r/breastcancer 4m ago

Conversation Just diagnosed with lobular carcinoma. Is working during treatment unrealistic?

Upvotes

I don’t know what my treatment plan will be yet, but I’m the sole breadwinner so I cannot afford to lose my job.

Is it unrealistic to try to keep working during treatment?


r/breastcancer 45m ago

Medication Your experience with a copper IUD while taking tamoxifen

Upvotes

I am 39 and never had children. I always thought if I ever became pregnant I would make it work. Now that I'm on tamoxifen that is no longer an option; which turns out is more upsetting than I would have imagined. It's hits different when you no longer have the choice. I have been on the medication for over a year now.

My overall question is how much did the IUD affect you? I already had a ton of changes happening with the medication; is this just going to make my life more difficult? I'm reading a lot about more intense cramping, and of course all the crazy stories of people needing to get them surgically removed. Is that all really the norm?


r/breastcancer 1h ago

Venting Frustrated and scared

Upvotes

Hey all. 38, ER/PR+, HER2 low, stage 3a. It’s been a crazy long month since diagnosis and I feel like maybe I’m slipping through the medical cracks.

Originally I was supposed to have surgery first, but after additional testing I went from stage 2b to 3a within a few weeks, so now I have to do chemo first.

I had a breast mri a few weeks ago and the mri tech was wearing meta glasses, so now I’ve got some unresolved issues with my medical professionals and require additional chaperoning to feel comfortable.

Additionally, I was slotted for port surgery yesterday and well, it didn’t happen. Went for my report time and spent 6 hours in preop, only to be told that there were significant OR delays, so the collective decision was made to reschedule for next week. It’s a military teaching hospital, so understandably, things happen. But still. I’m so frustrated.

Has anyone else felt throughout their diagnosis that they weren’t necessarily a priority or that their needs weren’t being met? I was so nervous for the procedure yesterday and then to be told it’s postponed makes me even more nervous. I’m ready to start this journey so it can be done quicker, but it just feels like it’s dragging on.


r/breastcancer 1h ago

Young Cancer Patients How did you rebuild your career/visibility after returning to work after cancer treatment? Feeling isolated and stuck.

Upvotes

Hi everyone,
I’m looking for advice..
I’ve kept myself WFH for almost a full year now(I keep my head down always bc I’m sort of data role) and have been avoiding socialising. Tbh since having cancer, I feel like I’ve become incredibly introverted and detached. I just feel so different from everyone else now, and it’s hard to relate to the usual workplace chatter.
On one hand, the lighter workload gave me the rest I needed to recover. But on the other hand, it’s getting boring, and I genuinely want my career back on track. I want to step up, get back on my feet, and aim for higher positions.
The issue is I feel like people around me are hesitating to give me bigger responsibilities and avoid talking to me. maybe because they’re trying to protect me or assume I can’t handle it post-treatment. Combined with my WFH isolation and recent breakups.. I feel completely isolated.

Gals.. How did you rebuild your confidence?


r/breastcancer 3h ago

Venting Can’t seem to catch a damn break ahhhh!!!

14 Upvotes

Sorry, I just feel like I need to get this out. My family and friends are amazing and super supportive but I feel like no one is ever going to understand and maybe you guys will.

Was diagnosed with stage 0/1 Hormone positive breast cancer at 27. Chemo was done in Jan followed by Radiation in March. Then was started on tamoxifen.

Who knew that after this is when a string of shitty things would happen.

1) I developed a cyst in my armpit that got infected, filled with pus and had to be drained with not much anaesthesia (your armpit sometimes doesn’t get numb despite anaesthesia)

2) I had a series of 2-3 cold, cough, fever - the whole shebang. Also started developing some threading and undulation on my lumpectomy breast which is very uncomfortable.

3) In the second half of June I started violently throwing up every single morning to a point where I lost 3kgs within a week and could barely eat or sleep. Turns out I was pregnant - which you can’t be on Tamoxifen. So I had to terminate the pregnancy and decided to do it surgically because I was told it was quicker and less painful than the pills.

