Frequently Asked Questions

The following are some frequently asked questions that may help you as you manage your Breast Cancer.
How is breast cancer staged?

Cancer staging is a way to describe how much the cancer has spread when it is first diagnosed. The stage of a cancer can help determine how serious the cancer is and what treatment options are available.Cancer is given a stage based on tests and lab results, and doctors may use a cancer’s stage to discuss your prognosis.

  • Stage 0: an early form of breast cancer called carcinoma in situ. This stage of cancer has not begun to spread.
  • Stage I: a relatively small tumor that either has not spread to lymph nodes or may have spread to a single lymph node
  • Stage II: these breast cancers are larger than stage I tumors and cancer cells have spread to several nearby lymph nodes
  • Stage III: these tumors are larger than stage II cancers and have spread to nearby tissue (such as the skin or muscle surrounding the breast) or to many lymph nodes
  • Stage IV: the most advanced stage of cancer. Stage IV breast cancer is also called metastatic breast cancer because the cancer cells have started to metastasize (spread) beyond the breast and nearby lymph nodes and have invaded distant tissues such as the lungs or liver.

American Cancer Society. Understanding a breast cancer diagnosis. Available at www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis.html

My doctor said my cancer is ER-positive, HER2-negative. What do these terms mean?
  • Hormone receptor (HR) status: breast cancer cells may have receptors on their surface that respond to the hormones estrogen or progesterone. A tumor is considered to be hormone receptor-positive if it has estrogen receptors (ER-positive or ER+), progesterone receptors (PR-positive or PR+), or both. The cancer cells will begin to grow and divide in the presence of these hormones. If the tumor is positive for at least one of these receptors, hormone therapy drugs can be used to lower estrogen levels or block estrogen receptors.
  • HER2: HER2 is a protein found on the surface of all breast cells and it promotes the growth of cells. Breast cancer cells with a higher than normal level of HER2 proteins are called HER2-positive tumors. These tumors tend to grow and spread faster than other breast cancers. HER2-positive tumors are more likely to benefit from targeted therapy against the HER2 protein. HER2-negative tumors do not respond to HER2 targeted therapy.
  • Triple negative breast cancer: these cancer cells don’t have estrogen or progesterone receptors and they also don’t produce much HER2 protein. Triple negative breast cancers tend to grow and spread faster than other breast cancers. Hormone therapy is not useful for these types of tumors because they do not have hormone receptors. Chemotherapy is the standard treatment for triple negative breast cancer.

 

American Cancer Society. Understanding a breast cancer diagnosis. Available at www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis.html

How do I cope with my sadness and grief?

It is normal to experience grief, sadness, anger, crying spells, and fear after a diagnosis of cancer. Grief and sadness are normal, healthy reactions to the uncertainty of life with cancer. These feelings usually do not last long, and although they may seem like depression, they are not.

 

About 1 in 4 people with cancer do develop depression. Depression may make it more difficult for you to seek help or keep up with treatment plans. Some people may be embarrassed or afraid to admit they are depressed. However, it is important to realize that depression is not a sign of weakness and it can be treated with medications or counseling. Talk to your doctor if you experience any of the following signs of depression:

  • Your grief lasts for week and doesn’t seem to be improving
  • You are having difficulty with day-to-day activities (such as being too sad to get out of bed or leave the house)
  • You feel useless, worthless or hopeless
  • You have very low energy and decreased drive
  • You have trouble making decisions

 

American Cancer Society. How do I cope? Available at www.cancer.org/treatment/understanding-your-diagnosis/after-diagnosis/how-do-i-cope.html

What are some questions I should ask my doctor?

If you’re like most people, you will have many questions about your cancer diagnosis and treatment plan. There is no one-size-fits-all approach to treating cancer and receiving personalized information is vital to your health. Many people feel anxious about questioning their doctor or worry about not understanding medical terms. The following strategies may help you talk to your doctor and get the information you need:

 

  • Remember that there is no such thing as a stupid question or silly concern. He or she is there to help you.
  • Medical terms can be confusing. Feel free to speak up immediately and ask for an explanation anytime you are confused. It is important that you leave each doctors appointment with a clear understanding of your treatment plan and any side effects you might experience.
  • Bring a family member or friend to your appointments if you can. They can take notes while you ask questions.

