One Size of Breast Cancer Does Not Fit All
This month's Myth is based on National Breast Cancer Coalition's (NBCC) Myth #12: Everyone's breast cancer is the same.
The other day a friend called me and said, "Omigod, I have breast cancer. Can you tell me your doctors so I can get the same good care you got three years ago when you were diagnosed?"
I was sorry to learn this bad news but glad to help this babe in the woods. Before suggesting that she call the SHARE hotline, I gave her quick and simple intro to the reasons why she might not get the same care I got because her cancer might not be the same as mine.
First I shocked her with this fact: There's no such thing as Breast Cancer, The Disease. We know from the amazing work that scientists have done on genes and proteins and the way they work that BC is, biologically, several diseases.
Each of the main biological types and the other types, such as inflammatory BC, requires different treatments.
So unlike in days gone by, it's not just the size of a breast tumor that's important for making treatment decisions. And it's not even the stage or the grade of the tumor that's the main thing (See below for definitions of stage and grade). And it's not even just whether lymph nodes are involved that fully determines surgical and post-surgical decisions.
While all these things are important, the most important things we know now are the biological characteristics.
If a tumor is hormone receptor (aka Estrogen-receptor, or ER) positive or negative, different treatments will be indicated. If it is Her2/neu positive or negative, different treatments will be advised.
If a tumor is negative for Estrogen-receptors, progesterone receptors and Her2, it will get still another type of treatment. (Click here for my article on Triple Negative [Estrogen, Progesterone, and Her2-negative] breast cancers.)
Treatments may vary within these general categories known as phenotypes, too.
Some of the characteristics of a tumor may be determined by pre-surgical imaging and pre-surgical biopsy. Others may not be determined until after a tumor is removed and analyzed by pathologists.
So I told my friend to ask her doctors several questions right off the bat.
- Where is my tumor? This is important because a tumor in a milk duct (called ductal carcinoma in situ) may require nothing more than watching.
- What stage is it? This is important because a small tumor means that a lumpectomy may be the preferred surgical option, and whether the tumor has spread to lymph nodes influences both the surgery and possible additional treatment.
- What grade is it? This is important because grade determines the pace at which the tumor is expected to grow.
- What are the biological characteristics of my tumor?
- How important is my age to deciding on what treatment, given all of the above?
- How important is my family history of breast cancer, given all of the above?
- Given all this, what are the treatment choices I will have and what are the expected benefits and risks of each choice?
- Are there tests to determine my risk of recurrence and the value of chemotherapy?
Some of these questions cannot be answered before surgery or by a surgeon. It's a good idea to line up a breast cancer oncologist and a breast cancer radiation oncologist for consultations. Some of these specialists are willing to see a patient before surgery.
For further information on characterizing BC and related treatments, go to NBCC's website www.stopbreastcancer.org, or to www.cancerhelp.gov, an interactive touch-screen patient guideline web site of the National Cancer Institute.
Posted December 21, 2009.
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— Sue