The Diagnosis and Illness Pathway of Breast Cancer in Women

Transcript

My name is Donna Stern and I’m a medical oncologist. I work at St. Mary’s Hospital in the department of medicine/oncology. My major role is clinical care, but we do participate in clinical trials as well which is doing clinical research. So, basically we see patients, we do consultations, we are probably the first line after the surgery, and as a team of oncologists, I or we decide on the clinical care of the patient; whether the patient should have chemotherapy and/or radiation and/or endocrine or hormonal therapy.

It’s important to emphasize that I’m part of the team. Not only a team of oncologists, but we have nurses, we have nurse clinicians, we have psychologists, we have music therapists… and as a team we take care of the patient.

So, breast cancer is different from other cancers because breasts are associated with femininity and wholeness of women. So, it’s always different from other cancers. It’s the commonest cancer amongst women, first of all. It’s always shocking when a patient is told she has breast cancer. First of all, breast cancer is not one disease, it’s many different types of disease. So, it can be more aggressive, it can be less aggressive. Each cancer is unique and the approach to each cancer has to be unique and individualized.

The two main ways in which patients present is one – a woman will go for a routine mammogram and will be called back and will be told that there’s something abnormal, then she will be told to see a surgeon, the surgeon will do a biopsy and proceed with surgery. That’s happening more often because of screening mammograms. The other common way is that a patient will feel an abnormality on the breast. It could be a lump, it could be a nipple discharged, it could be a change in skin colour. She will go to her doctor and then we’ll have a mammogram, biopsy, and proceed the same way. So, those are the two common ways.

You know, in an ideal world, we want things to happen right away, but it’s not an ideal world and every health system has its wait times. It’s frustrating but there’s no way around it. A woman has her lump, she has to see her doctor, and then she has to be referred to another doctor or she has to have a mammogram, and then the doctor has to do a biopsy, it has to be confirmed because not all lumps are malignant. Then, if she has cancer, the surgeon has to schedule the surgery. Then, you have to wait for the results of the surgery to come back, because the type of treatment you receive will depend on the surgery findings. Then you need to see the medical oncologist, sometimes the radiotherapist.

All these things require wait times and there are guidelines in Canada for the wait times. It’s frustrating that you have to wait, but there’s no way around it. If you feel you’re waiting beyond what the guidelines are, then that’s important and then you should complain. But, there’s no way around it. As for the anxiety, I wish I knew how to advise people on that.

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