Diagnosis & Initial Consultation
After finding out you have breast cancer, you may feel shocked, upset, anxious or confused. These are normal responses. Talk about your treatment options with your doctor, family and friends. Seek as much information as you need. It is up to you how involved you want to be in decisions about your treatment.
Breast cancer is the most common cancer in Australian women. Although rare, breast cancer can also affect men. Early breast cancer can be treated successfully and for most women breast cancer will not come back after treatment.
Everyone reacts to a diagnosis of cancer differently. It is often difficult to take in the diagnosis immediately. It is normal to ask 'why me?' or to feel sad, angry, helpless or worried about your future.
Having cancer doesn't mean you need to lose hope. The outlook for breast cancer is improving constantly.
Sharing your diagnosis isn't easy. You may feel uncomfortable talking about it. You may be unsure how you will react when you tell your family and friends and how they will respond. Having other people know will help you and your family share your anxiety and fears. You don't have to face cancer alone.
Tips for telling others
- Break the news when you feel ready.
- Ask for help. Family and friends may be able to tell others if you don't feel like it.
- Be prepared for questions.
- Draw boundaries. You don't have to share every detail about your diagnosis with everyone.
Helping your family adjust
Cancer is difficult for everyone it affects. Your family needs to adjust to the diagnosis too. Family members may experience stress as roles change and they learn to adapt and cope. They may feel uncomfortable because
they don't know what to say but feel they should say something. They will experience the same fears, anger and anxieties as you. If your family has difficulty talking about the cancer it may help to speak to a counsellor or have them go to the doctor or hospital with you. This may help them accept your illness.
How do I tell the children?
Children usually guess something is wrong even if they don't know what it is. By telling your children you will give them an opportunity to ask questions and express their feelings about what is happening. Reassure your children that the cancer is not their fault – it's not anyone's fault. What and how much you tell your children will depend on their ages.
If you don't feel you can tell them, ask your doctor or a relative to do it for you. To help your children cope:
- Tell them how you are feeling.
- Give them the opportunity to discuss their feelings and fears.
- Answer their questions simply and honestly.
- Reassure them you love them.
- Do things together.
- Assure them that cancer is not contagious.
Helping your friends adjust
Most of your friends will be looking for a comfortable way of dealing with your diagnosis. They may want direction on how to behave with you. Let them know how they can help you. If you think of something they can do, you will be doing them and you a favour.
Looking after yourself
Learning to live day-to-day will be hard and every day is likely to be different. Many people find that keeping busy helps them to feel that life stretches before them.
Tips for looking after yourself
- Stay active and exercise regularly if you can. The amount and type of exercise you do will depend on what you are used to and how well you feel.
- A balanced and nutritious diet will help you to keep as well as possible and better cope with the cancer and treatment side-effects.
- Do as much as you can – sometimes this may be less than you are used to.
- Let your doctor know if you are having trouble sleeping.
- Seek practical and financial help if you need it.
What can I expect at my first consultation?
When you first arrive to see Dr Gordon-Thomson you will be greeted at reception by Tania or Lisa. They will ask you to complete a patient information sheet and a medical history form. You can be assured that your information will be treated with the utmost of confidentiality.
Dr Gordon-Thomson will ask you about your previous medical history, your current symptoms, and perform a clinical breast examination.
A history and clinical examination provide important information on which to base further investigation.
Relevant history includes details of:
- current medications or recent changes, especially hormones such as the pill / HRT
- hormonal status /menstrual history
- previous breast problems, particularly previous breast investigations, biopsy results
- risk factors, particularly strong family history of breast /ovarian cancer.
- previous/ recent imaging /date and results /screening or diagnostic.
History of presenting symptom
- site — constant or changing
- duration — when and how first noted
- any changes since first noted
- relationship to menstrual cycles or exogenous hormones
- associated symptoms.
Clinical Breast Examination
After the woman has removed all clothing from the upper half of her body, Dr Gordon-Thomson will look at her breasts while she is seated to see whether any changes are visible. Following this, you will be asked to lie down, so Dr Gordon-Thomson can examine both breasts and nipples as well as the armpits.
The physical examination should establish the nature and site of any abnormalities found either on visual inspection or palpation of the breast. In particular, the physical examination should establish whether there is a discrete lump present or an area of textural change. The findings of the clinical examination should be correlated with the area of concern found by the patient or referring doctor, and also specifically with any abnormalities which may have been reported on imaging.
The distinction between diagnostic breast imaging for the assessment of breast symptoms and breast screening is an important one. Screening is an assessment for women who have no breast symptoms. These women are being assessed, usually using mammography alone, with the aim of detecting breast cancer at an early stage. Women with breast symptoms should be advised not to attend Breastscreen NSW for mammography, but are most appropriately assessed at a diagnostic imaging facility, often using both mammography and ultrasound, to provide an explanation for their symptoms and exclude breast cancer as a cause.
The sensitivity of mammography increases with increasing age. Sensitivity is improved with the addition of ultrasound over all ages though the size of this benefit is greater in women under the age of 50 years. Given the limitations of both mammography and ultrasound, they are often used in a complementary capacity to give information in the evaluation of breast abnormalities. Mammography and ultrasound used in combination will correctly identify about 95% of breast cancers in symptomatic women. Therefore, a small but significant proportion of breast cancers will not be diagnosed on imaging alone and clinical opinion is crucial in determining whether further testing such as biopsy is needed, despite normal imaging findings.
What is a Triple Test?
The triple test refers to three diagnostic components:
- medical history and clinical breast examination
- imaging – mammography and/or ultrasound (+/-MRI)
- non-excisional biopsy – fine needle aspiration (FNA) cytology and/or core biopsy. This is when a sample of cells or tissue is extracted from the lump.
The sensitivity of the ‘triple test’ is greater than any of the individual components alone. The triple test is positive if any component is indeterminate, suspicious or malignant.
It is the responsibility of the managing clinician to correlate the pathological results with the clinical and imaging findings. Most women show no signs of cancer on any of the tests. The small number who do show possible signs of concern on one or more of the tests will be advised to undergo further investigations. The triple test is preferably managed by a single clinician who takes responsibility for coordinating the entire investigative pathway, and correlating the results with the woman’s symptoms.
The Triple Test is the recommended approach to maximise diagnostic accuracy in the
investigation of breast changes.
- The assessment of breast symptoms using the triple test requires a multidisciplinary approach.
- Each component of the triple test plays a part in revealing the likelihood of breast cancer or other diagnoses.
- The key to the triple test is the review of all results and correlation with the presenting symptom. If results are inconsistent or if they are benign but do not account for symptoms then further investigation is warranted.
- The correlation of findings of the triple test provides a sensitivity of nearly 100% in the detection of breast cancer.
- One clinician must take overall responsibility for correlating and interpreting the results of the clinical examination, the medical imaging and the pathology.