Ask an Expert: Why aren’t breast cancers taken out immediately?

  Q: “It has been two weeks since I was diagnosed with infiltrating ductal carcinoma, and I have not had my MRI, PET, CT or follow-up. Everyone says, ‘You have time.’ How do they know I have time? How do they know that my cancer cells aren’t dividing right now? Why aren’t breast cancers taken out immediately and patients treated for any cancer spread right away?”

Answer from Stacy Lewis, M.D., medical director, Providence Cancer Center, and oncologist, Providence Oncology and Hematology Care Clinic:
 
I understand your sense of urgency. You are absolutely justified in wanting to begin treatment as soon as possible. This should be the goal of your medical team, as well. However, it’s important for your medical team to take time to determine which treatment options will be best for you. It’s also important for you to take time to consider all of your options carefully, to make an informed decision, and to make sure that you are comfortable with your decision.

Is there time for all this? Yes. How can you be sure? It’s a matter of weighing the importance of the decisions you need to make (for example, should you have a lumpectomy and preserve your breast, or would you feel safer having a mastectomy?) with the facts about cancer cell division and growth.

You may think of cancer as growing and spreading very quickly, but this is not the case with most cancers. Breast cancer grows by cell division, and with most breast cancers, each division takes one to two months (see Ask An Expert: Breast Cancer Growth Rate). By the time a breast cancer is large enough to be detected in an examination or a mammogram, it is composed of millions of cells that have been dividing for years. So while it may seem as though your breast cancer showed up all of a sudden, it probably has been growing, very slowly, for a long time.

That doesn’t mean that a person should drag her feet about seeking treatment. But it does mean that there is time to make well-considered treatment decisions. I know that each day following your diagnosis must seem like an eternity, but I recommend that you use this time to learn everything you can about your condition and your options.
 
Follow-up scans – what, when and why

You asked why you had not been scheduled for follow-up scans. In general, once a biopsy confirms a diagnosis, it is not recommended to undergo further, extensive testing (such as CT scans, bone scans or chest X-rays) prior to surgery. The reason for this is that the chances of finding evidence of cancer in other parts of the body through these tests is very small. 

If you were having symptoms that suggest metastases (spread of the cancer), however, then tests aimed at evaluating your specific symptoms would be reasonable.

After surgery, further scans might be necessary if the surgery reveals that you have a very large tumor or extensive lymph node involvement (typically, more than 10 involved lymph nodes). In this case, there is a higher likelihood that your breast cancer may have already spread outside the breast and lymph nodes, and that it may be large enough to be visible on a scan.  The results from more extensive testing with CT scans or a PET scan may change your treatment plan.

Emotional follow-up and support

What concerns me most about your question is that for two weeks, you haven’t had access to anyone who could answer it for you.

At Providence Cancer Center, one of the first steps after a woman’s diagnosis is to refer her to a breast cancer patient advocate who can answer questions like yours. Our advocates meet with patients one-on-one to explain treatments, to help patients navigate through their appointments, and to refer patients to other supportive resources, such as: 
  • Providence Breast Cancer Outreach Program, which introduces newly diagnosed patients to volunteers who have been through breast cancer treatment
  • The Jill Lematta Learning Center at Providence Cancer Center, where patients and family members can look up health information online and check out books and articles on a specific diagnosis
  • Support groups for patients and family members
I know that cancer is a frightening diagnosis. I hope that my answer helped ease some of your concerns, and I urge you to seek out a breast cancer support group in your community for ongoing emotional support as your treatment and healing continue.

March 2008

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