Receiving a diagnosis of breast cancer — even if it is found in its early stages — is a life-altering moment that can bring with it a wide range of emotions. The shock and fear can be overwhelming, filling you with uncertainty, and you likely have many questions about what comes next. Here are essential questions for your health care team to help you prepare for the journey ahead.
- What is my breast cancer subtype and stage?
It’s important to know that not all breast cancers are the same, and there’s not a one-size-fits-all approach to treatment. Having a complete understanding of your diagnosis will help as you go through your treatment journey. Ask your doctor about your hormone-receptor (HR) and HER2 (human epidermal growth factor receptor-2) status, any genetic drivers, and other factors, such as tumor size, grade, and nodal involvement. This will help you and your health care team determine your best treatment plan.
There are four major breast cancer subtypes, with HR+/HER2- being the most common, accounting for approximately 70% of all female breast cancer cases in the United States. Your subtype, among other key details, is determined by biomarker testing — also known as mutation, genomic, or molecular testing.
Biomarker testing plays a fundamental role in your breast cancer diagnosis and potential treatment as it can also help determine if your tumor is driven by genetic mutations like BRCA1 or BRCA2 — which are commonly associated with breast and ovarian cancer — as well as detect the expression of genes associated with more aggressive tumors that put you at a higher risk of the cancer returning (recurrence). This information is important for selecting the right approach to treatment both in the short and longer term.
In addition to your subtype and other relevant genomic information, your health care team should tell you your breast cancer stage. Your breast cancer stage is determined by a variety of factors — including your tumor size, grade, and the number of lymph nodes that the cancer has spread to — and helps your health care team assess the severity of your cancer. While in early breast cancer (eBC) – spanning stages 1, 2, and 3 — the cancerous cells are only located in the breast tissue or nearby lymph nodes, knowing your tumor stage may help you and your doctor determine the right approach to surgery, among other treatments.
Even if your doctor has already shared this information with you, it’s normal to have more questions. You’re not alone, and it’s OK to ask! It can be confusing to try to understand what your specific breast cancer diagnosis means for your treatment plan. A recent online survey conducted by The Harris Poll found one-quarter (25%) of those with eBC aren’t sure what the stage of their tumor means for their immediate and future treatment plans — even though nearly 9 in 10 (85%) have discussed it with their doctor.
If your doctor uses words you’re not familiar with, ask them to clarify. Consider bringing a friend or family member with you to your appointment. Have a notepad handy with a list of your questions and jot down important information you receive during the appointment.
The research was conducted online in the United States by The Harris Poll on behalf of Novartis among 501 adults 18+ who have been diagnosed with breast cancer, including 432 with early breast cancer (eBC). The survey was conducted March 10 – March 28, 2023. Data are weighted where necessary by age, gender, race/ethnicity, region, education, marital status, household size, household income, and propensity to be online to bring them in line with their actual proportions in the population of US adults diagnosed with breast cancer. Respondents for this survey were selected from among those who have agreed to participate in our surveys. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within ±5.6 percentage points using a 95% confidence level. This credible interval will be wider among subsets of the surveyed population of interest. All sample surveys and polls, whether or not they use probability sampling, are subject to other multiple sources of error which are most often not possible to quantify or estimate, including, but not limited to coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments.
- What is my risk of recurrence?
When discussing treatment for eBC, you may already be thinking about your risk of recurrence. Approximately one-third of people diagnosed with stage 2 and one-half of people diagnosed with stage 3 eBC will experience distant recurrence after initial treatment. The risk of breast cancer recurrence depends on various factors, including your initial breast cancer diagnosis, the presence and/or expression of certain biomarkers, lifestyle, and more.
It is common to feel anxiety or concerns about your cancer returning. The Harris Poll survey found that 54% of eBC patients agreed, “I am very worried about my breast cancer returning despite all the treatment(s) I am undergoing/have undergone,” and 66% expressed, “I wish I had more information about things I can do to potentially prevent recurrence.”
After your initial eBC treatment — which often includes surgery, sometimes followed by chemotherapy or radiation — you may start adjuvant treatment to prevent or minimize the risk of the cancer eventually coming back. The goal of adjuvant treatment is to reduce the spread of any cancerous cells that were missed during surgery.
For some patients, the idea of initiating adjuvant treatment after undergoing active therapy and “ringing the bell” comes as an unwelcome surprise. Ask your doctor about your personal risk of recurrence ahead of this point. Armed with information about your individual diagnosis and unique factors, with support from available predictive and prognostic tools, you and your doctor can work together from the onset on a comprehensive plan to keep you cancer-free while maximizing your quality of life. Discussing your concerns early with your doctor can also help you manage any feelings of anxiety and uncertainty about your cancer returning.
- How do I know if my treatment plan is “right” for me?
Before you start a new treatment, it’s important to discuss your treatment goals, as well as your expectations, with your health care team. The Harris Poll survey found that eBC patients’ biggest challenges in living with breast cancer include living with uncertainty (51%) and dealing with treatment side effects (38%).
You and your doctor should work together to create the best overall plan for your treatment goals and desires for quality of life. Your doctor can help you better understand your treatment options, help you decide on the best course of action to achieve your treatment goals, and share information about how potential side effects could impact your daily life.
If you want to learn more about what to expect from each treatment, here are a few questions that can help you start the conversation with your doctor:
- What are my treatment choices according to the guidelines? Which do you recommend for me and why?
- What can I expect from this treatment?
- Can you provide an overview of possible side effects? What are they, and what should I do if I experience any side effects?
- How will this treatment affect my daily life? Will I have to make any lifestyle changes? Will I be able to work, have a love life, maintain my overall wellness, and perform my usual activities?
- How often will we check in to make sure we are assessing how I’m doing on my current treatment plan?
Our biggest tip: Navigating breast cancer can be daunting, but it’s important to remember that you don’t have to go through this journey on your own. By staying informed, you and your loved ones can be better prepared. Ask your doctor questions to help you better understand your breast cancer diagnosis, including your risk of cancer recurrence, and the latest treatments, research developments, and clinical trials available to you. You can also check out this resource for more information on eBC.
10/23 309184