question about which MD will be first

windingshores · February 2015

I have posted a couple of times. Radiologist had me a BIRADS 5 with 95% chance of malignancy. I get biopsy results tomorrow or the next day. I think I will meet with my primary care and she will know, but as I prepare and research MD's, I was wondering if I would see a medical oncologist or breast surgeon first, or if they are generally schedule together or what. Also is it better to have the surgeon and oncologist at the same facility?

Thanks!

WinningSoFar · February 2015

The way it worked for me is that the breast surgeon saw me first and then recommended an oncologist and in fact he called her and told her that I was going to need an appointment ASAP. They were not in the same building, but in the same general area and knew each other (from Tumor Board meetings I think). I believe that the BS also recommended a radiation oncologist, but that might have been the oncologist. I recommend getting an initial consultation with the RO just so you understand all of the primary treatments and how they interact. The BS acted like the initial navigator of my treatment, until I started chemo, then I would say the oncologist took on that role.

Forgot to write this: the BS knew who specializes in oncology for breast cancer, and in my case, inflammatory bc. Some oncologists see more colon cancer for example, something you might not know yourself. My first oncologist in 1999 was a colon cancer guy and I never knew that.

SpecialK · February 2015

Which doctor you see first depends a bit on what your biopsy reveals - some types of breast cancer benefit more from chemo first, if it is needed, than others. If that is the case for you a medical oncologist might treat first, but if surgery first is the best thing, then a surgeon, and possibly plastic surgeon, might treat first. I had surgery first with an oncological breast surgeon and plastic surgeon, then received chemo from a medical oncologist, but did not require radiation so did not meet with a radiation oncologist. If I were being treated today, I would have been seen first by a medical oncologist for chemo due to new drugs that have been developed and are now given prior to surgery. My BS, PS and MO were all in individual private practices, but all communicated with each other and worked together to coordinate my care, but some do find it easier to have all specialties under one roof at a comprehensive center.

Meadow · February 2015

I agree with Winning, after biopsy confirmed I had cancer, I saw my surgeon. Because their practices overlap so much the Oncologists and Breast Surgeons are very familiar with each other, have people they like to refer to, know each other very well. My surgeon had a pick of oncologists he preferred for me, and his office set my first appointment for me. My Oncologist referred me to the Radiologist. If I had met anyone of my team and felt we were not a good match I of course could change and see whomever I felt was a better match for me. I was fortunate love every one of them. I hope you will too. Ask a lot of questions when with the Surgeon, like, "should I make my own first appointment with the Onc, or does your office do that?" Whom do you like for me, in the system, do you have a preference?" Your team is very important. They will help save your life. Keep us posted!

Meadow · February 2015

Yes SpecialK is right too, different kinds of cancers require chemo first, others will want surgery first. Ask whenyou get your biopsy results who they want you to consult first. The Breast specialist sent me to the Surgeon first, and he knew that with wilth my kind of cancer I would need chemo first to eradicate as much cancer as possible before surgery. They will take care of you... help direct you. My cancer center also has people they call Navigators, nurses who will help you the entire journey. I kept her number in my phone and could always reach her, or she called me back without much wait. I called her about anything that I had questions about, no question was too small. Her name is Madonna by the way, she made me feel comforted!

windingshores · February 2015

Thanks everyone. I really appreciate all of this info. (I am thinking I will request a double mastectomy, we'll see what the biopsy says).

NineTwelve · February 2015

The radiologist who read my biopsy results referred me to a surgeon first, and the surgeon referred me to a medical oncologist. My GP was in the loop for a while via telephone, but I haven't been back to see her since my diagnosis five months ago.

windingshores · February 2015

Thanks NineTwelve. I am going to switch facilities when I get my biopsy results. I made an appt. for Thursday with my primary care doctor, which should be after I have the biopsy results. I'll talk to the radiologist about which specialist to see and talk to my PCP about a referral. I want to go to a cancer center in Boston once things get rolling. Everyone has been really helpful and I appreciate it.

NineTwelve · February 2015

I'm going to a cancer center. It was scary to walk in there for the first time and see bald people with respirators, but now I'm comforted by the fact that this is what they do: they take care of people with the same illness I have, and they know what they're doing.

I have seen several doctors in only a few short months. In the beginning I was numb and just went along like a sheep. But I did switch doctors (medical oncologist) because the first one seemed totally burnt out and stressed. And at one point, when I got a bad feeling about a procedure, I spoke up to my new M.O. who reassured me there were other options that would work just as well.

I will say, you will have more interactions with your M.O. than your surgeon, so make sure you get one you like and trust.

Keeping my fingers crossed that you get encouraging news at your first appointment. Please come back and give us an update, if you feel up to it. There are a lot of caring and knowledgeable people on this board.

Beachbum1023 · February 2015

Windingshores, I think that trusting your team is important no matter who chooses. You have to like them and trust them with your life. I have 16 Doctors on my team. While I see a few on a regular basis, the other specialists are available to me anytime I need them. I prefer that team simply because I have constant "second" opinions for treatment, and I can change the plan if needed. On three separate occasions my case has been presented to the Tumor Board, and I am confident that they have developed a working plan for me.

