Newly Diagnosed?



This is an overwhelming time in your life that will pass with each day. You are now a survivor but you have some research to do. The first question to ask is, where will I receive treatment? Should I visit my local oncologist? Often, your local cancer center can be very helpful with guiding you to the correct resources based on your needs. There are many institutions that promise better treatment on television. But be wary. Most protocols for common cancer types are the same regardless of where you receive treatment. If you do intend to seek a second opinion, consider doing this in collaboration with your local oncologist. There is usually a nurse navigator who can take the information from your initial appointment and fax that to any surgeon and/or oncologist that you ultimately choose to have manage your care. This can be very helpful as I have found that they are often able to get appointments faster than the average person. It also means that you have a local advocate, which can be very beneficial emotionally. Getting "plugged in" locally also means that you will be able to get some treatments near home (at your choosing). For instance, you may decide to have certain treatments (if recommended) such as pre and post surgery physical therapy, chemotherapy, or radiation locally even if you elect to have an out-of-town surgeon and/or oncologist. Also see the US News and World Reports Top Cancer Hospitals for 2016.

Unfortunately, there are many decisions that need to be made and you may feel hurried to make them. You may be given the option for neo-adjuvant chemotherapy (chemo prior to surgery) or adjuvant chemotherapy (post surgery). In most cases, the outcomes are the same. However, one recent study suggests that African American women benefit from neo-adjuvant chemotherapy. This will also give you information about your tumor's response to chemotherapy; is it a non-responder (NR), incomplete responder (IR), or a complete responder (CR). Often, incomplete and non-responders can be offered additional therapy.

Another choice that women must often face faster than they would prefer is whether to have a lumpectomy with radiation, mastectomy (total breast removal), or bilateral mastectomy (removal of both breasts). Genetic counseling prior to surgery helps with this decision as there are now many genes that are known to increase the chance of a new primary breast cancer or other types of tumors. Please see a description of such genes on the website of the U.S. National Library of Medicine.

Note that if you choose an academic institution, you may be offered the opportunity to enter a study. This could be very beneficial as follow-up will likely be much more intense. There are many very new treatment and trial options for patients with TNBC based upon the above information including the genetic testing of your tumor which may help direct care.

Some links to centers for breast cancer care on the east coast: Johns Hopkins, Cleveland Clinic, UPMC, and Sloan Kettering. Some other breast centers are the Mayo Clinic, Northwestern, Barnes Jewish Hospital and Washington University, University of Michigan, University of Colorado, and MD Anderson. Partners Healthcare, associated with Harvard, offers online second opinions. There are also many more centers listed on the Women's Choice Award site that may be a good fit for you.

Whether or not to have reconstruction is also a very personal decision. Your doctors can help to guide you in this matter. Please also refer to the website of the National Cancer Institute (www.cancer.gov). Another link that may be helpful is the NCI patient guide.

If you are looking to enter a trial, one place to start is the NCI-Supported Clinical Trial search page. Also try ClinicalTrials.gov.

There are many trials available for early and late stage TNBC.

I hope that you find this information helpful and look forward to any comments regarding experiences at any of the above institutions!

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