Nafisa Tejpar, MD, FACS
8 Tips on How to Choose a Breast Cancer Surgeon and Why You Need to Do Your Homework for Biopsy or Surgery
Hint: Do your own research! Consider, but do not simply rely ONLY on a referral from a physician, mammography center or your insurance plan. Some imaging centers are obligated to refer in their network. Some insurance plans might direct you to who THEY want you to see, which may or may not be the best choice for such an important decision. Don't let anyone railroad you into their decision. Do your homework and then YOU decide. (An article in the Journal of the American Society of Clinical Oncology cautions that some insurance plans and some providers do not refer women to the most experienced breast cancer surgeons and it can affect their treatment. I suggest that you read at least the initial summary and the Discussion section at the end of that article.)
Women who find a lump or suspicious area on their breast usually imagine the worst – cancer. While some lumps or other symptoms do indicate cancer, there are also a range of benign breast diseases that can produce symptoms similar to breast cancer. Even if your fears of cancer become a reality, early detection and choosing a good surgeon can help you obtain the most successful treatment.
Most women who find a lump or other abnormality initially see their primary care physician or gynecologist who will usually recommend a diagnostic mammogram (more views of the breast than in screening mammograms) and possibly a breast ultrasound. Other women learn of a potential problem through a routine mammogram. Then comes the decision to find a breast surgeon / general surgeon for a review of the tests and a possible breast biopsy or other treatment.
But who IS the best breast cancer specialist for you? Do you just rely on the names given to you by your primary care physician or the radiology center?
Finding the right breast surgeon can mean getting better breast cancer diagnosis and care.
CBS News and WebMD summarized the article that I mentioned from the Journal of Oncology (cancer care) on a study of 1844 women with breast cancer and the results of those who simply accepted the names given to them and those that did their own research to find the best breast surgeon. (You can find the CBS summary here, or the original journal article here with a summary at the beginning and discussion of potential impact at the end of the article. )
Some of the study’s findings were:
• women have better outcomes with highly experienced breast cancer surgeons
• only 1/3 of the 1844 were treated by a breast surgeon who does a high volume of procedures (more than 50% of their entire practice devoted to breast cancer surgery.
• women who did research and chose their own surgeon were twice as likely to see a highly experienced surgeon as those referred by another doctor or their health plan. Initial physicians and plans may not give you the best or most experienced surgeon. Sometimes referrals are made based on provider networks that restrict to whom they can refer or who are employed through their hospital or hospital physician group. Two thirds of women did not do the research to find the best breast surgeon for them.
• Surgeons who worked closely with hospitals designated as having cancer centers had better outcomes.
So how do YOU find the best breast cancer surgeon?
2. Ask several people, especially those who work in healthcare – nurses, physicians, physician assistants, women’s centers and your own friends and family. Listen for the names that come up frequently. (Be aware that some hospital systems refer to surgeons they employ, even though other breast cancer surgeons work closely with the hospital but retain their independence.)
3. Find a breast surgeon with significant years of breast surgery experience and with the majority of their general surgery practice devoted to breast cancer surgery. Ask when you call how much of the practice is devoted to breast surgery and how long the physician has been in practice. Any general surgeon can do breast surgery, but those who specialize in breast cancer do better. A breast cancer surgeon may also do a few other general surgery procedures, but 75% of their practice will be breast cancer diagnosis and surgery. Having to distinguish between breast cancer and benign disease over and over and over, doing a high volume of specific procedures repeatedly makes them better surgeons, both in diagnosis and treatment.
4. Find a breast cancer surgeon that is not only experienced, but that also keeps up to date with new and improved techniques and options. You can find a surgeon who has been in practice for 20 years, but still approaches breast cancer as they did 20 years ago. Does the surgeon do more recent breast procedures like Mammosite (a procedure that allows some women to do 5-day radiation treatment instead of 6 weeks, if needed.) Not all women are candidates for this approach. Discuss it with your surgeon if biopsy reports indicate that you will need radiation) Are they experienced in techniques like radioactive seed localization of tumors, and nipple saving mastectomy?
5. Find a breast cancer surgeon that seeks additional training and certifications related to breast cancer diagnosis and treatment.
6. Find a surgeon that cares about your comfort. It does not mean that everything will be painless, but find a surgeon who does her or his best to minimize pain or discomfort of a biopsy or other procedure. Many surgeons are not touchy feely personality types, but you should be able to tell whether they are concerned and sensitive to your comfort.
7. Don’t be afraid to get a second opinion. This is a very important decision. Don’t be intimidated and stay silent. Don’t let others decide for you.
8. Make a list of any important questions you have for the surgeon about their experience and/or about your situation. While your surgeon may have limited time, it is important that you have your important questions answered so that you can make informed decisions and feel more peace about what is for many people a frightening and sometimes overwhelming process. Ask your most important questions first so you can be sure they get answered.
Do your best to do your homework and choose the very best experienced breast cancer surgeon that you can and then work closely with him or her in your journey. Together you can make the best possible decisions and take the best actions to maximize your chance for positive outcomes. And, you can be at peace, knowing that you made the best decision you could make in finding an experienced and caring surgeon.
Dr. Tejpar has had a private independent surgery practice focused exclusively on breast cancer evaluation and breast cancer surgery in Orlando, Florida. Dr. Tejpar’s total commitment has always been to the well-being of her patients -- and patients know it.
She is a Diplomate in the American Board of Surgery, a Fellow of the American College of Surgeons, and an active member of the American Society of Breast Surgeons. She has passionately given quality care to patients in Central Florida for over 25 years and has always been one of the pioneers of new techniques and procedures to minimize discomfort to patients and improve outcomes.
Dr. Tejpar was one of the first Orlando breast cancer surgeons to do minimally invasive surgery such as sentinel node biopsies that takes 3-4 lymph nodes instead of routinely removing all lymph nodes in breast cancer surgery. She was one of the first breast cancer surgeons in the Orlando area to do Mammosite implantation (for short term radiation therapy). She was one of only two Orlando breast cancer surgeons to obtain Ultrasound Certification by the American Society of Breast Surgeons to help her become even more accurate in diagnosing breast cancer and benign breast disease. She is experienced in Mammosite radiation treatment, nipple saving mastectomies, and locating very small tumors with radioactive seed localization techniques. She has added the capability to receive digital mammography from local imaging centers to assist in accurate diagnosis. Dr. Tejpar has been a breast cancer advisory board member for the breast care team of Florida Hospital, since the advisory board was created and is widely recognized as a breast cancer expert in the Orlando area. Although her practice was always independent, she has been one of the breast cancer team members at Florida Hospital Cancer Institute's Breast Cancer Center.
To read more about Dr. Tejpar, click here to see a bio.
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