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Breast cancer: diagnosis BREAST CANCER: DIAGNOSIS
Women visiting their GPs complaining of pain in the breast or having detected a breast lump may be referred to a specialist for further investigations, although some women, particularly young ones, may need to push their GPs for a referral. Sometimes, specialists have a particular interest in and experience of breast diseases, but often referral will be to a general surgeon at a hospital. A specialist in breast cancer will be more experienced in treating women with this disease than will a surgeon who also deals with a variety of other conditions, and it is wise for all women to ask to see such a specialist.
If, having seen a consultant, you would like a second opinion, or feel you would prefer to be treated by a surgeon who specializes in breast diseases rather than by a general surgeon, do discuss this with your GP, the practice nurse, or the breast care nurse if your hospital has one. They will be able to find out which hospitals have designated breast surgeons. You should be able to choose to be treated elsewhere if you have any concerns about the treatment you are being offered, but in practice you may have to be prepared to push hard to get what you want.
Your GP will have written a referral letter to a specialist asking for an appointment to be made for you. If what is said in this letter leads the specialist to suspect you have cancer of the breast, you may be seen within a few days. If cancer is diagnosed, or suspected, the course of events will vary depending on the normal procedure at a particular hospital.
Clinic visits
Any necessary investigations may be carried out at your first clinic visit, and you may be asked to return to discuss the results within a week. At some clinics, all investigations ??? be done and their results received during the first visit. If treatment is necessary, it may begin within a few days. However, at some hospitals, women have to wait 6 to 8 weeks after a diagnosis is made before their treatment can start. Although this delay is not likely to have any harmful effect on the outcome of treatment for most cancers, it can mean a very difficult and anxious few weeks for the women concerned and their families.
About 90 per cent of cancers are obvious to the specialist on clinical examination. If cancer is suspected, any of the investigations explained above can be carried out to confirm or refute the diagnosis. Some hospital specialists, having received a referral letter from a GP, will arrange for a mammogram to be done before the woman attends her first clinic so that the X-ray results are available when she sees the specialist for the first time. Diagnosis is often made following a clinical examination, mammography and cytology, i.e. a fine needle aspiration biopsy.
Some specialists prefer to discuss at the first clinic visit the possible courses of action should their suspicion of cancer be confirmed. They feel that this allows the woman time to consider her options and to talk things over with her family, and they find that many women return for their investigation results with a firm resolve to fight the disease. Many other specialists prefer to leave any detailed discussions until a second clinic visit when the results of the tests are known. You may wish to consider for yourself which you would prefer, and be ready to ask the specialist to discuss things with you at the outset if you feel this would be helpful. Always remember, you are free to do nothing: having no treatment is an option open to you if you choose it.
For the majority of women, the clinical examination will indicate a benign condition such as a non-malignant tumour, a cyst, or a normal change in the breast. Further investigations may be required, and arrangements will be made for these to be carried out if necessary.
It is a good idea to take someone with you when you go for your clinic visits - perhaps your husband, partner or a friend. People often find it difficult to absorb what they are told when they are anxious - particularly if the news is not good. It may also be helpful to have made notes of any questions you wish to ask the specialist or breast care nurse.
The breast care nurse
Once you have discussed the diagnosis and possible treatment with the surgeon, you may be able to talk to a breast care nurse, perhaps to clarify any points you have not understood. At some hospitals a breast care nurse always attends the clinics; at others you may be given a card with her name and a contact number. You and your relatives may find it easier to discuss things with a specialist nurse, and she will probably be very aware of the worries you are likely to have. If your hospital does not have a breast care nurse, there may be someone else you can talk to if you would like to do so.
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