Breast Cancer Treatment Team
To treat breast cancer effectively, a number of medical professionals with a variety of specialties are needed. Each breast cancer diagnosis is unique and treated differently. Some women may visit a cancer center where a group of physicians who specialize in breast disease (radiologist, oncologist, surgeon, etc.) work together to determine treatment. Other women are referred to cancer specialists by their primary care physician (family practitioner, gynecologist). The information below outlines the different physicians and health care professionals involved in diagnosing and treating breast cancer.
Depending on the situation (stage of cancer, size and location of town, and so forth), some women will have more options in choosing a cancer treatment team than others. However, breast cancer is not usually a medical emergency since the majority of breast cancers are detected at early stages before the cancer has spread past the breast. Most women have a sufficient amount of time to learn about and decide upon treatment options.
Even though physicians administer treatments to patients, each patient is ultimately in charge of her own health. Women who have been diagnosed with breast cancer are encouraged to educate themselves on all aspects of the disease, including the variety of treatment options available. Each patient is also entitled to copies of examination reports, pathology analyses, and mammography films. Patients diagnosed with breast cancer should not hesitate to get a second opinion before beginning treatment. The purpose of a second opinion is to obtain a comprehensive, independent review of breast cancer diagnosis and the planned course of treatment. It is essential that women have confidence in their physicians and cancer treatment teams before proceeding with treatment.
Medical professionals involved in breast cancer diagnosis and treatment may include:
- Gynecologist or OB/GYN, family practitioner, or other primary care physician
- Oncologist (general, medical, radiation, surgical)
- Nurse/oncology nurse specialist
- Oncology social worker
- Radiation therapy oncologist
- Radiation therapy technologist
- Radiation therapy physicist
- Reconstructive/plastic surgeon
Gynecologist or OB/GYN: Often a woman’s primary care doctor, a gynecologist is a physician with a medical doctorate (MD) who specializes in women’s health. Many physicians in this field also practice obstetrics—the specialty of pregnancy and childbirth. Gynecologists and OB/GYNs (obstetrician/gynecologist) perform clinical breast examinations (CBE) on women during routine physical exams to check the breasts for any abnormalities. Women who detect a breast lump or other abnormality during breast self-examination (BSE) will probably first visit their gynecologist or family/general practitioner. A gynecologist or OB/GYN may refer a patient to another physician (such as a radiologist or oncologist) if he or she believes a breast abnormality is present. Some gynecologists havemammogram equipment in their offices, but mammogram films are typically interpreted by radiologists, especially when a lump or other suspicious area is found. Diagnostic mammography is performed when a breast abnormality is detected as opposed to screening mammography, which is performed on asymptomatic women (those who do not show any signs of breast cancer).
Radiologist: A radiologist is a physician who specializes in the use of radioactive substances (such asx-rays) to diagnose and treat patients. After obtaining his or her medical doctorate (MD) or doctor of osteopathy (DO) degree, these physicians complete additional special radiological training (residency) to make them eligible for certification by the American Board of Radiology. Radiologists may specialize in a variety of areas. Here are a few:
- breast imaging
- bone densitometry to help detect osteoporosis
- gastrointestinal (digestive system) imaging
- genitourinary (reproductive system and urinary system) imaging
- neuroradiology (imaging of the brain, spine and nervous system)
- pediatric imaging
- pulmonary/chest (respiratory) imaging
A radiologist who specializes in breast imaging interprets mammograms, and sometimes the results of other breast imaging tests such as ultrasound. In most cases, a technologist will organize and perform mammography or breast ultrasound, and the radiologist will read the results. Some radiologists also perform image guided breast biopsies. Radiologists who must intervene with a patient by surgery or other means to conduct an imaging test are called interventional radiologists. For example, radiologists who perform angiography (blood vessel imaging) are interventional radiologists.
Oncologist: An oncologist is a medical doctor who trains in the diagnosis and treatment of cancer. If a radiologist detects breast cancer, a woman may be referred to an oncologist for treatment. Medical oncologists specialize in the use of chemotherapy and other drugs to treat cancer. Radiation oncologists specialize in the use of x-rays and other radiation methods to kill tumors.