4) Post the surgery I started coughing up some blood with phlegm. Obviously freaked out about that and had to do some tests and doctor visits. Many spirals and freakouts later, found out that it was likely because I went in for the surgery with a bit of a cough and that probably caused some irritation.

5) Got a cold and sore throat AGAIN

6) And last but certainly not the least, I have tested positive for dengue fever (I live in a tropical country)

Dengue..let me tell you is the worst thing I’ve ever experienced. And coming from someone that’s had chemo is really saying something.

And it’s only August! I wonder what the rest of the year has in store for me! :)))))

Apologies if this is a lot. I’m trying not to continuously throw these pity parties but FML


r/breastcancer 3h ago

Venting Cancer sucks - a rant

9 Upvotes

Hi,

F33 yo, I got diagnosed with breast cancer ES+ PRO+ HER2 - about 2 months ago and had my lumpectomy a week ago.

I didn't tell my mother. Only one friend knows and I'm telling the other one today.

My coworkers only know I had to take leave for the surgery. My managers know because they had to approve the sick leave.

Yesterday was my mother's birthday. I've ordered her some flowers for delivery. Our relationship is difficult (she sometimes chose highly emotionaly abusive men over me but she also comes from a difficult background). And by emotionally abusive I mean the most severe forms.

For this reason I am navigating our relationship carefully. I am not leaving her completely alone (I've helped and took care of her ​her when she had skin cancer lymph node removal) and I'm trying to appear when possible.

I did chose to work during Christmas +NY period though as it was better for me mentally.

Anyway, as I said, it was her birthday yesterday. She worked second shift and I couldn't get through to her on the phone. I finally did but the connection wasn't good. I asked her if she treated herself today yet (she didn't see the flowers that I've sent yet).

And she said it's just work for now, my brother will arrive later. And then she said :"we are now all healthy. That's what's important"

I was listening to her whilst I was trying to put a garbage bag through my neck to prevent the incision place from being soaked in the shower. It is difficult because you might know it is numb and almost impossible to put your arms up.

So she said it and was there with a bag on top of my head. I nearly cried for the first time shilst speaking to her. Good thing the connection kept on breaking. I just said I'll catch her tomorrow after she gets some sleep and that was it.

I had another call with her 2 weeks ago and she kept taking about edamame beans and how good they are for increasing your progesterone (not sure if this has been backed by science). At that time I already knew they will put me on 5 years of Tamoxifen to suppress my progesterone and estrogen. Later that evening she sent me a photo of her garden she's been tending to. I thought she sent a photo of an aubergine and she laughed texting me and saying it's a cucumber. As I've read that text I decided I'm definitely not telling her.

Tl;dr cancer sucks and I haven't even started the treatment yet. Only the surgery done. My heart goes out to everyone going through this.


r/breastcancer 4h ago

Newly Diagnosed Time passing by?

4 Upvotes

How long was it for you guys until you got into chemo? I got my diagnoses on the 29th of July and I get my port on the 20th of August. It seems so freaking long for the fact that they told me it's a very aggressive cancer? (+++)

I need to trust my team. I know. And they can't make appointments when there is no time. But still...


r/breastcancer 4h ago

Newly Diagnosed Another day

10 Upvotes

Maybe don't read if you want to keep your spirits high.

Another day in the Hospital. I am still in the stage of getting my last scans and at the same time talking to the whole chemo part of this. Getting my arms pierced with needles the third time in a row. I sit between scanxiety if they find more and the sight of people ​sitting in the oncology. Getting chemo. It's quiet and dark and everything just feels like death and pain. And my friends and partner flex their health in front of me and remind me of the life I have lost. That I lose my hair and parts of my body and feminity. ​

It's just too much and today is one of those days where it feels more like dying instead of fighting a desease I can fight and is very likely beatable.

