The more you learn about the specifics of your breast cancer diagnosis, the better informed decision you will make. As discussed in the previous chapters, the size, stage, lymph node involvement, HER-2 status, and estrogen receptor status will assist you in choosing, along with your doctor, your best breast cancer treatment. It is your right and responsibility to understand the information that has been presented to you.

The dilemma is that there is no one right decision or choice in your breast cancer treatment. The more information you have about your specific breast cancer — its characteristics, size, and so on — the more confident in your decision you will be. This is the time that you should not leave any stone unturned as far as the information available to you.

Once you have had all the necessary diagnostic tests and biopsies, the next step is to decide on your treatment of choice, whether you will have a full mastectomy of the affected breast, bilateral prophylactic mastectomy, lumpectomy and radiation, lumpectomy with radiation and chemotherapy, or lumpectomy and adjuvant chemotherapy (adjuvent therapy is a treatment that aids the effectiveness of the primary treatment). There are other choices for older women, such as whether to have a lumpectomy without radiation therapy, axillary node procedure, and so on. If you have an estrogen-receptive tumor, you may also need hormonal treatment. If you have an HER-2 tumor you may be offered trastuzumab as part of your treatment plan.

There are two categories of treatment options; one is directed at the breast and regional nodes, such as lumpectomy with radiation, and the other is treatment directed at the whole body, as with systemic chemotherapy.

Full Mastectomy

In a full mastectomy the entire breast is surgically removed. A bilateral prophylactic mastectomy may be considered if you have a strong family history of breast cancer and have tested positive for the gene that predisposes you to breast cancer. Lumpectomy with radiation is a partial mastectomy with radiation therapy. Another option is a lumpectomy, radiation, and chemotherapy combination, which is recommended for breast cancers after the tumor size, grade, estrogen-receptor status, and a woman's health and age are all taken into account.

Systemic Breast Cancer Treatment / Chemotherapy

The adjuvant chemotherapy choice is one of the most difficult, because it means that chemotherapy might be recommended by your doctor but it is not imperative in your breast cancer treatment. Adjuvant chemotherapy is given as a precautionary measure, along with the primary treatment. It is a personal choice to receive it and will depend on how aggressive you want to be in your breast cancer treatment.

Deciding whether to have adjuvant chemotherapy carries much responsibility, because chemotherapy has many temporary side effects some of which can be permanent life changes, such as early menopause. This may or may not be important to you, and your values can influence your decision. The challenge presented to you may find you questioning what you value in life. For example, a young woman faced with breast cancer who wants to have children may seriously have to examine the percentage of benefit of having adjuvant chemotherapy and its impact on early menopause. Another woman who has had children, or who does not wish to have children, may view this decision differently.

In general, this initial treatment decision is one of the most difficult times in the cancer experience, because there are many unknowns. Knowing that there are choices can be a stress-producing time for such an important life-sustaining decision. This is the time when gathering information about your tumor, seeking a second opinion, and seeking the advice of medical professionals in the field or family friends whose opinion you respect are extremely important to your peace of mind.

Side effects and cancer treatment will be further discussed in Chapter 5.