By Amy Lacey and Annie Harris

There are a lot of things patients must consider after a breast cancer diagnosis, such as what type of treatment options they will pursue and what they want their future to look like.

Thanks to advances in treatment, more robust screening guidelines and multidisciplinary teams like VCU Massey Comprehensive Cancer Center’s breast health team, more people than ever are living full lives after a breast cancer diagnosis.

Two members of Massey’s breast health team, Mary Helen Hackney, M.D., medical oncologist and director of community oncology at Massey, and Patricia Bragg, M.P.H., FNP-BC, family nurse practitioner in the division of surgical oncology, share what breast cancer patients can expect during their first appointments as well as what care and recovery look like.

As a reminder, what are the current screening guidelines?

Massey providers recommend starting regular mammograms at 40 years old. This guidance is shared by most U.S. medical organizations including the United States Preventive Services Task Force, which recently lowered their recommendation from 50 to 40. If there is a family history or other high-risk factors, some women may decide with their provider to start screening earlier.

As for when to stop, Hackney says she looks at the individual’s health and preferences to make that decision with her patients.

“If they’re 75 and in good shape and probably going to live another 10 or 20 years, I’d say keep doing that mammography. But if someone older than 75 tells me they wouldn’t pursue treatment if something was found in a mammogram, then we may look to stop screening,” she said.

While mammograms are an excellent tool to help catch breast cancer early and lead to early interventions, they don’t catch everything — so if you find a lump, it’s important that you bring it to the attention of a physician.

What advice do you have for individuals as they prepare to go to their first appointment?

A multidisciplinary approach, especially at the beginning of your cancer journey, is key to successfully treating breast cancer and will put you in the best stead for longevity.

Treatment will look different depending on the type of breast cancer, but many patients can expect surgery as well as systemic therapy such as chemotherapy or hormone therapy.

“I encourage patients on their first visit to keep an open mind regarding recommendations for treatment. I reassure them that their case has been reviewed by the breast health team with a plan for moving forward,” Bragg said.

Cancer patients may also be asked if they want to participate in a clinical trial, which Massey considers part of the best “standard of care.” Currently, there are more than 30 clinical trials for patients with breast cancer that are incorporating the latest innovations in treatment, including modifying the type and duration of radiation therapy for some breast cancer patients.

What does a multidisciplinary approach to cancer care look like?

Massey’s BC4 (multidisciplinary) clinic was piloted about seven years ago and continues to grow. What is unique is that new breast cancer patients see the entire team on day one.

Typically, patients will see a surgical oncologist, medical oncologist, radiation oncologist, social worker, breast navigators and nurses. The care team reviews their imaging and pathology, typically the day before the visit. Patients are also reevaluated following surgery or every once and a while depending on treatment.

“The high-risk breast clinic continues to grow, where I am seeing patients with a higher risk for breast cancer due to family history, high-risk breast lesions or genetic predisposition. I evaluate them for additional imaging as well as treatment,” Bragg said. “We work very closely with breast imaging to provide our patients with the best care possible. There is so much more involved in caring for patients, but compassionate listening is probably the most important.”

Can people going through breast cancer treatment still have children?

Being diagnosed with cancer may feel like the rest of your life is put on hold, including having children.

Part of Massey’s comprehensive treatment planning is discussing fertility preservation in women of childbearing age, as there is a risk of the treatment leading to early menopause. Hackney recommends patients who hope to have children speak to their provider about egg or embryo freezing options prior to beginning any systemic therapy.

Women who are currently pregnant can be safely treated during pregnancy starting in the second trimester without harm to their baby. Recent research also suggests that some women with previous hormone receptor-positive breast cancer can temporarily interrupt their endocrine therapy to have a baby, and then restart the therapy, without increasing risk of cancer recurrence.

What resources are available for patients after treatment or when they’re in remission?

By focusing on the whole person – not just the disease – patients we see are offered the most advanced technology, treatment options and clinical trials with compassion and respect.

As medical advances have led to improved cancer outcomes, the population of cancer survivors has grown exponentially. Massey experts are increasingly focused on ensuring that those patients survive well, studying common side effects of cancer treatment such as cognitive dysfunction, neuropathy and heart damage to assess patients for appropriate interventions.

There is also increasing evidence to support that regular exercise can help reduce both the risk of cancer recurrence and reduce side effects of treatment.

Massey’s unique Survivorship Program follows cancer patients through and beyond treatment to help monitor for side effects and connect patients to treatments and clinical trials that can help them live better, longer.

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