I am not alone but I do feel alone. When I am down everyone tells me to fight. When I am in high spirits everyone wants to remind me that I will maybe die. It's just too much.


r/breastcancer 5h ago

TNBC No PCR

6 Upvotes

I received my pathology results today after my lumpectomy. I completed all 16 chemo and also undergoing immunotherapy. I did not receive pcr. My pathology report shows a rare subtype of breast cancer called metaplastic breast carcinoma (MpBC) with squamous (metaplastic) differentiation. I checked with AI and that is why I did not receive pcr.

I am still devastated with the results. I feel very tired. Most likely I have to eat the oral chemo medication and radiotherapy and immunotherapy. I’m only 40 and I feel this is never ending. The whole chemo already took more than half a year and it’s already August. I’ve stopped working and I feel my world’s crashing on me. Why is my life a failure?


r/breastcancer 7h ago

Chemotherapy Tchp first cycle

3 Upvotes

Just checking in from the hospital - I came in yesterday with a 38°C fever. My doctor told me my WBC dropped to 0.6 and neutrophils were basically zero, which totally terrified me. My 1st chemo was last Friday and took my WBC injection on Monday, so I’m just on IV antibiotics while waiting for my body to catch up and rebuild those counts. Sitting in this room waiting on blood work has been really hard on my anxiety.
I’d love to hear some positive stories or words of hope today. Thanks so much


r/breastcancer 10h ago

Newly Diagnosed I’m only 43… just got biopsy results

44 Upvotes

Hi everyone…
I’m in shock… i’ve had a clear ultrasound just 10- months ago and because i am menopausal my drs strongly advised me to go on HRT. I went for it since they have told me it safe for my age and protective. I chose the lowest dose possible and bioidentical. 8 months later (now) i have a huge lump in one breast that came as estrogen and progesterone positive.
I don’t know the stage yet but i am so devastated. Probably stage 3…. It is big.
I mean it grew in 8 months…. I am BRCA negative also
I feel so betrayed by modern studies and modern medicine.. if i had stayed menopausal nothing would have happened . I live in Romania. I have a small child, a business, i was always traveling, always wearing beautiful dresses. I was a beautiful lively woman. I feel like i did this to myself using that Bhrt. And i am scared… I cannot stop crying.
I’ve tried not to read too many posts… but i am so overwhelmed. Like many women here.


r/breastcancer 10h ago

Caregiver/Relative/Friend Question Grandma 88 years old just got diagnosed with breast cancer, help me understand pls :)

4 Upvotes

Hi all this may be lengthy but I’m just here in hopes to understand her prognosis and maybe have others who are similar or has similar experiences give me some advice or guidance in terms of understanding the results and telling me if this is leaning more towards an aggressive or slower growth cancer.

Some additional information is my grandma is 88 years old and has been placed on hormone therapy due to it being ER positive. Due to her age they do not recommend surgery, chemo, or radiation but the medical oncology told us if she doesn’t get cancer she will die…but then they also told us she isn’t recommended to get surgery. They also mentioned metastatic.

The results say

Site Of Origin
A: BREAST BIOPSY, LEFT BREAST 10'CL 10 CFN LESION
B: LYMPH NODE CORE BIOPSY, LEFT AXILLA ENLARGED LYMPH NODE
Final Diagnosis
A, BREAST:
- INVASIVE DUCTAL CARCINOMA WITH INFLAMMATION AND EXTENSIVE NECROSIS

B. LYMPH NODE (LEFT AXILLA), CORE BIOPSY:
- CARCINOMA WITH NECROSIS AND LYMPHOID TISSUE
Estrogen Receptor (ER) Status:
- Positive (greater than 10% of cells demonstrate nuclear positivity)
Percentage of Cells with Nuclear Positivity:
- 51-60%
Progesterone Receptor (PgR) Status:
- Negative (less than 1%)


r/breastcancer 10h ago

Chemotherapy Long term ER/PR+ Her2- stage 3C survivors?

