What to Look for in a Breast Program

What to look for in a choosing a breast center and a breast cancer specialist.

A woman who discovers that she has breast cancer typically consults a radiologist, a pathologist, a breast surgeon and an oncologist to determine what her treatment plan should be. She will try to weigh and synthesize often-conflicting advice from several doctors on her own. But there is a better way: Assemble a team of experts to work together to devise the best treatment plan. We recommend choosing a cancer center that uses a multidisciplinary team approach where the oncologist, radiologist, surgeon, pathologist and anyone else involved meet to discuss each woman's case and determine the best treatment plan for her.

A breast program must address a patient's emotional, psychological and educational needs as well as her medical needs. A patient who understands her disease, knows what her treatment options are and has a strong support system is in the best position to be an effective partner in her health-care decisions.

Early, accurate diagnosis of breast cancer is probably as important to a woman's survival as any element of treatment. Diagnosis is done by radiologists (medical doctors who take and read images, typically mammograms, of the breast) and pathologists (physicians who analyze cells and tissue to discern whether they are benign or malignant). The more experience a practitioner has with a procedure, the better. Reading mammograms and analyzing biopsy tissue is a difficult and subtle pursuit, involving as much art as science.

This is one of the reasons why large cancer centers, where physicians handle thousands of cases each year, are better places to go for an accurate diagnosis.

Attributes of an Excellent Breast Center and its Physicians

Multidisciplinary Breast Conference for Every Patient All the specialists involved meet to discuss the care of each patient before treatment. Ideally, the patient is present as well, so that she can be consulted regarding her priorities and preferences.

Comprehensive Care The center offers as many breast services as possible, from radiology to reconstructive surgery, under one roof. This allows specialists and staff to work as a team and effectively coordinate care.

Specialized Radiology A dedicated breast-imaging center is likely to provide better screening than an all-purpose radiologist.

State-of-the-Art Technology FDA-accredited mammography, breast ultrasound, stereotactic biopsy and ABBI systems

Coordinated Care Each patient should be tracked by one staff person, who answers her specific questions.

Research and Clinical Trials If a center does research on new therapies, this indicates its commitment to pushing the envelope of available care.

Access to a Genetics Counselor Even with a clear mammogram, a woman with a family history of breast cancer may want to know about risk factors and the implications of genetic testing.

Comfortable Treatment Area If the center maintains its own chemotherapy treatment area, ask for a tour. Is the atmosphere frightening or comforting? Are extra chairs available for family and friends?

Quick Response If you have symptoms, a breast center should not simply do your mammogram and send you home. If a first mammogram indicates the need for further screening, it's better to be given the option of waiting 30 minutes for the news and then continue testing rather than to return another day.

Surgical Specialist Doctors who call themselves breast surgeons should perform at least 90 percent of their operations on breasts. Ask. Too many general surgeons now call themselves breast surgeons, but only experience builds expertise.

Patient Comfort A biopsy can initiate anxiety. Can you receive some form of sedation during the procedure? QUICK CONSULTATION. You should be able to ask a radiologist to explain any irregularities on your mammogram as soon as an interpretation is available.

On-site Counseling and Support Groups Examples include breast cancer survivor groups and groups composed of women at high risk for breast cancer. Sessions should be led by counselors who specialize in these issues.

A Patient Advocacy System A quality center assists women in dealing with physicians, insurance, and emotional needs. Sometimes the support may be a nurse who accompanies patients to appointments.

Resource Center Books, videos, Internet access and staff trained to help you research medical literature should all be available.

Patient-Friendly Procedures Policies should be set up for the convenience of the patient, not the hospital staff. Ask about private dressing rooms and waiting areas separate from the breast center's main lobby. Patients in hospital gowns should not be required to sit with fully dressed patients. Are there private lockers?

Sensitive Trained Staff A nurse or radiology technician who can help a patient, whose mother had breast cancer, get through her mammogram can be as much of a lifesaver as any piece of technology.