14 questions to ask about a breast cancer diagnosis

Any woman who receives a breast cancer diagnosis should ask these pertinent questions.

Focus Cancer 1
Now that we are in October, we all know it is Breast Cancer Awareness Month. If you post a photo on DUX Dental’s website, they will donate $5 to Barbells for Boobs.(1) Barbells for Boobs is a 501(c)3 nonprofit organization dedicated to the early detection of breast cancer, with an emphasis on women and men under the age of 40.(2)

Following the theme of Breast Cancer Awareness, here are 14 questions about a potential breast cancer diagnosis that are worth asking your health-care provider.(3)

1. What type of breast cancer do I have? What is the location? Is it infiltrating or invasive, or noninvasive?
2. What is the size of the tumor?
3. Has the cancer spread (metastasized) to the lymph nodes?
4. What is the stage of the breast cancer? The TNM staging system that is the most common one used to describe the stages of breast cancer is the AJCC/TNM. This system takes into account the tumor size and spread (T), whether the cancer has spread to lymph nodes (N), and whether it has spread to distant organs (M, for metastasis). Numbers after the T, N, and M give details about the cancer.(4) This is necessary to determine the type of treatment.

Normal breast (left) and tumor®

5. What is the grade of the tumor? Tumor grade is the description of a tumor based on how abnormal the tumor cells and tumor tissue look under a microscope in the pathology report. It is an indicator of how quickly the tumor is likely to grow and spread. Tumor grading systems differ depending on the type of cancer, and may be one of the factors considered when planning treatment.(5)
6. What is the estrogen receptor and progesterone receptor status (ER/PR-positive or negative)? Estrogen and progesterone can attach to receptors on cells. If the cancer is ER/PR-positive, the cancer cells can sense estrogen’s signal and use it to encourage growth of the cancer.(6) If this is the case, anti-estrogen drugs such as tamoxifen that block the receptors and estrogen’s growth signal, or drugs such as aromatase inhibitors (anastrazole, letrozole, or exemestane), can be used as treatment. Alternatively, ER/PR-negative tumors, which are more aggressive, are treated differently.
7. What is the HER2 status? HER2 (human epidermal growth factor receptor is another type of growth signal receptor, which may be present on breast cancer cells. One of the drugs specifically targeting the HER2 receptor is trastuzumab (Herceptin®).
8. Will treatment include surgery, and if so, what type of surgery? Surgery can include mastectomy, lumpectomy, and more.
9. Should reconstruction be performed, and if so, what type and when?(7) The surgery rebuilds the breast mound so that it is about the same size and shape as it was before. The nipple and the darker area around the nipple (areola) can also be added.
10. Is radiation needed? There are different types of radiation and side effects.(8) Radiation therapy is a highly targeted and effective way to destroy cancer cells in the breast that may be present after surgery. Radiation can reduce the risk of breast cancer recurrence by about 70%. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.
11. Is chemotherapy needed? Chemotherapy is usually suggested for high risk cancers, which is determined by higher grade, ER/PR, and HER2 negative types, a high score on the Oncotype DX test, and other factors.
12. If I need chemotherapy, will I need to take any other medications?
13. If so, which medications and for what length of time?
14. Should I participate in a clinical trial?(9)

There are many in the dental community who want to raise awareness of breast cancer. Smile Pink is a group of dedicated dental professionals who have come together to increase Breast Cancer Awareness via the dental community.(10) Visit the National Breast Cancer Foundation's site to learn more.(11) Their mission is to help women now by providing help and inspiring hope to those affected by breast cancer through early detection, education, and support services.

Maria Perno Goldie, RDH, MS, is the editorial director of RDH eVillage FOCUS.

References
1. http://bibezeforboobeze.com/
2. https://www.barbellsforboobs.org/
3. http://health.clevelandclinic.org/2014/02/14-questions-about-your-breast-cancer-diagnosis/.
4. http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-staging.
5. http://www.cancer.gov/cancertopics/factsheet/detection/tumor-grade.
6. http://ww5.komen.org/BreastCancer/TumorCharacteristics.html.
7. http://my.clevelandclinic.org/disorders/Breast_Cancer/hic_Breast_Cancer_QandA_Timing_of_Reconstruction.aspx.
8. http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-treating-radiation.
9. http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-treating-clinical-trials.
10. http://www.smilepink.com/.
11. http://www.nationalbreastcancer.org/breast-cancer-awareness-month.

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