Though most breast surgeries are done by general surgeons, surgical oncologists also perform operations to remove cancer. Surgical oncologists may perform breast biopsies, lumpectomies (removal of a breast lump), mastectomies (removal of the affected breast), axillary node dissections (lymph node removal), or sentinel node biopsies on breast cancer patients.
Nurse/oncology nurse specialist: Registered nurses (RN) play a key role in breast health and cancer treatment. In addition to performing clinical breast exams and teaching patients how to do monthly breast self-exams, many nurses have extensive breast health training. Oncology nurse specialists are medical professionals who has taken additional courses and received specialized training in the care of cancer patients. Oncology nurse specialists may prepare and administer treatments, monitor patients, prescribe and provide aftercare, and teach and counsel patients and their families throughout the treatment process. Some oncology nurse specialists are also certified nurse practitioners.
Oncology social worker: An oncology social worker provides counseling and assistance to people with cancer and their families. More specifically, an oncology social worker deals with the non-medical crises that can result from cancer, such as financial problems, housing when treatments must be taken at a facility far away from home, and child care. These professionals usually have an advanced degree in social work and experience dealing with cancer patients.
Surgeon: In many cases, a general surgeon or breast surgeon will perform breast surgery on cancer patients. A surgeon is a medical doctor with advanced training in operating procedures. Surgeons usually perform breast biopsies, lumpectomies,mastectomies, axillary node dissections, or sentinel node biopsies on breast cancer patients. In cases where breast surgery results in permanent physical alterations, some breast surgeons work closely with plastic surgeons who may reconstruct the contour of the breast during the same operation in which the breast was removed.
Radiation therapy oncologist: A radiation therapy oncologist is a medical doctor who undergoes special training in radiotherapy to become certified by the American Board of Radiology. This training includes special instruction in the use of radiotherapy systems and other radiation therapy devices to treat cancer. Radiation therapy oncologists are usually assisted by technologists and physicists.
Radiation therapy technologist: A radiation therapy technologist is specifically trained to operate the sophisticated systems and computers used to deliver radiation therapy to the breast or other regions of the body. Typically, technologists have two or more years of training in radiation therapy and are certified by the American Society of Radiological Technologists. The radiation therapy technologist performs the patient therapy session under the supervision of the radiation therapy oncologist.
Radiation therapy physicist: A radiation therapy physicist has an advanced degree in physics and/or chemistry and assists the team by assuring the quality and calibration of the therapy systems used for patient care, developing new applications for radiation therapy, and assisting with the development of new applications. The radiation therapy physicist usually works with the radiation therapy oncologist and technologist during a patient’s treatment session.
Pathologist: A pathologist is a physician who specializes in the diagnosis and classification of diseases by using laboratory tests. After breast cancer has been detected, the pathologist will study a sample of cancer cells to determine the origin of the disease and whether or not it is invasive (has invaded nearby tissues in the breast). A pathologist will also assign a grade to a patient’s breast tumor to identify the type of tumor present and help recommend a treatment plan for an optimal outcome.
Reconstructive/plastic surgeon: If the breast is removed (mastectomy) as part of treatment, a plastic surgeon may perform breast reconstruction in many instances. Plastic surgeons are medical doctors who specialize in surgery to alter the appearance of certain areas of the body. Plastic surgeons are certified by the American Society of Plastic Surgeons. Breast reconstruction is done to rebuild the contour of the breast as well as the nipple and areola (darker pigmented region around the nipple) if desired. Plastic surgeons sometimes work with a woman’s breast surgeon to perform breast reconstruction during the same procedure during which the breast is removed. Or, in some cases, women may elect to have breast reconstruction performed after recovery from mastectomy.
- The American Society of Clinical Oncology (ASCO) maintains an oncology physician database at http://www.plwc.org/. Women may search for an oncologist by name, city, or state.
- The American Society of Plastic Surgeons (ASPS) maintains a database of board-certified plastic surgeons. Women may search for a plastic surgeon by name, city, state, or zip code at http://www1.plasticsurgery.org/ebusiness4/PatientConsumers/findasurgeon.aspx.
- To learn more about breast cancer treatment, please visit http://www.imaginis.com/breasthealth/treatment.asp
- For additional resources, please visit the Imaginis.com Breast Health Bookstore at http://www.imaginis.net/bookstore/breasthealth/
Updated: October 18, 2009