Advice from an Expert

Dr. Charles M. Balch, oncologist, surgeon and one of the world’s preeminent melanoma and breast cancer experts, has devoted more than 40 years to trailblazing research and to leadership positions in academic and clinical settings. Dr. Balch is a renowned teacher and lecturer and a revered mentor in the field of surgery and oncology. A past President of the Society of Surgical Oncology and past Executive VP and CEO of the American Society of Clinical Oncology, he currently serves as professor of surgery at the University of Texas MD Anderson Cancer Center in Houston and as editor-in-chief of Patient Resource Cancer Guides.

When you learn you have breast cancer, you have many decisions to make. From my experience of more than four decades as a breast cancer surgical oncologist, I empathize with how unsettled you feel. The best advice I can give is to become a serious consumer of health care. That means being informed about your diagnosis, your treatment plan and your involvement in your own care.

Although that may sound like a tall order, resources such as this guide will give you the foundation to move forward confidently. And, because I’ve seen firsthand the advances that have been made in treating breast cancer, I’m hopeful there are even more on the horizon.

First, a little background. The landscape has changed tremendously since I was a young surgeon at the University of Alabama in Birmingham. At the time, very few options were available for treating breast cancer. A complete or radical mastectomy that removed the entire breast, including the muscles beneath it, was the standard of care. I saw how women with breast cancer were drastically impacted by that surgery: her physical appearance, her relationship with her breasts, how her clothing fits, her sexuality and more.

I combined my ambition to become a surgeon with a focus on oncology because exciting things were happening in the field of human immunology and, specifically, in breast cancer treatment. I adopted the mindset that has served me well throughout my career: I don’t treat cancer … I treat people with cancer.

How to get started

Once you receive a breast cancer diagnosis, you may feel that it is an emergency to treat it, but you may not need to rush. As physicians, we know it takes years for breast cancer to evolve to the point that we can first detect it; therefore, you can feel comfortable taking a bit of time to learn about your diagnosis, explore your treatment options and meet with the various specialists who are involved in those treatment strategies, such as a surgeon (including a reconstructive surgeon), medical oncologist and radiation oncologist.

A crucial decision to make is where to be treated. Look for a treatment center and specialist with experience treating your unique type of breast cancer. You may live close to a cancer center or university hospital, and that is a great place to start. If you live in a small town that doesn’t have access to leading technologies or specialists, you may travel to a larger cancer center that does. This doesn’t mean you must be treated there. You may find that the best treatment plan for you can be delivered at your local hospital, but until you explore all your options, you can’t make an educated decision.

As you think about where to be treated and by whom, consider that we now have many options depending on a patient’s age and stage at the time they are diagnosed. With the advent of molecular testing, advances in radiation therapy techniques and the ability to personalize therapy, more pathways to treatment are available to help cure and manage breast cancer at all stages.

Though surgery is still the primary way to remove a tumor, systemic drug therapies (chemotherapy, targeted therapy, immunotherapy and hormone therapy) are available. Neoadjuvant therapies – drug therapies given before surgery – are being used to reduce the size of the tumor and give you more surgical options, such as a lumpectomy and radiation therapy instead of a mastectomy. After surgery, more drug therapies might be necessary to destroy cancer cells that may remain.

Also, be sure you understand the results of the molecular profiling tests that were done during the diagnostic process. Your tumor may contain genetic mutations for which a targeted therapy exists. These results are important for your family members, too. You may have inherited the mutated BRCA gene, and that information is essential to share with your family members so they can take preventive measures to reduce their risk of developing cancer.

Lastly, ask about clinical trials. Will they offer you the best treatment option available? I often tell my patients that nearly all the standard therapies we use to treat breast cancer today are thanks to patients who previously have volunteered for clinical trials.

Taking the opportunity to educate yourself gives you time to get a second opinion, discuss your options with your family and get opinions from other breast cancer survivors.

I encourage you to be thorough and trust your intuition. You don’t ever want to look back and wish you would have made a different treatment decision. You don’t want to have any regrets. Instead, equip yourself with the tools you need to make a considered and thoughtful decision. Make the best decision for you, and then don’t look back again as you go forward in your cancer journey.

Your role as a patient

As a physician, my goal is to help preserve quantity of life. I look for ways to help my patients live longer. Today, personalized therapy helps me achieve that goal. However, to treat the whole patient, I also have to understand each person’s vision for quality of life, which makes us partners in care. That begins with communication, including some very personal discussions that measure desire for achieving the maximum quantity of life while preserving quality of life issues as much as possible.

Think about your diagnosis and how it fits in with your goals. For example, a patient who has advanced cancer may hope to see a child graduate from college, so we can plan treatment with the goal of extending life. Another patient may want to travel and enjoy the time they have without multiple treatments, especially when there is a diminishing prospect of benefit. We can oftentimes opt for strategies that have fewer side effects. Someone else may be in her childbearing years and want to maintain her fertility or explore options for fertility preservation. Everyone has their own life goals.

I consider it a privilege to be able to assist each patient in achieving their personal choices, as long as they are fully informed and understand their treatment options.