Breast cancer (all types)
Prepared with OnCo (onco.cc/prep/breast-cancer/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
12 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Oestrogen and progesterone receptors, HER2, Ki-67 and grade, Genomic recurrence scores, BRCA1/2 and other germline variants), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (screening), which of the standard options do you recommend and why?
- 6.For my situation (early disease, all types), which of the standard options do you recommend and why?
- 7.For my situation (ductal carcinoma in situ), which of the standard options do you recommend and why?
- 8.Are there clinical trials I could join, for example of Trastuzumab deruxtecan, Datopotamab deruxtecan, Oral SERDs?
- 9.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 10.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 11.I read that “Metastatic disease remains incurable for almost everyone”. How does that affect my plan?
- 12.I read that “Triple-negative and inflammatory breast cancer still have the worst outlook”. How does that affect my plan?
The words I may hear
- Mechanical theory: stiffness, pressure and force as causes: Cancer cells feel their surroundings.
- Seed and soil hypothesis of metastasis (Paget): Stephen Paget asked in 1889 why breast cancer spread to some organs more than blood flow could explain, and answered that a travelling cancer cell (the seed) grows only where the organ (the soil) suits it.
Tests and results to bring
Biomarker results to ask for: Oestrogen and progesterone receptors, HER2 (including HER2-low), Ki-67 and grade, Genomic recurrence scores (Oncotype DX, MammaPrint), BRCA1/2 and other germline variants, PD-L1 (triple-negative), ESR1 and PIK3CA mutations (advanced hormone receptor-positive).
Scans and tests linked to this cancer: DPYD genotyping and DPD phenotyping before fluoropyrimidines, HRD genomic scar scores (GIS, LOH, HRDetect), Mammography & tomosynthesis, Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC), Serum tumour markers: proper use and misuse, SPECT/CT.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Screening: Mammography every one to three years from around age 40 to 50 depending on country; MRI for high-risk women. (Mammography & tomosynthesis)
- Early disease, all types: Breast-conserving surgery with radiotherapy or mastectomy, sentinel node biopsy, then treatment by receptor type on the subtype pages. (HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Triple-negative breast cancer (TNBC), Hypofractionated radiotherapy)
- Ductal carcinoma in situ: Surgery with or without radiotherapy and endocrine therapy; active surveillance under study. (Ductal carcinoma in situ (DCIS))
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.