 

You may not know what questions to ask your doctor. Here are a few suggestions. For more questions, please visit the links in the resources section.

  • What type of breast cancer do I have? What stage is it? Has it spread to my lymph nodes?
  • What is the hormone-receptor and HER2 status of my cancer? What do these terms mean?
  • What are my chances of survival, based on my cancer as you see it?
  • What are my treatment options? What side effects might I experience?
  • How long will treatment last? What is my treatment regimen? Where will it be done?
  • Is there anything I can do to help manage side effects?

 

American Cancer Society. Questions to Ask Your Doctor About Breast Cancer. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/questions-to-ask-your-doctor-about-breast-cancer.html

Breastcancer.org. Communication with Healthcare Providers. Available at https://www.breastcancer.org/tips/compliance/healthcare

Susan G. Komen Breast Cancer Foundation. Questions to Ask Your Doctor.

How is breast cancer treated?

Once breast cancer has been confirmed, treatment usually begins within a few weeks. The type of treatment recommended depends on the size and location of the tumor, the stage (extent) of the cancer, and lab test results. Breast cancer treatments fall into a few general categories:

  • Localized treatments remove, destroy or control the cancer cells in a very specific physical area. For example, radiation and surgery are targeted to the tumor and minimize damage to surrounding tissue.
  • Systemic treatments are used to destroy and control cancer cells within the entire body. Systemic treatments are particularly useful for cancer cells that have begun to spread from the original tumor site. Examples of systemic treatments include chemotherapy and hormone therapy such as fulvestrant, tamoxifen, and aromatase inhibitors (e.g. letrozole, anastrozole, or exemestane).
  • Targeted drugs may be used alone or in combination to destroy cancer cells. These drugs are used in specific patients based on lab results or previous responses to therapy. For example, abemaciclib (Verzenio®) is used in women with HR+/HER2- metastatic breast cancer. It may be used in combination with aromatase inhibitors as initial therapy in postmenopausal women, in combination with fulvestrant if cancer has progressed after hormonal therapy, or alone in women whose disease has progressed after hormone therapy and prior chemotherapy.

National Institute of Health. National Cancer Institute. “Breast cancer treatment (PDQ®)—patient version.” Available at https://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_185

 

What are clinical trials?

Clinical trials test the safety and benefits of new treatments, as well as combinations or new doses of standard treatments. Our knowledge of breast cancer treatment has vastly improved based on the results of these studies. There are 4 main phases of clinical trials:

  • Phase 1 trials investigate the safety of a drug over a range of doses.
  • Phase 2 trials study how effective a drug is in treating a specific cancer.
  • Phase 3 trials evaluate how well the drug works compared to standard treatments.
  • Phase 4 trials are performed on drugs that are FDA-approved and look for long-term side effects of treatments.

 

There are many benefits and potential drawbacks to participating in a clinical trial and you should weigh your options before enrolling in any treatment regimen. Clinical trials offer the opportunity to try new treatments that may benefit you as well as expand our knowledge of effective treatments. In clinical trials of breast cancer, placebos are not used for ethical reasons. Instead, you will receive either the new treatment or the standard treatment. Some potential drawbacks include unknown side effects of new treatments and lack of testing centers in your area.

 

To find clinical trials in your area, you can look at databases of clinical trials such as:

https://www.cancer.gov/about-cancer/treatment/clinical-trials

https://www.nih.gov/health-information/nih-clinical-research-trials-you/finding-clinical-trial

 

How do I find support groups in my area?

Support groups can be an important resource for people diagnosed with breast cancer. They vary in format, from in-person groups, to support groups for family and loved ones, to online or telephone support groups. No one support group model is right for everyone and it is important to find one that meets your needs. You can find local support groups by asking your doctor, community center, or place of worship, or through an online search.

