathologic evaluation as well as a complete workup of both breasts, as noted above. You should discuss this with your treatment team or primary care doctor as they can help you arrange for this.
Second, good pathologists are never offended by a request for an outside opinion. They also usually know the names of some of the finest breast pathologists in the country and should be willing to arrange a consultation with one of these doctors.
In most cases of breast cancer, it is not necessary to obtain this in-depth consultation. However, if there are any unusual aspects of your case, it can be important in your decision-making process. The matter of obtaining additional consults may take a week or more.
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