Newly Diagnosed Treatment Decision Question Please

OneLuve

Hello All,

I was diagnosed with DCIS Stage 0, grade 2 intermediate both er/pr positive. I've had two opinions from two different breast centers, their breast surgeons and plastic surgeons. Plan- Lumpectomy, sentinel node biopsy, reduction and lift all at once now scheduled for the end of next month, followed by 6 weeks of radiation and then tamoxifen for 5-10 years. I am afraid but ready to get it done. I'm worried about the lead surgeon on the team I chose. Both teams seem quite thorough and both centers are well-equipped; both have said the same about my diagnosis. The center that is the farthest away has the most renowned breast surgeon. The center closest to me has a very good plastic surgeon, a very good oncologist. The breast surgeon seems astute and well trained but has only been in the profession for 8 years, including her fellowship time and she has only been with the center since May 2015. It doesn't speak to her capabilities and she certainly laid out a good plan but I can't research her much other than her licensure, which is good and her schooling, which is good. I spoke with one of her patients who gave good reviews but she hasn't had surgery yet, just a care plan and chemo. I know length of time doesn't necessarily determine skill. I'm just wondering if I made the right choice.

Moderators

Hi OneLuve-

We want to welcome you to our community here at BCO. We're sorry for the circumstances that have brought you here, but we're glad you've found us, and hope you find the support and encouragement you need as you begin your treatment.

You're sure to get a variety of responses from members of the community about your dilemma; some people prefer a more experienced breast surgeon, while others place higher importance on their oncologist. And for some, having a top-notch plastic surgeon is a higher priority. It's a very personal decision. It sounds like you've done quite a bit of research, and that your decision was not made lightly. No one can tell you whether or not you've made the right choice, as you have to make the choice that's right for YOU. Her qualifications matter, certainly, but what matters most is how you feel in her care.

We suggest heading over to our Surgery forums, and reading some of the posts from our community about their surgeries, and how they chose their doctors, and what sort of process they went through in making their decision. It might help to hear from others in your position what was important to them, what they wish they'd done, or why they're happy with their decision.

The Mods

BrooksideVT

Well, my primary way of researching a physician is to look first at the hospital/s at which he or she practices or has privileges, then at training. Someone who has completed residency and a fellowship and has been practicing eight years will have performed thousands, of surgeries and have achieved a great deal of expertise. It is perfectly normal to visit this surgeon and ask her about her professional credentials, including how many surgeries she performs each year, how many are breast surgeries, how her outcomes correlate with those of that particular hospital. This is all information my bs volunteered. He said something along this line, "I limit my practice to cancer surgery. I perform 300 surgeries each year, half of them for breast cancer." As to outcomes, each of my docs has prefaced his remarks with, "In this facility. . . . "

One other step you might take would be to grill your primary care doc. He or she will probably have a pretty good sense of who does what best in your area and can help you identify which criteria is truly significant, and which is not.

And by the way, while there are definite advantages in having your team all housed in one nearby hospital, you can have your BS, your RO, and your MO all at different hospitals and they will still be able to work together for your benefit.

april485

Hi OneLuve, as you can see, I have a very similar diagnosis to you. I did have lumpectomy, radiation and am taking an aromatase inhibitor instead of tamoxifen due to family history of blood clots (mom had an aneurysm) so tamoxifen is contraindicated for me. The only curious part of your treatment plan for me is the sentinel node biopsy since you are not having a mastectomy?

Most of us who had lumpectomy for DCIS did not get nodes taken as DCIS by nature cannot travel to nodes. They do take sentinel nodes if you have mastectomy (if you allow them to) because it is the only chance they will get to check them. With lumpectomy, if any invasive BC is found, they can do the nodes later and if you have a mastectomy later, they will take them then. Taking nodes can up your risk of lymphedema by quite a bit so most doctors feel it is not a necessary component of non-invasive cancer surgery.

As for your Breast Surgeon, my question to you is do you like her? Do you feel comfortable with her? 8 years in medicine is a decent amount of time to learn your craft in my opinion. I would go with makes YOU feel comfortable. If you like your MO and your Plastics surgeon, it seems to me that 2/3 of your team inspires the confidence you seem to need so I would personally consider using the surgeon as well so you have all of your team in one place working together.

Hugs and best to you whatever you decide to do!

OneLuve

Thank you very much. I will look at the surgery forum. Yes, the oncologist, the radiation oncologist and the plastic surgeon are all highly rated but most importantly by their patients and they each have many years of experience. I feel pretty good about the team.

Sincerest and Happy Holidays!

OneLuve

Thanks april485. I really do feel comfortable with her, the hospital (I've been treated at the hospital before for other reasons), the oncologist, the radiation oncologist and the plastic surgeon, all highly rated and respected by their patients as well. Even the coordinators are thorough. I like the bs my pc recommended and the center where she works, but they are so highly sought after the feeling is rushed to me, extra busy, long commute to get there and expensive parking fees. The care plans are similar so it has come down to more comfort with the plastic surgeon, radiation oncologist and oncologist, as well as distance, ease of commute and the time spent face to face with each provider and well as team coordination and the ease in which they do so.

As for the sentinel node it is because of the breast lift and reduction I will have during the procedure. It has been explained to me by both surgeons that they will need to take the nodes now, because of the plastic surgery they will likely not be able to get them afterwards if the surgery pathology shows something different or if there is a reoccurrence..

april485

Ahhhh, that explains the sentinel node biopsy. Did not catch that in your post above. Glad you have a good team in place. Now, please know that we all wish you an easy time moving forward with your treatment plan. It really does get better for us DCIS gals (and some guys of course) eventually, so know that we are here if you need us.

OneLuve

Thank you for listening. I hope you had a good holiday celebration.

ChiSandy

I was given the choice of two breast surgeons at Kellogg--both renowned, one who was the son of an equally renowned surgeon and the other who does nothing BUT breast cancer surgery. I had heard about the first one from the bra/prosthetic fitters at Schwartz’, but hadn’t heard of the latter. I checked out where she trained and her research--she has a dizzying number of scholarly research articles published and also has written with some other famous breast surgeons. The kicker was that I could get in to see her the next week at Evanston, but I’d have had to wait three weeks and go up to Highland Park or Glenbrook for the other guy. I asked my primary--and he said she’s terrific and he even prefers her to the big guns downtown at Northwestern. She was also one of the earliest adopters of SNB to rule out the need for an ALND, and also perfected a technique for nipple-sparing mx as well as lx with as good a cosmetic result as possible. And she didn’t push me into a mx--in fact, told me that I didn’t have any pressing need for a bmx and that overall survival for lx+rads was exactly the same. She has a great bedside manner too. I’m very happy with her.

OneLuve

@ChiSandy thank you for sharing this good information. I am still processing it all and will share as I continue through all treatment phases.

tgtg

Another suggestion, OneLuve, if you have personal friends who are physicians, ask them, "Which [surgeon/oncologist] would you want your wife to have treating her if she were in my position?" That question can draw out answers about more than technical expertise--like candid comments about how you and a certain doctor might interact.

Example: one internist friend predicted, given my questioning nature and one oncologist's "my way or the highway" nature , that either she and I would argue or I would just walk out! Another internist friend echoed that sentiment, even more bluntly, but also said that she has all the paper credentials and cachet that make her look really good--provided her patient is a sheep and says, "Aye, aye, maam" without questioning anything.