Have you been overwhelmed with emotion and information when newly diagnosed with breast cancer? My guest, Dr. Deanna Attai, is an Associate Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California Los Angeles. Episode 7 takes us from being newly diagnosis with breast cancer to the clinical visit and what are next steps.
As past president of the American Society of Breast Surgeons I have leaned on Dr. Attai since I first met her in May of 2019 at the ASBrS annual conference. Breast cancer is not one disease and patients bring to their consult with a wide variety of knowledge regarding their diagnosis. Tumor biology, stage, grade, and family history are some of the factors discussed after being newly diagnosed with breast cancer.
Step 1: Knowing the Type of Breast Cancer
She guides us through how she helps patients who are confused and fearful to process all the information recognizing this time is challenging for the newly diagnosed. Dr. Attai states patients come into their appointment most often knowing they have breast cancer. What they may or may not know is the type of breast cancer they have. For instance, is it:
- Ductal
- Lobular
- invasive or noninvasive
- Knowing the estrogen/progesterone HER2/Nu status
The time from diagnosis to initial consult can vary for patients from a day to a week. During this time, they may or may not have done research while others come in knowing about their pathology report, receptor status and other details. Some have done some directed research while other have only made some assumptions on what type of breast cancer they think they have based on age and lack of family history.
Step 2: the Consult
I found it very enlightening to hear Dr. Attai say she does not always assume the woman or man has actually been told they have cancer. This is her process and what she asks the patient explaining this helps her meet the patient where they were:
- I have reviewed your patient records after you found a lump or had a mammogram followed by the biopsy.
- Who called you with the results and what were you told?
- What is your understanding?
Finding a Friend or Advocate when Newly Diagnosed
Emotional trauma has to be dealt with by the medical team. She recommends bringing a friend or advocate to the consult who will first listen, then ask questions at the end on the patient’s behalf. Dr. Attai has her own method of providing this information in a PowerPoint chart that can be tailored to each specific patient. She sends this home as something tangible the patient can then revisit to understand on a deeper level over time.
Social Media Support for the Newly Diagnosed.
I asked Dr. Attai to give us her advice about finding support via social media. She knows a thing or two about this since she is a co-moderator of the #bcsm breast cancer support community on Twitter and has written and done research about the topic. Her advice: choose your support people carefully since there are so many different groups on social media. Reach out to advocates who can take their own breast cancer experience out of it and advocate for you, the patient! Here are some tips we discussed since breast cancer is common and social media has infiltrated so much of our lives:
- Research your source to see if it is credible or not? Use well established advocacy or educational organizations physicians feel are credible such as The National Cancer Institute, American Cancer Society, or BreastCancer.org.
- For one on one or those individuals running groups, weigh what you are hearing online and compare them with credible national resources and what your surgeon told you.
- If you hear about a treatment that is not being talked about anywhere else, bring it back to your medical team to help them validate the efficacy.
- I added my personal advice. Find a supportive, positive group. Bad news travels fast and it is easier to dive down into the drama hole than to dig deeper and share evidence-based resources supported by science and research.
- If you are in a group and you are not “feeling it”, support or otherwise, leave the group, take a break, and continue your search.
- We both agreed it is OK to make comparative notes with other patients who are having the same treatments. It can be reassuring to compare notes regarding side effects.
Shared Decision Breast Cancer Consult
Considerations for surgical treatment options as part of next steps for the newly diagnosed can include: Size of the tumor relative to size of the breast, if there is more than one area of cancer, will neo-adjunctive therapy be needed? Important considerations to for patient decisions can also include:
- Are you a candidate for breast conservation surgery? Why or why not?
- Is a full mastectomy a better option for optimal safety outcomes for the patient?
- Is oncologic surgery combined with plastic reconstructive surgery a good choice to discuss?
- Coordinated multi-disciplinary care is critical from the very beginning even if the healthcare team are in different cities or facilities.
- Breast size, overall desired breast size, body habitus, other medical comorbidities can be part of the discussion for breast reconstruction. Patient safety considerations always come first.
- What is the patient’s preference and what are their possible misconceptions about what surgery can achieve?
Dr. Attai goes on to give details about follow up clinical visits and national guidelines for surveillance. I invite you to listen to this comprehensive podcast, takes notes, re-listen, and learn how you can take control of all the information you are given when newly diagnosed with breast cancer.