Following a breast cancer diagnosis, essential testing helps to confirm the diagnosis, determine the stage of the disease, and guide treatment planning. Expert Dr. Daniel Silbiger discusses these key tests, sharing insight on the value of seeking a second opinion and important questions patients should ask to ensure they receive an accurate diagnosis.
Dr. Daniel Silbiger is a hematologist/oncologist at the Cleveland Clinic. Learn more about Dr. Silbiger.
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Transcript
Laura Beth Ezzell:
What testing should take place following a breast cancer diagnosis, and what is the purpose of that?
Dr. Daniel Silbiger:
Absolutely. When someone’s diagnosed with a breast cancer, they’ve obviously gone through a number of breast imaging studies.
Depending on the type of breast cancer and where it was, how large the tumor is, if lymph nodes are involved, that might then dictate if we need to do more imaging such as whole-body imaging like PET scans or CTs of the chest, abdomen, pelvis, and bone scan. Based on that then we have to make a decision of surgery, radiation, and those types of treatments for my area called medical oncology ones. And usually when I meet with patients for the first time, I discuss with them that each of these steps is unique for that individual, the type of the breast cancer, and, of course, the extent of any new symptoms that that patient may come with.
Laura Beth Ezzell:
Yeah. And thank you for explaining that because everybody wants to know the steps right away and how quickly they’re going to move through those steps. So, what questions should the patients ask to make sure they get an accurate diagnosis?
Dr. Daniel Silbiger:
I think it’s really important to understand, first of all, the stage; right? So, I think patients really need to understand from their providers, “Hey, doc, is this a localized cancer, has this spread elsewhere?” I think that is foundation. And to understand too what type of a breast cancer is this? Is this hormone-positive? We call it estrogen-, progesterone-positive. Is this HER2-positive? These are the three features that we always need to know about the breast cancer as we’re coming up with an ideal plan. So, I think those things are really important to know the stage, and then to know what options do I have?
From a surgical perspective, can we conserve the breasts or not, or do we have to do a more aggressive mastectomy? How aggressive of a lymph node assessment do we need to have? So, that’s that surgical discussion, and then a radiation piece discussion as well comes along.
And then afterwards comes my piece typically of discussing what types of treatments. I know folks are really scared about words like chemotherapy, you know, do I need to get those kinds of IV medicines or not? And, of course, if it’s hormone-positive, what type of estrogen-blocking medicines may or may I not need?
Laura Beth Ezzell:
Yeah. Great points there. And can you talk about second opinions? What’s the value for patients there?
Dr. Daniel Silbiger:
Absolutely. People get so nervous to ask me and say, “You know, my family really wanted me to seek a second opinion,” and I’m not trying to boast here, “I really like you and I like your opinions.” And I say to them, “That’s okay. I talk to my colleagues all the time and I get second, third, fourth opinions on how I’m treating my patients sometimes because that’s what we do, we’re a team.” And so, what I tell folks is, it’s a very reasonable idea to get a second opinion if it gives you reassurance and comfort. Perhaps your provider might say, “I’d like you to get an opinion and see if there is a clinical trial available at another institute,” or “This is in the pipeline, this drug, for getting approved, but I’m not sure I should use it on you just yet.”
And so, I tell folks that sometimes it’s good to seek a second opinion outside of where they live too. So, if someone lives in Texas, for instance, maybe go outside of the area, perhaps come here to Cleveland Clinic as an example and get the opinion. Because a lot of times, it’s good to hear differences geographically on opinions too. I really think overwhelmingly, thanks to national guidelines and national and international meetings we have, we really have similarities amongst how we treat patients. But the nuances are: are there, for instance, studies available at certain institutions that may not be at the initial institute that one seeks their care at? Or perhaps there are some unique approaches to integrative health and so forth in other institutions as well.