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Advanced Breast Cancer: Managing Your Medical Care: Diagnosis To Treatment Decision


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Breast cancer is not what it used to be. Treatments have come a long way.

Think about your goals and commit yourself to doing every thing you can to reach them.

Do not make a treatment decision before you have to. Some patients feel that if this is cancer "I ought to be doing something within 24 hours of diagnosis. However, statistics show this is not true.  Deciding on a treatment is not usually an emergency type decision, In fact, you may have up to 30 days to make a decision without harm. Ask your doctor how much time you have to make a decision. Use the time to allow your emotions to settle so you can:

  • Get an understanding of what generally happens with breast cancer
  • Find the best doctor for you and your needs
  • Learn about the tests your doctor may suggest. 
  • Learn the pros and cons of all available treatments
  • Select a person to act as a patient advocate to go with you to doctor appointments, at least until a treatment decision is made. 

Best results occur for women who choose the best available cancer doctors - doctors who are qualified by training and experience, and who perform a large number of the treatment you decide upon. 

  • The quality of the facility in which the doctors work is also important. 
  • Also consider whatever other factors are important to you when considering a doctor and a treatment facility.
  • You can interview more than one doctor who fits your criteria before making a decision.
  • Since you will likely have more than one cancer doctor, if a team leader doesn't emerge naturally, pick one of the doctors to be the leader.

Seriously consider getting a second opinion. Doctors who work with breast cancer are used to patients asking for a second opinion. 

  • According to Consumer Reports on Health, a second opinion changed the original recommendations for more than half of the breast-cancer patients in a 2006 study. A second opinion also uncovered problems missed by the original caregiver. A second opinion is particularly warranted if the diagnosis is of an unusual form of breast cancer or if it is Stage 2 and has spread beyond your breast.
  • Second opinions should be from a doctor who is not connected with the first one. Consumer Reports recommends that the opinion be from a doctor connected with a comprehensive cancer center that takes a team approach.
  • If you are not satisfied after a second opinion, consider getting the doctors to speak with each other to see if they can resolve their differences. Also consider continuing to get opinions until you are satisfied that you can make a decision about how to proceed, and with which surgeon. Don't use the quest for additional opinions unduly delay the start of treatment.
  • Check your insurance to see whether a second opinion will be covered. If it is not, consider paying for it yourself. 
  • Do not use choosing an oncologist as an excuse to put off treatment.

When it comes to making a medical decision:  

  • Decide who you want to make medical decisions (for example, you, a family member, or a particular doctor). 
  • Learn the basics about breast cancer and your specific diagnosis. [If you have advanced breast cancer (Stages III or IV), click here].
  • Learn the pros and cons about available medical treatments such as chemotherapy, surgery (lumpectomy or mastectomy), and radiation.  
  • If you have a choice between a lumpectomy and a mastectomy, cosmetics should not be the deciding factor. Reconstruction after a mastectomy is now so refined that women who have reconstructions report feeling good about their appearance. If reconstruction is done at the same time as the surgery, you do not even have to wake up and see one side of your body different from the other. 
  • So called "alternative treatments" should only be considered complementary to Western medicine, not instead of it. There is no scientific proof such treatments by themselves cure breast cancer.
  • If you choose chemotherapy and want to preserve the ability to have a child, options are available.
  • Ask all questions of concern to you about the treatment plan you are leaning toward using. 
  • Consider looking at published treatment guidelines such as the guidelines published by National Comprehensive Cancer Network (NCCN) offsite link, and/or hiring a research firm to uncover all available treatments including cutting edge experimental treatments and possibly adding another opinion.
  • Make a treatment decision based on your own lifestyle and beliefs.
  • The decision making process is likely to be easier if you speak with at least one person who has gone through what you are. Information from a support group of other women with breast cancer may also provide practical tips.

When a drug is recommended, keep in mind that all drugs have risks as well as the benefits. Learn what they are.

Learn how to maximize your limited time with a doctor. Learning about your condition and the basic medical terms helps.

Gather the tools you need to make the process easier - for instance, a method of recording your appointments.

Keep in mind that drugs and treatments do not work in a vacuum.

  • Start adopting a healthy, cancer prevention, lifestyle. With prostate cancer, this particularly includes deceased meat and milk consumption. 
  • If you smoke, use the diagnosis as a wake up call to quit.
  • Start getting exercise. It doesn’t have to be in a gym.
  • Get needed rest and sleep.


  • Pain does not have to be part of a health condition. If you have pain, speak with your doctor about alternatives for getting rid of it, or at least decreasing how much it hurts. There are even doctors (known as Palliative Care Specialists) who specialize in treating pain and reducing symptoms. You can receive palliative care at the same time as you work to cure your condition.
  • To stay in control of your medical care even if you become unable to speak for yourself, consider writing a Healthcare Advance Directive such as a Living Will. The documents are free and easy to obtain. You don't need a lawyer to complete them.
  • To learn how to finance treatment, click here.
  • Once you have made your decision, see: Managing Your Medical Care: Part II: Once A Treatment Decision Is Made

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