When it comes to treating HR+/HER2- early breast cancer, your preferences play an important role in shaping your treatment plan. Studies show that if you’re diagnosed with early breast cancer, your prospects are generally good. And your outlook about your treatment matters for your physical and mental health.
It's not just about what the doctors suggest based on medical guidelines. It's also about what matters most to you as a person. By actively taking part in your treatment decisions, you can create a plan that feels right for you and supports your early breast cancer journey.
What Does Patient Preference Mean?
In talking about early breast cancer, patient preference refers to your treatment choices. Some things to think about may include:
- The level of risk you’re willing to accept
- Informed decision-making
- Emotional and mental support
- Your personal values and lifestyle
- Working with your health care team
M. Michele Blackwood, MD, chief of breast surgery at RWJBarnabas Health and Rutgers Cancer Institute of New Jersey, points out that when you educate yourself about your condition, you can make better decisions about your risks. “The first risk we talk about are the risks of surgery – meaning are you healthy enough to have surgery and how well do I think you can recover from the surgery,” she says. You need to think about other conditions you may have, like end-stage kidney disease, high blood pressure, or issues with your blood vessels, to figure out whether there might be further complications during surgery.
Another factor is looking at lifespan, says Blackwood, who’s also a professor of surgery at Rutgers Robert Wood Johnson Medical School. “Lifespan is really important because if it is less than 5 years from diagnosis, that means a patient has several health issues, and many times we put this patient on an anti-estrogen pill or sometimes we do not do anything, because some of these are very slow-growing cancers, and that’s not what is going to kill them.”
Dhivya Srinivasa, MD, founder of the Institute for Advanced Breast Reconstruction, says it is important for patient preferences to include making informed decisions. “All treatments are related. What kind of surgery you have may impact whether or not you need radiation. A lot of women are shocked to find out that if they had a mastectomy, they wouldn’t need radiation.” A common response from some patients is that specific information wasn’t always shared with them.
Srinivasa recommends that patients “bring someone with them during the visit because they are going to meet several doctors who are all doing something a little different. And in the beginning, it’s kind of hard to figure out what each person is in charge of. If you bring someone with you, take some notes, and then go back and revisit.” She also says that if you change the type of surgery you have, you should go back and ask your oncologist if what was said in the previous visit still holds true.
An important challenge in finding patient preferences is working together and talking to the medical team. Srinivasa says that breast cancer care has become “so multidisciplinary … because we realize that we all have to hang out in a room together and talk about each patient to understand the best decision, because everything I do affects what other people do.”
Sometimes, listening to patients means that your care team respects your desire to consider alternative treatments. Breast cancer self-care advocate and author of the book Make Room for Healing, Travis Brady wanted to try Eastern therapy alternatives. She included reiki (guiding an energy force believed to flow through the body with gentle touch for healing and improving balance) and acupuncture as ways to combat her breast cancer. “I looked for people who had a positive impact on my mindset.” And the mental impact should be considered in terms of the patient's preferences.
Why Is It Important to Educate Yourself About Your Condition?
Wade Smith, MD, a medical oncologist and hematologist at City of Hope Orange County, says, “Of the four subtypes of breast cancer, the one known as HR+/HER2- is the most common. It’s important to understand what subtype of breast cancer you have so you can understand the treatment options and make fully informed decisions that align with your goals.”
Brady says that educating yourself also allows you to advocate for yourself. “What you believe matters,” she says, and knowing about your condition means shopping around to find doctors and a health care team interested in “building relationships” and “upholding your wellness and health goals.”
You’re more empowered through knowledge. “If you’ve been diagnosed with HR+/HER2- early breast cancer, your doctors might suggest surgery alone, surgery along with neoadjuvant/adjuvant chemotherapy, radiation therapy, as well as endocrine [hormonal] therapy in order to improve outcomes,” Smith says. Knowing the cancer stage and judging your overall health also play a role in figuring out treatment. “Take the time to learn about the effectiveness and side effects of each treatment so you and your doctor can identify the best one for you,” he says.
Researching your condition can help you have more meaningful communication with your doctors and other professionals. Breast cancer patient advocate Jessica Baladad says that many patients often wonder, “ ‘Am I making the right decisions? Am I doing enough?’ And especially for those of us who are diagnosed at an early stage, the question always lingers, ‘Is it going to come back?’ ” Educating yourself allows you to express your concerns and goals more accurately, which makes you more likely to have a more personalized and effective treatment plan.
