Why An Oncologist Is A Necessary Player

“So does the same surgeon who does the mastectomy do the reconstruction or does another surgeon take over because that’s such a long surgery?” The nurse looked at the patient with surprise then responded, “I’m sorry, but you’re only scheduled for a mastectomy today.” Think this kind of miscommunication doesn’t happen?  It happened to my friend’s mother-in-law, it almost happened to my mother, and it happens more than it should. Why?

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Diagnosing Breast Cancer

Sometimes cancerous masses are found during routine mammograms or breast exams from the patient’s primary care doctor (the patient hasn’t had any symptoms yet).  Other times, a patient may have a family history of breast cancer (or may have the BRCA gene), and may schedule an appointment with an oncologist to monitor her health and prepare with a prophylactic mastectomy. But because there are so many facets of the process, some hospitals miss crucial steps along the way. 

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In some situations, when cancer is suspected or determined through biopsy (which, like a mammogram, may be done by a technician or nurse instead of a physician), the patient is sent directly to the doctor who will provide the treatment: a radiation oncologist or a surgeon. The patient assumes that she is being sent to the right person; the doctor assumes that the patient not only understands that radiation or surgery is the appropriate treatment but also that the patient has elected to pursue treatment in that way.

Why An Oncologist Is A Necessary Player

Although both surgery and radiation may be the right way to treat the cancer, an oncologist should be consulted to make sure that everything is done in the best way for the patient. For example, an oncology consult would have helped my friend’s mother-in-law understand that one surgeon performs a mastectomy and then a plastic surgeon performs a reconstruction. She would have been referred to a plastic surgeon who could have explained the risks and benefits of immediate vs. delayed reconstruction, saline vs. silicone, and all of the other factors associated with the reconstruction procedure.  

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Another major issue that an oncologist could help a woman avoid is radiation before reconstruction. Radiation treatments can cause extensive tissue damage – so much so that some plastic surgeons may refuse to perform a reconstruction, which may completely eliminate the option. Most women would choose their lives over their breasts, even if the choice is difficult and emotionally challenging.  But for women who undergo treatments without having been properly informed, learning that reconstruction will be more difficult, less effective, or even no longer possible afterward undergoing one of these treatments can be devastating. And even though my friend’s mother-in-law was able to be reconstructed eventually, her emotional recovery from the mastectomy would likely have been eased by the foreknowledge of a delayed reconstruction – or simply avoiding the problem altogether by having an oncologist manage all of the treatments and doctors involved.  

Ask For A Referral

Whether the step is omitted to save on costs or to have more streamlined treatment, an oncology consult may be overlooked. However, for the patient’s mental and emotional well-being, an oncologist is a crucial player in helping the patient look beyond the cancer and through complete recovery. If you were recently diagnosed with breast cancer, make sure that you add an oncologist to your treatment team if one wasn’t immediately consulted.