Richard D. Lindsay: Questions women should ask about breast cancer

CHARLESTON, W.Va. -- Breast cancer is a scary disease. In 2013, there were about 230,000 new diagnoses of invasive breast cancer, and about 40,000 deaths.Recent articles in the media have described certain genetic studies that can be done to increase early diagnosis and treatment for those women who have a genetic predisposition to Breast Cancer.Most people would be surprised to know however, that those genetic tests have been around since 1995! -- and that it is likely that there are more than a few women who should have been tested (as well as some of their mothers and daughters) who were not, and have since suffered the worst that can happen to someone who has cancer.Unfortunately, a significant number of women have, and have to, place their lives in the hands of physicians who do not keep current with Breast Cancer diagnosis and treatment as it should be practiced.Here are some of the questions that women need to ask their doctors:1. How often do I need a breast exam?2. Does breast cancer occur in women even in their 20s? 3. How often do I need an ultrasound, a mammogram, a CT scan or MRI of my breasts?4. What is the difference between the ultrasound, mammogram, CT or MRI studies in diagnosing breast cancer?5. Why should I wait until the next office visit for you to re-examine a breast lump that has been found? Why can't you send me to a surgeon now?6. How long is it safe to wait to biopsy a newly found breast lump?
7. How long is it safe to wait between the breast biopsy and the definitive surgery?If you have cancer and the doctor tells you your choice for surgery is either lumpectomy with chemotherapy and radiation or mastectomy, you need to ask these questions:1. Is my cancer "triple negative"? What does this diagnosis indicate or mean?2. What is the Grade -- I, II or III -- and what do the different grades mean?
3. What is the Ki67? What does that measure and what does that mean?4. How do the prior three answers affect the chances of re-occurrence?5. If I have a re-occurrence, can the choice of radiation as part of an initial treatment as opposed to a mastectomy, keep me from having necessary radiation when and if I have a re-occurrence?6. Do I qualify for genetic testing, and why?When your doctor answers these questions and then states that choosing a lumpectomy gives the same recurrence rate as mastectomy, ask the doctor to tell you what medical information or study backs that statistic up based on the type of cancer -- triple negative; Grade I, II, or III; high or low Ki67; or positive or negative genetics. Because only then can you be more certain that you made the correct choice between lumpectomy with chemotherapy and radiation and mastectomy.I do not have to tell anyone that breast cancer is a deadly disease, but women need to be aware that the physicians they are relying upon to potentially save their lives need to have more than just a casual familiarity with the diagnosis and treatment of breast cancer.
Additionally, as a service to the public, groups that support fighting breast cancer could help women a great deal by printing and providing a questionnaire that women can acquire and actually take to their physicians for answers. My office would be glad to work with others on preparing such a checklist. Most people are too shaken or upset by the doctor telling them they have cancer to be able to think of all the relevant and important questions off the top of their heads. Make no mistake, the answers are important to know and understand when making choices regarding breast cancer.Lindsay is a doctor and lawyer in Charleston.
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