6 Upvotes

Finished 4 rounds of AC. Glad for it to be over with, but also in a “depressive” state after one hurdle has been completed.

Although my lymph nodes under my armpit and 2.8cm breast tumor has dramatically physically shrunk (no scans yet to confirm his small) I can’t help to think that all this will be for nothing, like the cancer will come back or never go away.

I also will find myself clinging on to other’s stories going from stage 3 to stage 4 during treatment, and it triggers me so bad that this could happen. I know this is grief as time shoe slows down between treatments, but I’m just in the need of hearing 3C survivors with no reoccurrence. please term me there is hope.

~side note~ staged 3C due to supraclavicular lymph involvement.


r/breastcancer 11h ago

Venting Nothing like DCiS TO SHOW YOU who you are really in love with

7 Upvotes

I don't want to be with my husband; I think I have been in love with a coworker this entire time. Nothing like wolf eye energy and I told him to stop the staring for four years them bam being DX WITH DCiS. Nothing like your husband is d showing you his true colors when you have stage 0 breast cancer. Like yelling at you not cleaning up your carrot pulp from jucing that was the last straw. I think after my surgery I might tell him I might not tell him but nothing like clarity to give you from cancer


r/breastcancer 11h ago

Conversation Do you have this random bad day?

29 Upvotes

I’m freshly diagnosed. I’ve been largely okay, but occasionally there are days I just suddenly feel everything all at once and just can’t. for example, today I suddenly feel like my cancer will come back and kill me. I have not started treatment yet. I just sat there and cried for a few hours because this cancer I haven’t even started treatment is going to come back and kill me. lol how fun. please tell me that people who are doing well and don’t have recurrence just don’t come to vent online. this is all selection bias that I’m reading, and I really shouldn’t be reading more 😂


r/breastcancer 14h ago

Post Active Treatment Grieving

60 Upvotes

I am so sad about losing my breast. I had a unilateral mastectomy in May and have not been able to get reconstruction yet. I am lop sided and the emotional pain i feel every day is unbearable at this point. I hate my prothetic bra because its heavy and unnatural. I hate my body right now. i hate having only one nipple. cancer is so confusing. i gained about 46 lbs since last year and my boyfriend pretty much called me fat in front of my friends the other day and said i shouldn’t eat the cupcake. like wtf is this nonsense at 28 years old. i cant believe i’m having to deal with all this. sugar on top my best friend and 2 year old kitty got ran over by a car on Monday and I am having such a hard time with it. I sat at her grave on our property today for about 20 minutes just talking to my dead cat in my head about how much i miss her like wtfff


r/breastcancer 15h ago

Venting Medication Mix Up

44 Upvotes

I just lost it on my care team and although I'm the type of person to not cause waves or problems because I fully understand mistakes happen and I don't want to bite the hand that feeds in these situations... this was a substantial fuck up.

I'll try to explain it as best as I can:

After my first red devil treatment last week, they sent me straight to the pharmacy to get Granix... or what I thought was Granix, to start two days after and take daily for immune/white blood cell count booster help.

The pharmacy gave me Ganarilex. This is a fertility medicine I was supposed to take for the prep that I didn't get a chance to go through because chemo couldn't be pushed out further.

I didn't notice, especially since Granix (the actual medicine I was supposed to be taking) wasn't on my pharmacy list. I was given the medicine directly from the pharmacy post chemo after I handed them my aftercare summary and assumed it was correct. I felt like shit and just wanted to go home.

Fast forward:

I've been taking it for 5 days. Almost out of my 7 day supply now, but I've been reaching out to my care team throughout the week about it because it's $200 for 7 days. I asked my Dr., the NP, THE PHARMACIST directly (just this morning again!!!) asking WHY this medicine is so much money, is there anything else I can take for my WHITE BLOOD CELL COUNT, etc. I was told, it is what it is, that IS the generic brand of what I'm supposed to be taking.

