Who coordinates your medical care/treatment for LCIS?

Hi Leydi:

Despite the title of your post referring to LCIS, I see you actually have ILC (estimated less than 2 cms, ER+PR+, awaiting HER2 test results).

The lead role of the surgeon might reflect the fact that surgery is the primary treatment for breast cancer, and for many patients, is the first step in treatment. Thus, patients are commonly referred to a breast surgeon in the first instance. Breast surgeons who have completed a fellowship in surgical oncology are Surgical Oncologists by training. Breast surgeons commonly coordinate the initial clinical assessment and diagnostic procedures that constitute work-up for breast cancer.

Additional members of the team are added as indicated or requested, including a Medical Oncologist ("MO", expert in therapeutic drug treatments for cancer) and Radiation Oncologist ("RO", expert in radiation treatment for cancer). Some patients meet with all three types of specialists prior to finalizing their initial treatment plan.

For others, this may not be necessary. For example, with an initial diagnosis of extensive DCIS requiring mastectomy (no reconstruction), I did not meet with an RO or MO prior to surgery. In contrast, a person considering lumpectomy plus radiation may wish to consult with a Radiation Oncologist prior to surgery to obtain advice regarding whether they are suitable candidate for radiation therapy, various types and regimens, which of these are seen as potentially suitable in their case, what they involve and side effect profiles (with the understanding that the results of surgical pathology and axillary staging (e.g. sentinel node biopsy) may alter understanding of suitable options and actual treatment). Reconstruction-related concerns may be additional points of discussion.

There are exceptions to "surgery first" in which patients will receive "neoadjuvant" drug treatment prior to surgery, such as patients with inflammatory breast cancer ("IBC"), in which case consultation with a Medical Oncologist is mandatory.

With other types of invasive breast cancer, factors such as the extent of disease (e.g., large primary tumor), "triple-negative" (ER-PR-HER2-), and/or "HER2-positive" status may lead to consultation with a Medical Oncologist for consideration of "neoadjuvant" (pre-surgical) therapy. In the appropriate case, with extensive disease, shrinkage of the tumor may permit the option of lumpectomy plus radiation in lieu of mastectomy. Another potential advantage of neoadjuvant treatment is that it can provide information about "pathological response", meaning they can monitor during treatment and at later surgical removal, if the tumor responds / responded to the chemotherapy regimen (shrinks or disappears completely (i.e., "pathological complete response")). If the response is not adequate, this information allows a switch to a different regimen. It is possible that in such cases, the MO may take a lead role in coordinating treatment.

For patients who receive "adjuvant" (post-surgical) chemotherapy, HER2-targeted therapy (for HER2-positive disease), and/or endocrine therapy (for hormone receptor-positive disease, such as tamoxifen or an aromatase inhibitor), the MO may take over the lead some time after surgery, including long-term follow-up.

BarredOwl