Breast cancer beyond the sound bite

In In The News by Barbara Jacoby

By: Debra Johnson


While most news clips and sound bites you’ll hear this month focus on screening and early detection, those steps are often just the beginning of a life-altering journey. It’s also important that you know the side effects of treatment and options for breast reconstruction.

Patients must be proactive. Demand a cardiovascular ultrasound — also known as cardiac echo or echocardiogram — be performed prior to and during chemotherapy and radiation. This test, which is 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 you do not already have impaired cardiac function and can establish a baseline for your 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.

Ask your 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 your 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 breasts in order to be healthy again. Many women, however, suffer both a physical and psychological loss after a mastectomy. Breast reconstruction, insurance coverage for which is mandated by the Women’s Health and Cancer Rights Act of 1998, restores one or both breasts’ shape, appearance, symmetry, and size following mastectomy, lumpectomy or other trauma.

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 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. If you are confronted with a breast cancer diagnosis, demand a consultation with a plastic surgeon to determine if and when breast reconstruction fits into your 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. When you are fully informed, you are best prepared to make the important decisions regarding treatment and best equipped to manage your recovery.

Dr. Debra Johnson is in private practice in the Sacramento area and teaches as a clinical professor of plastic surgery at the UC Davis Medical Center in California. Dr. Allan Klein is the director of the Center for the Diagnosis and Treatment of Pericardial Diseases at the Cleveland Clinic.