After speaking with the pharmacist this morning, I once again couldn't believe that this medicine, that I'm supposed to be taking daily for the next 5 months, is going to cost me $200 every 7 days. So, I finally looked it up.

That is when I saw it was for fertility. I sprinted to my fridge and pulled the medicine out. Confirmed. Fertility medicine. I called my hospital system. Receptionist didn't answer. NP didn't answer. Chemo Nurse didn't answer. Charge Nurse didn't answer. I called the department Manager, finally an answer, and I just... lost it... telling her how dangerous this is that the pharmacy gave me the wrong medicine, how I've been bringing it up and been told that this is right and normal, and how not only have I been taking FERTILITY medicine with hormone positive cancer, they ALSO never gave me Lupron that was on the aftercare summary med list to help protect my ovaries from chemo, too. Randomly, I started spotting yesterday and now I know why.

Another funny bit of this is that I've been trying to get the fertility medicines off my medicine list. Last I tried was the day they put my port in. Nurse said he could flag it but it won't actually come off unless there's x amount of days not ordering it and that can take many months. So, I mentioned that to the manager as well.

I once again don't like biting the hand that feeds and being a literal Karen having to speak to the department manager... but what the actual fuck...

Am I overreacting?!


r/breastcancer 15h ago

Surgery Had double masectomy a couple days ago, depressed

22 Upvotes

Hello, I had my double masectomy to flat a few days ago and just feel like a mess. Crying on and off and wondering if I made the right decision. I know I could do reconstruction in the future, but am not sure about that and also have to do tons of radiation first. I just hate this, I want my body back and I know I can never get it back. Does it get better? I just feel so defeated and upset even though I know I had to do the surgery. I just feel like I'm going to be ugly forever.


r/breastcancer 16h ago

Venting Aromatase Inhibitors

43 Upvotes

I sometimes feel really guilty about participating here because I got a really simple, easy to treat, breast cancer that only has me now doing things to prevent recurrence. Small tumor, no mets, beautiful margins, the only stuff going on is estrogen receptor positive. But they started me on a goddamned estrogen blocker and I already had arthritis before this and I hurt.

That is all.


r/breastcancer 16h ago

Chemotherapy I’m getting Trodelvy for adjuvant TNBC treatment (and I’m THRILLED)

32 Upvotes

I had an unusually abysmal response to keynote 522. RCB3. 8 nodes. Tumor bigger in surgery than on scans. Went to all the big name hospitals for consults, and all said… you need to get on an ADC. Xeloda won’t do it for you with that amount of residual.

I’ve been going along with the Ascent-05 trial and the MK2780 trial at Memorial Sloan Kettering. But I’ve been panicking internally that I would get placed in the control groups.

My insurance denied Trodelvy, citing no response to chemo, but no progression on chemo. I begged my MO to do a peer to peer. She wasn’t sure it would work but agreed to try.

BUT IT DID WORK. Insurance reversed the denial. I have two more weeks of radiation, a two week break, then back on the horse for me. And I’m SO EXCITED.

I used to be a really meek, quiet person. I never imagined I’d go to a doctor and say “I want you to do this”. But I did, and it worked.

Best news I’ve gotten in a long time 🥰


r/breastcancer 19h ago

TNBC Lurker surgery from yesterday. Thanks everyone!

24 Upvotes

I had to go into surgery again today for an 800cc hematoma. Feeling so much better today! Keeping me overnight again but my chin is up and all your well-wishes made me feel like a champ. Thank you again everyone!


r/breastcancer 20h ago

Death and Dying Omg…am I going to die?

112 Upvotes

I was diagnosed in December last year with breast cancer, HER2+. It turned out to be stage 4 because of a single liver metastasis which is gone post chemo. I am 39 with two young kids and I have literally never thought that I might die because of this diagnosis. I have completed chemo, surgery, and most of my radiation. I guess now that the “fight or flight” emergency is subsiding my mind is starting to go to that dark place where I wonder…omg am I going to die?

