Who are all these specialists?
The following is a list of the many doctors you may encounter during your breast cancer experience:
- Surgeon (breast or general): Depending on the size of the community in which you live and the availability of breast surgery specialists, you might choose a breast surgeon or a general surgeon who has performed a number of breast surgeries. He or she will be your lead doctor through what is frequently the initial phase of cancer treatment. However, in some cases, if he or she determines from the biopsy or mammogram that the tumor is large, your surgeon might ask you to consult an oncologist to determine if chemotherapy is warranted to shrink the tumor prior to surgically removing it (called neoadjuvant chemotherapy).
- Plastic Surgeon: If you choose to undergo reconstructive surgery, you should choose a plastic surgeon who will work with your breast surgeon. Not only will they be sharing the operating room if your reconstruction process is begun during the mastectomy surgery, but they will need to agree on which type of reconstructive surgery is most appropriate for your body type and desired outcomes.
- Pathologist: Although it's not up to you which pathologist your surgeon chooses to work with, the pathologist is still a critical member of your team. He or she will perform several tests on pieces of the tumor removed to determine the aggressiveness of the cancer and the extent to which it has or has not spread through your body. This pathology report will be the basis for what your oncologist recommends.
- Medical Oncologist: A medical oncologist is an expert in the use of a variety of modalities used to treat cancer, including chemical and hormonal therapies. This is the doctor who will determine and oversee your chemotherapy regimen, if it's required. While your surgeon will have oncologists to whom they can refer you, you are completely free to choose your oncologist. When the surgery phase is complete, your surgeon will essentially hand you over to your oncologist, who will become your lead doctor.
- Oncology Nurses: The nurses who administer your chemotherapy treatments will be some of the most valuable sources of information in terms of practical tips to help you cope with your cancer treatment. If there is a nurse that you particularly like and find helpful, don’t hesitate to request him or her for subsequent treatments.
- Radiation Oncologist: A radiation oncologist is the doctor who plans a program of radiation therapy (i.e., local treatment of breast cancer with high dose x-rays), using physics to determine how to effectively radiate the entire breast for maximum impact on any remaining cancer cells, while minimizing damage to the healthy tissue. Although your medical oncologist can refer you to a radiation oncologist, there will be others to choose from, especially if you are at a large medical center. Ask around. The nurses, receptionists - even other patients in the waiting room - all may be able to give you information about the reputations and personal styles of the radiation oncologists.
- Radiation Therapist: Radiation therapists are the technologists who run the machines that administer your daily radiation treatment. There might be a few different people operating the machine you are assigned to, and although you do not choose them, like nurses, they will quickly become your friends because you will be seeing them daily for several weeks.
- Psychologist or Psychiatrist: Depending on your emotional state at various stages of your recovery, you might want to take advantage of the mental health resources the hospital can provide. Do not be afraid or ashamed to ask your surgeon or oncologist for recommendations if you feel yourself falling apart, feeling depressed, overwhelmed by fear or anxiety, or having difficulty coping. Remember, your doctors should be looking at you as an entire individual to be treated. Therapists affiliated with the hospital should be particularly adept at handling cancer and survivorship issues. If you need help, get it.
- Social Worker: Believe it or not, there are a wide variety of social and economic aspects to breast cancer that you may have never imagined. Since you may be overwhelmed right now simply adjusting to your diagnosis and physical changes, you might rely on a social worker to identify extra sources of support for you. They can help you find support groups, secure community assistance and even help in managing the insurance and financial aspects.
- Nutritionist: Good nutrition is important during treatment and throughout survivorship. Eating well can help you feel better and stay stronger and is good for your overall health. Ask your doctors if there is a nutritionist on staff who can review your diet: 1) while you are undergoing treatment, as there are certain foods that might help you tolerate chemotherapy and its side effects better than others; and 2) following treatment, when you will want a healthy diet forever.
- Geneticist: If you come from a family with a high incidence of breast cancer, you might want to consider genetic testing to help make your treatment decisions. If you are a carrier of the BRCA1 or BRCA2 gene mutationand are at high risk for recurrence, development of cancer in the other breast or ovarian cancer, you may want to consider more aggressive surgeries. Some women elect to have a mastectomy, or even a bilateral mastectomy, (removal of both breasts), as a preventative measure. However, think very carefully about genetic testing, as there are a host of ethical, legal and insurance implications should such information become part of your publicly available medical history. Ask yourself if there is anything you would do differently than what you are doing today if you discovered you carried the gene mutation. If there isn't, don?t bother to see the geneticist. YSC encourages young women to speak with a genetic counselor about the host of medical and psychological implications of genetic testing.
- Gynecologist: Your gynecologist should be informed and have copies of all your medical reports. If your hormones have been affected temporarily by chemotherapy (e.g., you experience menopausal symptoms such as hot flashes or irregular or absent menstrual periods), your gynecologist will be helpful to speak with about managing your reproductive cycle. Also, once you've had breast cancer, he or she might want to monitor you more carefully for other types of reproductive cancers.