What to Expect After a Breast Cancer Diagnosis

For someone on the receiving end of a breast cancer diagnosis, these are just some of the many questions that flood the mind. Exacerbating their stress is the fear of the unknown. In a recent webinar, a specialist with Baptist Health Cancer Care offered an overview of what typically happens for patients once they’ve been diagnosed.

“One in eight women will be diagnosed with breast cancer during their lifetime. The good news is that if we catch it early enough, it’s almost always survivable,” said surgical oncologist Nadia Nocera Zachariah, M.D., with Baptist Health Cancer Care. Dr. Nocera, who sees patients at the Baptist Health Plantation Wellness and Medical Complex, said that the five-year survival rate for of patients diagnosed with stage 1 breast cancer is 98 to 100 percent, and 90 to 100 percent for those diagnosed with stage 2 disease. 

A breast cancer diagnosis begins with a mammogram showing an abnormal finding, which is then confirmed by a biopsy, said Dr. Nocera. Although treatment plans are personalized for each patient depending on their cancer type and a host of other variables, breast cancer patients typically follow the same series of steps in their cancer journey, she said.

“First, we need to figure out if the tumor is benign or if it’s a high-risk lesion or a malignancy,” Dr. Nocera explained. “If it is cancer, we use several criteria to determine its stage, including the size of the tumor, whether traces can be detected in the lymph nodes and if it has metastasized to other parts of the body.”

Who’s on your team?

Once a diagnosis is made, breast cancer patients usually require a team of specialists for their treatment, according to Dr. Nocera. “Your care team will include a breast surgeon and a medical oncologist and, if needed, a radiation oncologist and a plastic surgeon,” she said. “One of the advantages of Baptist Health Cancer Care is that we have all of these specialists under one roof, so you don’t have to drive all over Broward going from one office to another for your cancer treatment.”

If surgery is required, there are two main options, Dr. Nocera said. For early-stage disease, the preferred option is a lumpectomy, which removes the tumor and a small margin of surrounding tissue through a small incision in the breast. “It’s same-day surgery and has a quick recovery,” she said.

Some patients, however, require a mastectomy, in which all of the breast tissue is removed. There are different kinds of mastectomies, Dr. Nocera said. A total mastectomy removes the entire breast, including the skin and nipple, while a bilateral mastectomy removes both breasts. “There is also a skin-sparing mastectomy, which removes breast tissue and nipple but preserves the skin for reconstruction, and a nipple-sparing mastectomy, which preserves the nipple and uses both the breast skin and nipple for reconstruction,” Dr. Nocera said. “Reconstruction can be a long process, however, and patients should consult with a plastic surgeon to see what is possible.”

What’s your Oncotype score?

Breast cancer patients typically have their breast tissue tested in what is known as an Oncotype DX test, said Dr. Nocera. The test can be done on early-stage breast cancers that have receptors for estrogen (“estrogen-receptor positive”) or which don’t have large amounts of the human epidermal growth factor protein (“HER2 negative”).

Patients are scored on a scale from 0 to 100. “A score of 0-25 reflects a low risk of recurrence and indicates that the benefits of chemotherapy likely would not outweigh its risks of side effects,” said Dr. Nocera. “A score of 26-100 signifies a high risk of recurrence and tells us you’re more likely to benefit from having chemotherapy in addition to hormone therapy.”

Which therapy is right for you?

Women diagnosed with early-stage breast cancer who have a lumpectomy to remove the cancer usually have radiation therapy after surgery. “Radiation therapy after lumpectomy lowers the risk of the cancer coming back (recurrence) and makes lumpectomy as effective as mastectomy,” according to BreastCancer.org, a development that Dr. Nocera called promising. “For some patients with invasive breast cancer, this means that a mastectomy may not be necessary.”

Another new development is the introduction in recent years of partial breast radiation therapy. “Whole breast radiation has been the standard of care for years but partial breast radiation is one of the more exciting treatments to come alone,” Dr. Nocera said.

With partial breast radiation, the radiation oncologist is able to deliver a higher dose to a much smaller part of the breast over a shorter period of time,” Dr. Nocera said. “So, instead of receiving RT five days a week for three to five weeks, as is required with whole breast radiation, partial breast radiation can be completed in as little as one to two weeks.” In addition, because radiation is focused directly on the lumpectomy cavity, healthy surrounding tissue is spared, she said, and recovery is faster.

Not all breast cancer patients require radiation therapy, Dr. Nocera said, but some will need chemotherapy, which may be administered before or after surgery. “If the patient has a large tumor burden, we’ll do chemotherapy first to shrink the tumor so it will be easier to remove during surgery,” she said. “Otherwise, chemotherapy typically comes after surgery.”

As a final precaution against recurrence, most patients who have been treated for early-stage breast cancer are placed on estrogen-blocking medication such as Tamoxifen for at least five years and sometimes up to 10 years, said Dr. Nocera. “Estrogen facilitates the growth of cancer cells and drugs like Tamoxifen block estrogen from connecting to those cancer cells,” she explained.

How can you reduce your risk?

Dr. Nocera concluded her webinar with some thoughts on prevention, offering these steps for decreasing one’s risk for developing breast cancer:

• Maintain a healthy body weight
• Eat a healthy diet high in fruits and vegetables
• Get regular physical activity
• Avoid alcohol
• Limit dose and duration of hormone therapy
• Avoid or limit breast feeding, if possible
• Avoid exposure to radiation and environmental pollution
• Consider chemoprevention if at increased risk

Prevention is one thing; detection is another, said Dr. Nocera, noting that every woman should be doing monthly self-exams, and should start their annual mammograms at age 40 – with or without the addition of an ultrasound, depending on what their doctor recommends. Your radiologist may recommend more frequent studies, depending on your risk factors, she said.

“I can’t emphasize enough how important your annual mammograms are. I would actually recommend that all women get an initial screening and risk assessment at age 30, just to see if their annual screenings should begin sooner,” Dr. Nocera said. “If we can catch breast cancer early, it’s much easier to treat and your chances of surviving are excellent.”