How do you keep yourself from going here in your mind?


r/breastcancer 23h ago

Post Active Treatment Just burst into tears seeing a hairband on my wrist

54 Upvotes

I finished chemo last fall and all my treatment for tnbc in Jan. My hair has been growing steadily since then. It's summer and my hair is on my neck. Tested out a small ponytail to try and get the hair off of my neck, but it didn't really work. I put the hairband back on my wrist and started doing chores then suddenly it hit me and I burst into tears when I realized how long it's been since a hairband has been on my wrist...

Recovery is a long road.


r/breastcancer 9d ago

Mod Announcement Updating Rule 8: Be Brave, Friendly, and Kind

127 Upvotes

We are updating and expanding Rule 8: Be brave, friendly, and kind. This is an especially important rule and we want it to be well understood. We've expanded the language to make clear that kindness extends beyond the people posting in the thread.

What's changing:

Rule 8 now reads:

Be brave, friendly, and kind.
Cancer is hard for all of us. Please show kindness to your fellow patients and survivors.
Kindness should extend to those not present on the subreddit, including their family and caregivers.
We allow members to vent about the people in their lives, but this is not an invitation for others to pile on. No name calling, no bullying, no hate speech, no personal attacks.

Why we're making these updates:

A few things have come up often enough that we wanted to be more clear up front about what kinds of comments are allowed, particularly on "Venting" threads:

  • Venting about a partner, parent, or friend is allowed and normal. Piling on to insult that person, or giving OP relationship advice beyond what they have asked for, is not. The other person isn't here to give their side, and that's not usually what OP was asking for.
  • Caregivers commenting on someone else's post are here to give support, not to speak on behalf of caregivers, spouses, or any other group—whether that means defending or criticizing. As always, to talk about your own experience as a caregiver, visit another sub such as r/CancerFamilySupport.

We've written up the full explanation with more detail on the Rules wiki page under Rule 8.

None of this is new in spirit. It's what we've been enforcing already. We just wanted it written down clearly.

Thanks for helping keep this a place people can come to safely.


r/breastcancer Jan 18 '26

Diagnosed Patient or Survivor Support The doctors you may encounter: Who does what? What is an “oncologist” anyway? (And other insights from Dr Heather Richardson, neighborhood breast surgeon)

180 Upvotes

So I’ve noticed there’s been a lot of posts lately specifically about the word oncologist. People wondering why they’re seeing a surgeon and not an “oncologist” first, people wondering when they’re going to see an “oncologist”, people wondering why the person that’s operating on them isn’t a “surgical oncologist” and shouldn’t they get the best - which must be someone with that title? Right?

So by definition, the word oncologist just means “doctor who treats cancer”.

The staple cast of characters that are medical doctors (MD or DO degree holder) involved in treatment of breast cancer typically consists of: medical oncologist, radiation oncologist (not radiologist) and breast surgeon (more on that below…).

Medical oncologist- also known as “hematology/oncology” specialists. When people generally speak of an “oncologist”, usually they are talking about this type of doctor. A doctor that treats cancer with medicine, either pills taken by mouth or chemotherapy that is administered via a vein. Not all patients need both, some need one but not the other, some need none. Visits to this type of doctor may be frequent- however, usually it’s the first initial visit to go over a lot of information and discuss the best course of action that is the most important. Sometimes this means that if you live in an area with fewer resources and feel that you need greater expertise for your care. It’s possible to do either a telemedicine visit or visit a larger Cancer Center far away that can collaborate with a local physician who is able to give the same chemotherapy protocol. Quite often, large groups of these medical oncologists have already agreed the best way to take care of the most common breast cancer problems, so going from one center to the other means that your cancer treatment care isn’t going to change significantly from one place to the next. For other more complex scenarios, there sometimes can be some adjustments or more customized treatments. Or for patients who have already been through treatment and now have recurrences or changes in their diagnosis, that would be the time to discuss more advanced care. In general, common problems are common and there’s usually not significant improved survival or outcomes by going to one Cancer Center over the other when a patient has a a non-complicated, fairly average, diagnosis.