Srinivasa says, “Sometimes, the hardest part of navigating a breast cancer diagnosis is knowing what questions to ask. And I think that’s where informed decision-making and patient education really play a role because sometimes, if you don’t even know what to ask, you don’t realize what you should have learned about until it’s too late.” Learning about your condition also helps you get specific resources and find support groups and even financial assistance you need to address the disease effectively.
Who Can You Reach Out to When You’re Trying to Form Your Preferences?
As you navigate your early breast cancer journey, you will naturally depend on a network of people and resources to come up with your preferences. Srinivasa says, “The best advice will come directly from a board-certified medical oncologist.” In addition to the oncologist, Blackwood says the breast cancer surgeon is essential in helping form your preferences, since they decide whether you should opt for surgery.
Another resource you might think about is a breast cancer tumor board. A group of people – medical oncologists, radiation oncologists, pathologists, plastic surgeons, and even social workers – will be presented with the “patient and her medical issues, and everybody looks at the slides and the imaging, and then we collaborate with each other so she and her family don’t have to go to see 30 different people,” Blackwood says. This option is helpful because sometimes, it is physically difficult to get to multiple offices. “This is a nice way to receive a high-level opinion without making the patient run around to all these different offices,” Blackwood says.
Srinivasa suggests using online resources like breastcancer.org and medical system websites like those of UCLA, Cedars-Sinai, and Stanford. Blackwood adds a note of caution: “Websites are available, but honestly, sometimes it confuses patients more than it helps them because it is not personalized to them. It offers relatively generic answers.”
Baladad created an app in 2021 called Feel For Your Life that you can use for self-exams and to get information on genetic testing, risk-reducing surgeries, and breast reconstruction options. The app can also use insurance information to figure out costs.
Brady suggests talking to other people who have had a similar diagnosis and asking them what they decided. Sites like The Breasties can offer a community of people who are willing to talk about their treatment and any side effects.
Tips for Thinking Through Tough Treatment Decisions
Considering all treatment options may seem overwhelming at first. But it’s crucial you take a close look at the information that is given to you to make a solid treatment decision. Blackwood urges patients with early breast cancer to search for the right doctor. “You have to pick the right doctor for you and your family and who you feel comfortable with, and the doctor has to have the communication channel open for you when you need answers,” she says.
Blackwood also suggests you take a cautious approach when getting opinions from multiple doctors. “Second opinions are highly encouraged in the breast cancer world. A second opinion is not a bad option, but please be careful with those because now people are getting third, fourth, fifth opinions. I think it confuses patients and their families more than it helps them,” she says.
Baladad offers more tips about making treatment decisions:
- Understand your right to make your own decisions. Know that you have a basic right to decide about your body and medical care without pressure or undue influence.
- Tell your doctor what you see for yourself on the other side of breast cancer. Think about the small goals you want to set, and work with your medical teams to explore options that will get you the best result.
- Decide your boundaries. Think about what you will say yes to, and what parts of your medical care are a hard no for you.
- Have a complete understanding of your care. When you’re making treatment decisions, ask your medical teams about what your care will look like during cancer and what maintenance will be required after you go into remission – things like medications, scans, and follow-ups.
When doctors are suggesting treatment, Brady urges you to ask your doctors for at least 24 hours to decide which treatment you prefer. She also says, “Ask for help. Ask questions like ‘Do you know someone I can talk to?’ and ‘What will the next 6 months to a year look like if I opt for a certain medical treatment?’ ”
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Jessica Baladad, founder, Feel For Your Life, Nashville.
Travis Brady, breast cancer self-care advocate; author of Make Room for Healing; Chapel Hill, NC.
Patient Preference and Adherence: “Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review.”
Dhivya Srinivasa, MD, FACS, founder, Institute for Advanced Breast Reconstruction, Santa Monica, CA.
M. Michele Blackwood, MD, FACS, director of Breast Surgery and director of Women’s Oncologic Health, RWJBarnabas Health and Rutgers Cancer Institute, and head of Breast Surgery at Cooperman Barnabas Medical Center.
Wade Smith, MD, oncologist and hematologist, City of Hope, Newport Beach, CA.
