It's October -- Breast Cancer Awareness Month. Pink ribbons are everywhere, as are ads for all things pink -- from lipsticks to appliances -- that will help raise money for breast cancer research. As a radiation oncologist who treats women with breast cancer, I am grateful for the heightened awareness about breast cancer and how to screen for it. Early detection has led to many women being diagnosed earlier, when the options for treatment are greater.
But this October, I'm asking women to take it up a notch. Let's go from "awareness" to "knowledge." Too often, women don't have enough knowledge about their treatment options, which can lead to making choices that aren't appropriate for their situation. Women don't know that they need to make choices about what's right for them physically, psychologically and in the context of their lifestyle. And too often, I encounter a newly-diagnosed, frightened woman who doesn't know that the choice for treatment is hers to make. Her surgeon, medical oncologist, and the radiation oncologist are all there to help guide her, but ultimately the decision should be -- must be -- hers.
There are a lot of variables with breast cancer, in terms of both the disease itself (e.g., stage, tumor type, location) and treatment. Women with early-stage breast cancer have the most options, but sorting through them can seem overwhelming. Choices will have to be made concerning surgery, systemic therapy, and radiation. And there are various options around each of those:
• Surgery: breast preservation, mastectomy/prophylactic mastectomy (made with the surgeon)
• Systemic therapy: chemotherapy, hormone therapy, both, or neither (made with the medical oncologist)
• Radiation: treating the whole breast, which will involve either six or three weeks of treatment, treating only part of the breast -- where the tumor was -- which can be done in five days (made with a radiation oncologist)
When a patient asks me what to do, I outline all her options and help her assess them in the context of her level of comfort, the data available concerning each option, and her lifestyle. For most women, the appropriate choice would be to preserve the breast. Too many women choose to remove the whole breast (mastectomy), even when the diagnoses indicate there is little chance of recurrence, because they want to be "sure" it won't come back, or think this improves their chance of survival. Women choose to have perfectly healthy breasts removed because they're misguided, misinformed, or too overwhelmed to weigh the options objectively.
When it comes to radiation, there are radical differences in treatment as well, ranging from six weeks of treatment to five days. Some women opt for six weeks of treatment, merely because it has been around the longest. Concerns about exposing healthy skin and tissue to radiation and/or the inability to devote six or even three weeks to daily treatment makes five-day, partial breast irradiation more appealing. Proximity to a treatment center, the demands of a job, and issues around family obligations all must be taken into consideration along with the medical issues.
The point is, there isn't just one approach -- or one context in which choices should be made. A woman has to choose a treatment plan that makes sense for her in every way. And she can only do that when she knows what her options are, and feels empowered to make the decision.
Knowledge is power. So let's start thinking about October as "Breast Cancer Knowledge Month." Don't just examine your breasts. If need be, examine your options, and choose the best one(s) for you. It's not just about your tumor, or your cancer, or your breast. It's about the rest of your life, in every sense.