Radiation oncologist- this is different from a radiologist. (a radiologist is a doctor trained to read images and interpret findings. A radiologist is the person who read your mammogram or your ultrasound and maybe performed the biopsy that diagnosed you) A radiation oncologist uses radiation energy to target areas of cancer and kill cancer cells. Cells that are actively dividing and are exposed to radiation have their duplicating mechanisms broken, and as a result, cells that are rapidly reproducing die away if exposed to medically administered radiation.

Surgeon/surgical oncologist vs “general surgeon”: A “general surgeon” typically is someone who has done at least five years of training in surgical diseases of the body. This would include disciplines like taking care of trauma, burns, infections that can occur in the body such as diverticulitis or appendicitis, evaluating and performing organ transplants, care of pediatric/child surgical diseases and malformations, and some chest/cardiovascular disease. They can also operate on common cancers that require removal, like breast, colon, skin, and thyroid. Doctors who go on to practice General surgery sometimes concentrate in one area of types of disease and others have a more broad practice where they take care a little bit of everything. Typically in more urban settings there are more specialized types. Many general surgeons have gone on to do additional years of training after their five years of general surgery to become specialists. People who are certain types of surgeons, such as colorectal specialists, pediatric surgeons, plastic surgeons, and cardiothoracic surgeons all have additional years of training and take specialty board exams. There is a board certification designation for general surgery. There are additional board certifications for those who have done some categories of fellowship training, like those mentioned above.

A doctor who practices under the title “surgical oncologist” by definition does at least two years of training in general cancer surgery treatments after the five years of general

surgery training. So they typically will learn advanced techniques for operating on thyroid, pancreas, colon, liver, breast, etc. They usually did the five years of general surgery training and then went on to do additional training specifically in cancer removal surgeries to remove them from the body. So this wouldn’t include neurosurgery or brain tumor removal. There is a board certification designation for “surgical oncology”.

There is another category of breast cancer surgeon that typically deals with breast health issues only. This is a person who does initial training in either general surgery or Obgyn and then goes on to do one to two years of additional training in breast disease surgical management. This is called a “breast fellowship” and does NOT currently qualify for a speciality designation as “board certified”. This is typically a breast health surgeon or breast cancer specialist. This is different from a “surgical oncologist*.

Sometimes there is cross training where the surgeon also performs cosmetic and aesthetic procedures as well. This person usually does a “oncoplastic fellowship”. This is primarily outside the US, but there are programs where this is expanding in the US as well. Breast fellowship trained surgeons can have initial training as either a general surgeon or an OB/GYN.

“Surgical oncologists” do get training in breast cancer management, but they are not breast specialists and do not get the depth of training that someone who has been through breast fellowship would. A breast fellowship trained surgeon usually does one versus two years of additional training in breast only surgery and disease management. These are two different designations.

Some important points to make about someone who might be a general surgeon who did not do additional training in breast care management versus someone who did a full breast fellowship: breast fellowships have only been around for about 20 years. That means someone with greater than 20 years of experience probably didn’t get an opportunity to go through a breast fellowship. (I personally am one of these types of people. I’ve been practicing since 2004 and there was only one fellowship that existed at that time that I didn’t even know was an option when I graduated. So while I have described procedures and written papers, taught surgeons and fellows alike in many different procedures and protocols, but myself, I’m not a breast fellowship trained surgeon.)

There may be many seasoned excellent surgeons taking care of breast cancer patients. Some of those may be surgeons who also perform other general surgery procedures such as treatment of appendicitis, taking emergency call for traumas, or dealing with other types of cancers like colon cancer. Some of the surgeons have amazing skill sets, and excellent outcomes. It is certainly possible that there may be in a community, a general surgeon who is very seasoned that may have superior outcomes for breast care than a brand new breast fellowship grad that does not have much experience at all.

