Building your medical team
If you already have a medical oncologist (if this is a recurrence of a previous diagnosis), then he or she will work with you and recommend other specialists to develop a metastatic breast cancer treatment plan. If metastatic breast cancer is the first breast cancer diagnosis you’ve ever had ("de novo metastatic"), you probably don’t yet have a medical oncologist. In this case, it’s most likely that your primary care physician will recommend a medical oncologist for you, who will then recommend any additional specialists to join your treatment team.
The doctors on your team may be involved in your care at the same or different times. They need to communicate with each other about your tests and treatments.
Your breast cancer medical team may include a number of specialists:
- surgeon: performs biopsies and other procedures and removes single metastatic cancers
- medical oncologist: specializes in chemotherapy, hormonal therapy, targeted therapies, new treatments that may be available through clinical trials, pain medications, and nutritional support
- radiation oncologist: specializes in radiation therapy
- radiologist: takes and interprets mammograms, ultrasounds, bone scans, CT scans, MRIs, PET scans, and other tests to determine the location and size of the cancer and to help determine how the cancer is responding to treatment
- pathologist: examines the biopsy sample and conducts special tests on cancer tissue to determine the "personality" of the cancer (characteristics such as hormone-receptor status and HER2 status)
Determining the personality of the metastatic breast cancer
It may seem logical to assume that metastatic breast cancer that has come back after an earlier breast cancer has the same hormone-receptor status and HER2 status as the original cancer. Still, research has shown that the "personality" of the metastatic cancer may be different than the original cancer. For example, the hormone-receptor status may change from hormone-receptor-positive to hormone-receptor-negative or vice versa. The HER2 status also may be different than the original breast cancer. If either of these factors have changed, they can affect your breast cancer treatment plan. You may want to ask your doctor how the hormone-receptor status and HER2 status of the metastatic breast cancer was determined. You also may want to ask if a biopsy of the metastatic cancer should be done.
Research on new treatments for metastatic breast cancer is ongoing
Scientists are continually studying new medicines to treat metastatic breast cancer with fewer side effects. As scientists learn more about how breast cancer genetics affect how the cancer grows and responds to certain treatments, they will be able to more precisely target treatments for specific types of breast cancer or that make the cancer more likely to respond to other treatments.
If you're being treated for metastatic breast cancer, you and your doctor might consider whether participating in a clinical trial makes sense for you. Clinical trials are designed to answer very specific questions about a new treatment approach, so your unique situation will be carefully considered before you're accepted into a clinical trial. Besides the benefits you might get from the treatment being studied, being in a clinical trial allows you to help researchers find better breast cancer treatments that may help extend lives in the future.
Learn more about clinical trials.
Take your time
There is time for you to get the information and attention you need to make decisions, even if it means extra phone calls to go over the information. If you're in shock or feeling scared or angry, it can be hard to process what you hear when you're talking to your doctor the first time. Bring someone with you who can take notes, or bring a tape recorder. Don't be afraid to ask questions or ask if one medical specialist has talked to another. Each doctor may give you new information that helps complete the whole treatment picture. Take the time you need to make decisions. If you'd prefer to think about treatment options and then call your doctor with your decision, let your doctor know. Each person makes decisions in a different way.
On the following pages, you can read about:
- Metastatic Breast Cancer Treatment Choices
- Genetic Testing and Metastatic Breast Cancer Video
- Complementary and Holistic Medicine and Metastatic Breast Cancer
- Clinical Trials for Metastatic Breast Cancer
- Communicating With Your Care Team Video Series
- Taking a Break From Treatment for Metastatic Breast Cancer
"I have people with metastatic breast cancer that I've cared for for 25 years. I expect that we're going to see more and more people with long survival with this disease, which is always a prelude towards disease cure."
Larry Norton, M.D.