The Waiting Game
Waiting for test results is the most stressful time in the breast cancer experience for many women. Knowing the results of all the combined tests shows you and your doctor the total picture of your breast cancer, which will guide your treatment options. It is recommended that you have a family member or friend with you when the doctor presents these options, so you have someone there who can help you process the information, take part in the discussion, and also to take notes.
When You'll Hear Results
At your first follow-up appointment after surgery, you usually will meet with your oncologist, who will be the doctor responsible for carrying out your breast cancer treatment post-surgery. In some cases, you may see the surgeon first, or you may meet with a team of medical experts to discuss options. For example, at a breast center, a team approach is often used.
At this meeting you will find out the exact size of your tumor, the stage of your breast cancer, lymph node involvement, the estrogen-receptor status and HER-2 status of your breast cancer tumor, and other specifics, such as the S-phase, if tested. Ultimately, your treatment plan regarding chemotherapy and radiation after surgery will be a decision you make with the oncologist.
It may also be recommended by your doctor that you have chemotherapy before surgery (neoadjuvant chemotherapy, which is used for women with large, locally advanced breast cancer). Generally it is recommended that the tumor be shrunk before surgery to allow the surgeon the best possible chance of removing it. If the tumor shrinks considerably with chemotherapy, it can even change the surgical options from a mastectomy to a breast-conserving option.
If you really want a breast-preservation approach but your doctor says the tumor is too big, you should at least ask about the possibility of preoperative chemotherapy. In some cases, but not all, this will shrink the tumor enough to allow a lumpectomy with good margins.
All of the specific characteristics of your breast tumor do not come to the doctor at the same time, but trickle in from the tumor's pathology report, blood tests, genetic testing (if done), the doctor's summary of, the whole picture, or consultation with another oncologist or breast cancer center before making a recommendation.
Most hospitals have tumor rounds, in which breast cancer specialists, oncologists, surgeons, radiologists, pathologists, and other breast cancer professionals gather to discuss newly diagnosed breast cancer patients (in confidence, of course). They further interpret the tumor's results and the presenting symptoms of the patient or other information and each professional gives her input and perspective. This is a huge benefit to the patient — there are several doctors weighing in on your case and more is definitely better.
In Her Own Words
After getting re-mammogrammed on the left side, I was terrified, waiting in that little booth praying that all was well. The technician came back and said, “You can get dressed but the doctor wants to see you.” I knew then that this was it. I was so afraid: Am I going to die? What am I going to do?
— Saundra, age 48, 1-year survivor
You can ask your oncologist if your case has been discussed during tumor rounds or can request that this be done, if available. These discussions do not take the place of a second opinion at a separate hospital or facility, but can provide additional information about your specific tumor. Having other specialists looking at your case objectively and making recommendations helps guide your treatment options, but it can also lend itself to more confusion if you don't understand everything that's being said.
You should ask your doctor if there are any controversial issues in your case. If there are not, the doctor should make that clear. If there are, you should know what they are. This is why it is important to talk to your doctor with a family member or friend present. And remember, the information presented needs to make sense to you. You are embarking on a six- to twelve-month treatment plan and you want to make sure that you are comfortable with the treatment option you have chosen.
What to Expect Next
You can definitely count on the test results not coming back as fast as you would like. The waiting period for your test results will seem like an eternity. You want immediate confirmation and results and it will appear as if no one is on your timetable. Some tests are invasive and may cause pain, while others are non-invasive and may only require a blood draw, x-ray, or ultrasound.
However, every test, whether it is arduous or not, causes anxiety. The emotional impact weighs heavily on the woman experiencing the test, even though the medical perception is that these tests are, for the most part, routine procedures.
Getting test results can be stress-provoking, and becomes your only focus until you finally have them. Whether you accept this process quietly and stoically or request medication to assist you in relieving the anxiety as you try to cope with the waiting period, it is difficult to go through this process. Solicit support from your anxious family and friends, but be assured that there is no good way to wait. One of the most trying times in the cancer journey is waiting for the initial test results.
Advocate for getting your results as soon as possible from your doctor, but know that there are often delays in getting these results because of your breast center's protocols on who can give you the information. You may receive your results from your oncologist, surgeon, or primary care doctor. The best person to find the results out from is the doctor you have a relationship with and to whom you can communicate your concerns and who can help you understand your test results. Many results can also be given by a knowledgeable breast cancer nurse.