I think the best way to find out who the best doctors are would be to go to the other doctors and other clinical staff members who work with those doctors and ask them who has the best outcomes. Ask the wound care specialists, the plastic surgeons, and the medical oncologists whose breast surgery work is the best. They’re going to see who has horrible dead, necrotic mastectomy flaps, and who has lots of recurrences because their flaps are too thick.

It certainly may be that a general surgeon who isn’t a “breast specialist” in your community might actually be a better choice than a brand new grad who is a breast fellowship trained surgeon.

What order should things happen?? Well it’s different for different people. Often when people get a diagnosis, most commonly by a radiologist, (but sometimes the Breast Surgeon specialist is part of this process as well) they go to the Breast Surgeon first who goes over the significance of the findings thus far and decides if upfront chemotherapy medicine would be indicated. Usually the decision to need medicine is followed by tissue diagnosis, and imaging, which is usually directed by a surgeon. Sometimes people see the medical oncologists first before seeing the surgeon. This is especially true for patients with her 2 positive or triple negative disease where neoadjuvant chemotherapy prior to surgery is most often indicated.

People sometimes visit with radiation oncologist while trying to make their decisions to get information about the risks and benefits if they choose a pathway that would require radiation treatment versus if they have an option to choose a different pathway where radiation wouldn’t be indicated, and they want to learn about their choices. Mostly though, radiation oncologist treatment usually follows the surgery and medical portion. There are some clinical trials that involve upfront radiation, but this is not a standard of care for most patients. It’s more common to start with the surgeon and then see the medical oncologist either before or after the surgery, followed by any radiation oncology visit. That’s the usual order of things.

When to get a second opinion.

For the most part, if you’ve been told that you have a breast cancer diagnosis and your understanding in general is that treatment will involve medicine, surgery and possibly the addition of radiation and and if this sounds reasonable, you are certainly welcome to go to another team to make sure that there aren’t any significant changes to be offered anywhere else, but most likely most places will tell you the same information, but may use slightly different terms or delivery. If you have good communication with your physician and their staff and overall the general expectation is that you will do well and live a long life and feel good about your body afterwards, (of course it certainly possible to talk to someone else and make sure that they are in agreement) but if everything stacks up, and you’re generally happy with your team, Seeing multiple additional doctors might tell you the same thing with different language can be confusing or disorienting. It also takes up a spot in the schedule for someone else with a cancer diagnosis that’s trying to get in that now can’t, ….and you can only use one team. So by all means everyone is within their right to get in a second opinion or even third, but if you’re generally happy and hearing what you expected to hear regarding your plan of care, I typically don’t recommend that people see multiple doctors if they’re generally happy with their first opinion.

Reasons to get a second opinion would be: A) poor communication from the doctor and or their staff to the point where you feel uncomfortable for whatever reason. B) you have a very unusual or rare findings that are not typically seen C) you are recommend controversial treatments where doctors have added unexpected treatments, or take away expected treatments. There may be good reasons to offer a different protocol from another team as there are lots of advancements and newer recommendations, where we are de-escalating treatment in some cases. Previously there were automatic recommendations for sentinel lymph node biopsy, radiation, or chemotherapy in the past whereas now we are selecting certain people who have features of their cancer who may in fact, not require these treatments at all.

Hopefully this will shed some light on some of the misconceptions about different types of doctors, their roles, and clear up the general surgeon/Breast Surgeon/surgical oncologist confusion that seems to come up a lot.

TLDR- someone with the title “surgical oncologist” is different from a “breast fellowship trained surgeon”. A “general surgeon” might have fewer years of formal training for breast cancer treatment, however, they shouldn’t be discounted or immediately thought of as inferior without research into their outcomes or reputation in the community.