National Breast Cancer Awareness Month — what patients should know

As specialists who treat breast cancer patients, we know a diagnosis of breast cancer is frightening and earth shattering to anyone. Once diagnosed, there are varied emotions and multiple stages of healing between surgery, chemotherapy, and radiation treatment.

While providers can focus on treating the cancer, it’s also important to make sure patients are fully informed regarding side effects of treatment and options for breast reconstruction.

Chemotherapy and radiation will likely increase the odds for curing the cancer, but they may also adversely affect the heart, leaving many cancer survivors at risk for cardiac disability.

Several chemotherapeutic agents can have detrimental effects on heart function and radiation can also potentially damage the heart and lungs, as well as weaken the rib bones making them more prone to fracture.

Patients must be proactive and demand a cardiovascular ultrasound — also known as cardiac echo or echocardiogram — be performed prior to and during chemotherapy and radiation. This test, which is safe and radiation-free, can be used to assess risk and inform the physicians of the need to potentially adjust treatment regimens.

Prior to chemotherapy, an echocardiogram can ensure that patients do not already have impaired cardiac function and can establish a baseline for the patient’s cardiac system. During chemotherapy, it can be used to monitor heart function to exclude chemotherapy induced dysfunction. During follow-up treatment, cardiovascular ultrasound can determine if new symptoms have developed that are potentially due to cardiac disease.

Patients should ask their doctor about the use of echocardiogram with strain imaging. This can provide early detection of heart problems due to chemotherapy and can allow for modification in the treatment regimen.

Echocardiograms are the safest and easiest way to monitor the patient’s heart to assure that cardiotoxicity has not led to adverse effects. Proactive detection can result in less disability, higher quality of life, fewer future cardiac complications, and lower subsequent costs for care.

When it comes to mastectomies, many patients are singularly focused on their breast cancer treatment and are willing to sacrifice their breast(s) in order to be healthy again.

Many women, however, suffer both a physical and psychological loss after mastectomy. Breast reconstruction, mandated by the Women’s Health & Cancer Rights Act of 1998, can make many women feel whole again.  This law covers all needed breast reconstruction as well as opposite breast surgery for symmetry. If a woman chooses not to undergo reconstruction, her insurer must also cover an external breast prosthesis and post-mastectomy bras.

Eighteen years after the passage of the Women’s Health Act, many women are still unaware of their breast reconstruction options.  In fact, less than half of all women requiring a mastectomy are currently offered breast reconstruction, and one-in-five women who do not elect to have breast reconstruction claim that they were not aware of the procedure and the mandated insurance coverage.  

Patients facing a breast cancer diagnosis should demand a consultation with a plastic surgeon to determine if and when breast reconstruction fits into their recovery.

Patients with breast cancer deserve to be fully informed about all options for treatment, side effects and their reconstructive options before making treatment decisions. A fully informed patient is best prepared to make the right decisions regarding treatment and ideally equipped to manage her recovery.

Debra Johnson, MD is in private practice in the Sacramento area and is a Clinical Professor of Plastic Surgery at the UC Davis Medical Center in California.  She also serves as the President of the American Society of Plastic Surgeons.  Allan L. Klein, MD, FRCP(C), FACC, FAHA, FESC, FASE, is the Director of the Center for the Diagnosis and Treatment of Pericardial Diseases.  He is a staff cardiologist in Department of Cardiovascular Medicine, at the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic and serves as the President of the American Society of Echocardiography. Both societies are members of the Alliance of Specialty Medicine.

The views expressed by contributors are their own and not the views of The Hill.