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Say you're a woman, and your latest mammogram has revealed a lump in your breast. What should you do immediately, without hesitation?
Read. That's right, read.
Educate yourself about your options and the possible repercussions, said Dr. Robert J. Goulet Jr., director of the Indiana University Breast Center and medical director of the IU Cancer Pavilion.
"There is no reason for you to rush into any decision," he said Saturday, as part of the Just Peachey Fund's "Note-able Afternoon" and "Note-able Night" fund-raiser. "You have more than enough time to ... ask appropriate questions and gain the education you need to make appropriate decisions regarding your health care.
"Don't be pressed into making a decision you'll regret one to five years after surgery."
Goulet cited statistics to back up his advice: The smallest tumor that can be detected by a mammogram is 1 to 2 millimeters - and takes about 6.6 years to reach that size, he said. By the time that tumor can be felt, it's about 1 centimeter in diameter, which takes an additional four years. For a tumor to grow to approximately 20 millimeters, about the size of a nickel from a single cell takes about 20 years, he said.
Because of the relatively slow growth of most breast cancers, he said, women have time to make sure they know what they're doing before they rush into unnecessary tests or surgery.
"Take control of the situation," he said. "Take a deep breath, consider your options, assess the resources that are available to you."
This does not mean you should ignore the situation or delay treatment, he said, but simply means being able to knowledgeably discuss the situation, treatment and options with your doctor or surgeon.
"I rarely see patients anymore who don't come into my office with a stack of articles they've pulled off the Internet and questions they want answered," he said.
Some of that research may include changes in breast cancer treatments.
For example, he said, what was for many years the most common treatment for breast cancer, the radical mastectomy, which removed the entire breast as well as lymph nodes under the arm, was developed in 1908 and didn't change until the 1970s. Now, reliable studies have shown that there is no survival advantage by having a mastectomy instead of a lumpectomy, which removes only the tumor, he said. "Eighty percent of breast operations are breast-preserving operations," he said.
Lumpectomy is usually followed by radiation therapy for about six weeks, he said.
Mastectomies are still done, he said, if there are tumors in more than one area of the breast, if the patient has had a failed lumpectomy or is pregnant, or if the patient prefers.
Goulet also discussed methods of determining whether or not a breast tumor is malignant (or cancerous,) or benign.
FNA, or fine needle aspiration, in which a needle is used to withdraw tissue from the tumor that can then be analyzed, is usually the preferable method for solid tumors, he said. "They can be evaluated immediately if the facilities are available."
Other needle biopsies can be done, and all are alternatives to a surgical removal of the tumor to do a biopsy. Again, he said, the woman should educate herself on all the procedures that are available.
"The patient must become an active leader of her health care team," he said.
Unfortunately, there is still no answer to the often-asked question of whether or not there is a test to determine if the cancer has spread beyond the breast, he said.
There is no reliable test, no blood test or X-ray, that can address that concern, he said. "So if certain criteria are met, we assume the cancer is elsewhere and treat the patient appropriately," he said.
Breast cancer is the most common new malignancy in women, he said, and is the third leading cause of death. In 1999, approximately 215,000 new cases of breast cancer were diagnosed, and of those, about 43,300 are expected to die, he said.
About 1 percent of breast cancers diagnosed each year are in men, he said.
Women are now 52 percent of the population but make 90 percent of the health care decisions and spend 66 percent of all health care dollars, he said. The Internet explosion also is giving the public access to information that previously was not available to anyone but doctors.
"If you don't take anything else home, remember the importance of taking charge of your health care," he told the approximately 150 women Saturday at 2517 Restaurant. "This is the consumerism era, and patients are demanding, and rightfully so, that they be an equal partner in health care. ... Women are discerning and increasingly empowered consumers of health care."