 

American Cancer Society. Support Programs and Services.  https://www.cancer.org/treatment/support-programs-and-services.html

 

Susan G. Komen Breast Cancer Foundation. Support Groups. https://ww5.komen.org/BreastCancer/SupportGroups.html

Can my breast cancer be cured?

There are many different methods available for treating breast cancer. The type of treatment decided upon by you and your physician depends on several factors, including, but not limited to:

  • how the cancer presents in your body
  • the presence or absence of certain biomarkers, which are tools that can be used to reveal more about your cancer type and help you and your physician decide upon the most optimal treatment
  • the presence or absence of certain mutations in genes
  • cancer stage
  • how you feel
  • your personal beliefs
  • your past medical history, and
  • any other medical condition you may have.

 

Currently, innovative drug-therapy options available for certain types of breast cancer have improved the methods available for treatment. However, it is important for your healthcare team to be familiar with individualizing treatment, since every person may respond differently. The best way to understand breast cancer treatments and their possibilities is to communicate openly with the rest of your healthcare team. Even if you are uncertain, it is important for other members of your healthcare team to know more about your preferences so that the information you receive is relatable and clear. Building this relationship is the best way for you to explore more about your diagnosis, treatments, and potential outcomes.

 

References/more information

American Cancer Society. “Treating breast cancer.” Available at cancer.org/cancer/breast-cancer/treatment.html

Breastcancer.org. Treatment and side effects. Available at www.breastcancer.org/treatment

National Institute of Health. National Cancer Institute. “Breast cancer treatment (PDQ®)—patient version.” Available at cancer.gov/types/breast/patient/breast-treatment-pdq#section/_185

 

Will I lose my hair when I start treatment?

Chemotherapy targets cells that divide rapidly, such as cancer cells. Hair loss is a result of chemotherapy attacking rapidly dividing cells other than cancer cells. The impact on your hair will vary, depending on the treatment.Targeted therapies are less likely to produce systemic side effects like hair loss than general chemotherapies.

 

Resources/more information:

Breastcancer.org. “Why and how hair loss happens.” Available at www.breastcancer.org/tips/hair_skin_nails/hair_loss

American Cancer Society. “Chemotherapy for breast cancer.” Available at cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html

American Cancer Society. “Treatments and side effects.” Available at www.cancer.org/treatment/treatments-and-side-effects.html

How can I tell if my treatment is working?

Treatment response is determined by clinically evaluating how your body is impacted by the methods being used. Laboratory tests, imaging, and consistent dialogue with the other members of your healthcare team are all important to their keeping up with how you are responding to treatments. Furthermore, evaluating this response—or lack of it—allows your healthcare team to research other treatment strategies that may enhance response.

Resources/more information:

National Institute of Health. National Cancer Institute. “Breast cancer treatment (PDQ®)—patient version.” Available at www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_185

 

 

Is targeted therapy better than chemotherapy?

The impact of various therapeutic options depends on the type of cancer you have, in addition to many other factors that need to be considered before deciding on a treatment plan (please see the answer to question 1 for more information). The treatment choice that is supported by your clinical presentation and the available evidence will vary from patient to patient. Therefore, targeted treatment is only “better” in certain situations and for specific patients. Understanding more about your diagnosis is the key to better recognizing why certain treatments are preferred in certain cases.

Resources/more information:

How long will I need to undergo treatment?
The treatment plan and strategy differ for each patient, meaning that the length of therapy will also vary, depending on the individual situation. Some instances call for monthly cycles for 6 months total, followed by reevaluation of the plan, while other patients require continuous monthly treatment until there is a change in the status of the disease. As we enhance our knowledge of this dynamic field, the length of treatment and specific treatment plans are designed to reflect careful decision-making by the entire healthcare team—always including, you, the patient.

References/more information:

Additional Patient Resources