Navigating a Breast Cancer Diagnosis
UF Health Jacksonville breast surgeon discusses the types of treatments available to breast cancer patients.
Being diagnosed with breast cancer can be an overwhelming and scary experience. Understanding more about the cancer and types of treatments available is an important part in taking the next step toward healing and recovery.
Leigh Neumayer, MD, a UF Health Jacksonville surgeon and chair of the department of surgery, wants women to be armed with the information they need to battle their breast cancer.
Breast cancer is a common disease in women. More than a quarter of a million women in the United States are diagnosed with breast cancer each year.
“Breast cancer is generally thought to be a slow-growing cancer, which means patients have time to make the right decisions for their health.” Neumayer said.
However, according to Dr. Neumayer, there is good news. The majority of women diagnosed, about 90%, will survive and go on to live a happy and healthy life.
“I look at treating the whole patient, not just the disease,” Neumayer said. “The treatment should never be worse than the disease itself.”
Common risk factors
Two of the biggest risk factors are gender and age, which unfortunately cannot be controlled. Women are more likely to get breast cancer, and the majority are over the age of 60. Other risks may include personal and family history, genetics or other minor factors.
“The truth is that we don’t completely know what causes breast cancer,” Neumayer said. “Eighty-five percent of patients have no risk factors.”
Neumayer still recommends maintaining a healthy and active lifestyle and not smoking, which may not only help prevent breast cancer, but other diseases and cancers as well.
One risk women should be aware of is taking prescribed estrogen for prolonged periods of time. This is often included in hormone replacement therapy.
“Women who take estrogen for a period longer than four years are at an increased risk for breast cancer,” Neumayer said. “I recommend taking it for a short time to help directly with symptoms. If it is not helping, then they should stop and speak with their doctor about other options.”
Leigh Neumayer, MD, is a UF Health Jacksonville surgeon and chair of the department of surgery.
Diagnosing the cancer’s stage and grade
In today’s age, health care has advanced significantly and most breast cancers are diagnosed through 3D or digital mammography. According to Neumayer, once physicians have found the cancer, there are four things they look for to determine what stage the cancer is at and how to proceed with treatment options for the patient.
First, they look at whether the tumor has spread to the lymph nodes. In the event that is has, there is concern that the cancer may have spread to another part of the body.
Next, they’ll examine the size of the tumor. Anything less than 2 centimeters is usually diagnosed as stage 1 cancer, in the event it has not spread to the lymph nodes.
A pathologist will also examine cancer cells under a microscope to identify the grade of the tumor, which determines if the cancer is slow-growing, or more aggressive and likely to spread. It can be grade 1, 2 or 3, with 3 being the fastest-growing and most aggressive. This information helps to further narrow down treatment options.
Lastly, they look for whether not the cancer cells have hormone receptors on them. For example, many cancers are considered hormone receptor positive. There are effective medicines that specifically target these receptors, blocking cells’ ability to multiply.
Today, most breast cancers are diagnosed through digital or 3D mammography.
Identifying the right treatment options
UF Health Jacksonville takes a multimodal therapy approach to treating cancer. The radiologist and pathologist help diagnose, and the surgeons, medical oncologists and radiation oncologists help with the treatment itself.
Treatment options include chemotherapy, hormonal blockade therapy, biological therapy, radiation therapy and surgery. Most patients will receive a combination of these options for their personalized treatment plan.
Deciding on the best treatment option is also dependent on whether the cancer is local, regional or systemic. Local or regional treatment targets the tumor in the breast and what may have spread to the lymph nodes. Local and regional disease is usually treated with surgery, and depending on the type of surgery, sometimes radiation and/or breast reconstruction.
Systemic treatment is used to treat any cancer cells that may have escaped the breast and are circulating through the body. Types of systemic treatment include chemotherapy, hormonal blockade or biological therapy.
The entire team of specialists at UF Health Jacksonville look closely at the all of this information, including the patient’s personal health, to form a personalized treatment plan.
Making the decision to get a mastectomy
Patients usually have a choice between a lumpectomy (removing the cancer and a rim of normal tissue) and a mastectomy (removal of the breast). This decision is normally a personal choice.
According to Neumayer, randomized clinical trials have shown that survival is dependent on the biology of the cancer and systemic treatment, not solely on what operation is performed on the breast. Many patients choose a lumpectomy, which is usually followed by radiation treatments.
For patients who do choose to get a mastectomy, Neumayer recommends consulting with a plastic surgeon so they can explore options for reconstructive surgery.
What are the chances of the cancer returning?
Long term, 20-25% of patients may see their breast cancer return, with the majority of these being ones who had stage 2 or 3 cancers. For those with stage 1 cancer, the chance is less than 5% at 20 years.
As patients navigate their diagnosis and decide on a treatment team and plan, they should remember that it is always reasonable to get second opinions on treatment options and the decision to have surgery. Patients should feel comfortable with the team they have as they start on the road to recovery.
“At UF Jacksonville, we have a full team of high-level specialists who work together daily to create an individualized treatment plan for our patients,” Neumayer said. “Health care can be confusing to navigate, and we are here to help patients feel safe on this journey.”
For more information on this topic, check out “Meet Virginia: Biography of a Breast,” a book authored by Neumayer that details a patient’s journey through her breast cancer surgery.
