Choosing your Doctors
There are a number of different entrances into Breast Cancer World. You or your partner may first feel a lump. Your GYN or PCP may find something during an annual exam. A mammogram or breast MRI may indicate a suspicious area. However you get here, you will suddenly be faced with the important and difficult decision of choosing a doctor. If you have felt a lump, your first call will likely be to your current doctor. After that initial medical connection, you will be referred to a breast cancer specialist--probably a surgeon, but possibly a medical oncologist or a radiologist with expertise in breast cancer imaging and radiologically-guided biopsies.
This is not a medical emergency. It most certainly is a psychological emergency, and you are in crisis, but you do have a little time to slow down, consider your options, and make the best choices for your care. Clearly, step one is to have a definitive diagnosis. Mammograms and breast MRIs can raise the question, but they cannot answer it. The only way to know for sure whether a suspicious lump/area is malignant is to have a biopsy and for a pathologist to then examine the cells under a microscope. There are several kinds of possible biopsies for breast cancer, and your doctor will suggest what makes the most sense for your situation. There are a number of helpful websites if you want more information: try Living Beyond Breast Cancer (www.lbbc.org) or the American Cancer Society (www.cancer.org) or the Komen Foundation (www.komen.org).
If you have a definitive diagnosis of breast cancer, you need a surgeon. This can get tricky. It is probable that your GYN or PCP will have colleagues and traditional referral patterns;s/he likely will give you a name and suggest that you make an appointment with Surgeon X. There are many general surgeons who do a great deal of breast surgery. There are also breast surgeons who have chosen to specialize in this field and devote 100% of their professional attention to breast cancer. My bias is probably obvious, but I believe that, for any medical problem, you want to find a doctor who deals with it every day. Ask. Talk both with your doctor and with any women whom you know (or know of) who have had breast surgery. Call the nearest NCI designated cancer center for names.
The most important thing about your surgeon is her/his technical skill. Many surgeons are also warm, engaging, and compassionate individuals. Certainly, the human chemistry matters, and it is best if you feel closely connected to your surgeon. Remember, however, that you really are hiring the surgeon's skills in the OR. You, hopefully, will only need her/him once or twice (e.g., if you need a second surgery for a full axillary node dissection or to achieve clean margins), and if you are confident that Surgeon Y is the very best available in your area, s/he's the one you want. Remember that breast surgeons do not usually do reconstruction. For that, you will need a plastic surgeon. Those of us in urban areas are often blessed with choices. In Boston, as well as in many other cities, there are a number of fabulous breast surgeons who combine the very best professional competence with very human sensitivity and care.
The choice of a medical oncologist is, perhaps, even more important. This is a relationship that will continue for years, if not for the rest of your life. You absolutely want to be cared for by a doctor whom you trust, respect, and like. While breast cancer surgery is pretty straight-forward with rather limited choices (wide excision or mastectomy with or without reconstruction), there may be a range of possibilities for your systemic care. Following surgery and the final pathology report, you will need to consult with a medical oncologist. Even if the recommendation is no systemic treatment, it is a doctor with this training who should help you make this decision. Again, talk to everyone you know about their experience with their oncologist. Call the nearest NCI designated cancer center. It is very important to identify a medical oncologist who is completely up to date on all the newest research and trials as well as someone who practices at a center/hospital/office that is comfortable for you. Many people travel a long distance for an opinion with an expert at a large Cancer Center, and then have the treatment itself with a medical oncologist close to home.
When you are meeting with a medical oncologist for the first time, in addition to all your questions about your cancer and proposed treatments, take a few moments to consider her/his style and environment. Does she listen to you? Is she respectful of you and whomever is accompanying you? How can you reach her between appointments? Does she correspond by email with her patients? Is there a specific time of day that she is usually available for phone calls? Look at the staff in the office, too. Are they friendly, efficient, respectful? Is everyone's privacy being protected? Is the space itself comfortable and welcoming?
Again, we are so blessed in Boston to have several great academic medical centers and many fine doctors. Many women, with whom I work, consult with two or three oncologists, at two or three institutions, before making a doctor decision. I tell them that the medicine in any of Boston's big hospitals will be the same, but the cultures are different. Without placing any value judgments, I assure them that they will feel most comfortable at one or another place. Pay attention to the pit of your stomach. Of course, you will be anxious during these first meetings, but how long the anxiety persists, how well cared-for you feel, and how comfortable you become during the discussions are important. You will know when you have found the right doctor. Remember that you are the consumer, that you have choices, and that your single goal is receiving the very best medical care for your unique situation.