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Next Steps After a Breast Cancer Diagnosis

No matter what you may do to prepare yourself, being told that a lump is indeed breast cancer is always a shock. And before you have time to think straight, you're plunged into a sea of new information and difficult decisions. Although you may feel very alone, you're not: The road to good treatment is well traveled. Our guide will steer you through these tough times.

By Janis Graham

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Breast cancer diagnosis and treatment
Eva Tatcheva
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Step 1: See a Surgeon

After a positive biopsy the vast majority of women need surgery to completely remove the cancer. You'll usually be referred to a cancer surgeon—also known as a surgical oncologist. Often times the radiologist or your primary care physician will suggest a surgeon you should see. More than 50 percent of new breast cancer patients rely on this recommendation, as it opens doors and ensures you get an appointment quickly, says Leslie Montgomery, M.D., chief, division of breast surgery at Montefiore-Einstein Center for Cancer Care in the Bronx, New York. Women who select their own surgeon usually do it because of a doctor's reputation or because they want to be treated at a certain hospital.

Don't spend too much time debating whom to meet with first. You may ultimately switch to another surgeon (because you want someone more qualified or aren't confident about the treatment plan outlined by doctor number one). Be aware that you'll be hit with a load of information at this meeting. If you arrive prepared you'll feel less overwhelmed. What to do beforehand:

Enlist a friend. At every medical meeting you'll need a second set of ears. "The average patient hears only about half of what's said, so it's critical to bring someone along to hear the other half," says breast specialist Katherine B. Lee, M.D., assistant professor of surgery at the Cleveland Clinic Breast Center in Ohio. Whether it's your husband, sister or friend, this person should be a careful and calm listener, a good note taker, and, if possible, able to accompany you on most appointments.

Learn the cancer basics. Most likely you've been told what type of cancer you have by the radiologist and were given radiology and pathology reports. If not, ask for copies. The surgeon should carefully review these results with you, since they're the key to deciding on treatments. Familiarize yourself with these common terms before your appointment:

"Invasive" versus "ductal carcinoma in situ." Most breast cancers are invasive, which means the cells have broken out of the milk ducts or glands where they started; ones that are "in situ" are confined and are the earliest form of breast cancer, with the best prognosis.

Hormone receptor status. Some breast cancer cells have receptors that can be activated by estrogen, progesterone, or both. You'll be a candidate for hormone-blocking agents like tamoxifen or raloxifene (for postmenopausal women) if your cells have these receptors.

HER2-positive or -negative. About 20 percent of all breast cancers overproduce a protein known as HER2. These tumors tend to grow and spread fast, so you may need more aggressive treatment.

Compile your questions. Keep a list of all the things you want clarified and bring it to the appointment. One question to include: "Whom can I call if I have more questions after this appointment?" Don't be surprised if you can't get all the answers yet. For instance, a surgeon usually can't tell you how much a cancer has spread until after your operation.

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