Once you have all of the info, you will be able to move forward and feel confident that all of the Doctors have a plan for the best outcome. Good Luck, I hope the waiting goes by quickly!

marie5890 · February 2015

Windingshores,

Don't make any decisions yet. Not even about whether or not to have a double Mx. That is a very huge piece of surgery that comes with it's own risks of complications. It's really important to know all possible options AND the risks that come with each options.

The most important thing to tell you right now, is to 1)get a clear picture of YOUR situation and then 2)make INFORMED choices and decisions.

Your team that will be put into place will help you navigate this. Well-informed Knowledge will be your power.

Professor50 · February 2015

I agree that having a team you trust is important. Because you really are in their hands. It doesn't mean you have to like them all or with they were your friends but you have feel like they know what they are doing and they respect you and see you as a person. When I had my biopsy, as soon as the results were in, the doctor who did the biopsy called me and I was literally dropped into this amazing net of incredibly competent women. My OB/GYN and the MD who did my biopsy suggested the same BS, who herself suggested the same MO that my OB/GYN did. My RO is a guy in the same practice with the MO. What made me feel really good was once during a conversation with my BS, she said something that I had only shared with my MO. Knowing they were all talking to each other about my case made me feel good.

Banita · February 2015

My OB/Gyn referred me to a breast surgeon for my biopsy since the radiologist who reviewed my mammogram and ultrasound results was highly suspicious of breast cancer. The surgeon is the one who gave me my results and reviewed the biopsy with me and made a recommendation based on the pathology report. As others have shared, it really depends on the type of cancer, the stage, grade and location as to what is recommended. My surgeon works very closely with a team of other professionals all at the same facility, and since my case was pretty straight forward (IDC 1.1 cm, stage I, grade II, HER 2+, ER-/PR-) and I had been reading alot about options, when he recommended a lumpectomy and radiation, I agreed with his recommendation and made my decision that day so we could go ahead and get the surgery scheduled. He referred me to medical oncologist for chemo once the surgery was done and a second pathology report and lymph node biopsy came back. After my chemo was almost over my medical oncologist referred me to the radiation oncologist. I thought it was wonderful that they all work in the same cancer center.

There were times when I started second guessing my decision when I heard that others with stage 1 cancer had opted for a mastectomy (this was after chemo when I learned more about radiation and the side effects). I wondered if breast conservation surgery was the way to go if there was a possibility the breast I was left with would be harder, smaller, permanently a different color, etc.. But aren't there disadvantages to a mastectomy, as well? What I realized is that this is a very personal decision and everyone is different. There is no one right way to go! I wish I had known more about radiation before I made my decison regarding the surgery, but I believe I would have made the same decision. I really trust the team of doctors. I'm almost done with radiation (only 6 more treatments), and it really hasn't been too bad.

proudtospin · February 2015

my primary care doc was the one who had ordered my usual mamo, when it came back with calcifications that needed testing, my primary care doc referred me to a breast surgeon who turned out to be one of the best in the state. She did the lumpies and really at first thought it was nothing but when it revealed that I would need radiation and followup, the BS referred me to MO & RO. I met with her suggestions but ultimately chose a dif facility for that portion of my treatment. I was still working and in order to deal with rads while working, I needed to do it at a facility near my office. Fortunately, my office was less than a mile from a top know Hospital and that is where I had all else and still go for my MO follow up

windingshores · February 2015

Thanks all. I got my results back today by phone (biopsy last Friday) and I have invasive ductal carcinoma, yes, and that lump is porgestreone and estrogen-positive. HER2 is pending (inconclusive at fiirst). I have an appt. with the surgeon at the smaller cancer center where my biopsy was done, on Friday. The NP who called me with results made that for me. I also called well-known cancer center for an appt. with a surgeon there (on the 25th) and a really good oncologist there too, for 3/4.

I feel urgent about getting these things OFF right now! I have autoimmune problems and have read radiation could be a problem. I have to investigate that. But many reasons my first reaction is for double mastectomy. I will listen and think and change in whatever way needed since I haven't had any conversations yet with anyone.

I guess I move on now to other topics since I am no longer waiting to hear.

grammakathy · February 2015

winding - I know how you feel about wanting things done right away. Rest assured that you have a team who has handled BC many times and there is no urgency. It is more important to make the right decisions for you. Focus on the next appointment and you will learn much that will help you decide. Have someone come with you to your appointments to take notes. And get your pathology and other reports in writing so you can refer to them later. My understanding grew and having a written report reinforced what the doctors were saying. Best of luck to you

windingshores · February 2015

I did get all my imaging and pathology reports yesterday. Grade 3, estrogen and progesterone positive, and HER2 positive via FISH. MD on Wed. Trying to have a good weekend with some success until it started to snow again!

question about which MD will be first

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