How treatment is planned

When you are diagnosed with breast cancer, a team of health and social care professionals will meet to discuss your treatment options. This is called a multidisciplinary team (MDT). They will look at a number of things, including the stage and grade of the cancer, and whether it has hormone or HER2 receptors. You may also have a gene expression test to find out the risk of a breast cancer coming back. All these factors can help the MDT and you decide on the best treatment for your situation.

You may be given a choice of treatment but you can also choose not to have treatment.

Your specialist will discuss the advantages and disadvantages of treatments with you. You will need to give permission (consent) before doctors can start your treatment. You may find it useful to make a list of questions and to have a relative or friend with you to help you remember what you speak about.

How treatment is planned (MDT)

A team of specialists will meet to discuss and decide on the best treatment for you.  This multidisciplinary team (MDT) will include:

  • a surgeon, who specialises in breast surgery and may also specialise in breast reconstruction
  • a plastic surgeon, who specialises in breast reconstruction
  • an oncologist (cancer specialist), who specialises in chemotherapy, radiotherapy, hormonal therapy and targeted  therapy
  • a specialist breast care nurse, who gives information and support
  • a radiologist, who analyses x-rays and scans
  • a pathologist, who advises on the type and extent of the cancer.

It may also include other healthcare professionals, such as a research nurse, physiotherapist, psychologist, social worker or counsellor.

Your cancer team looks at different factors to help decide which treatments are likely to work best for you.

These include:

  • the stage and grade of the cancer
  • whether the cancer cells have hormone (oestrogen) receptors or HER2 receptors.

They will also assess the chance of your cancer coming back when planning how much treatment to offer you.

After the MDT meeting, your cancer specialist or nurse will talk to you about the best treatment for your situation.

They may sometimes use a computer programme such as PREDICT or Adjuvant Online. These can help to show how much having a treatment like chemotherapy will reduce the chance of the cancer coming back. You might find this helpful, especially if your doctor has asked you to make a decision about having chemotherapy.


Gene expression tests

The National Institute for Health and Care Excellence (NICE) has recommended the use of a gene expression test called Oncotype DX. This is for women with ER positive cancer that hasn’t spread to the lymph nodes. This test provides more information about the risk of early breast cancer coming back.

The results can help women and their doctors make a more informed decision about whether or not to have chemotherapy after surgery. If the results show a low risk of the cancer coming back, it means you can avoid unnecessary chemotherapy and side effects.

Ask your cancer specialist or specialist nurse if you would benefit from this test. Oncotype DX may be covered by some private health insurance companies.

NICE guidance only covers England and Wales. If you live in Scotland or Northern Ireland, your cancer specialist will be able to tell you if this test is likely to be available. NICE recommends that other gene expression tests called MammaPrint, IHC4 and Mammostrat are still only used in research trials.


Giving your consent

Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment.

No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

  • the type and extent of the treatment
  • its advantages and disadvantages
  • any significant risks or side effects
  • any other treatments that may be available.

If you don't understand what you've been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it's not unusual to need repeated explanations.

It's a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.

People sometimes feel that hospital staff are too busy to answer their questions, but it's important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can't make a decision when your treatment is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you don't have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don't have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.

Back to Who will be involved in my treatment decision?

Getting a second opinion

There are many reasons for wanting a second opinion about your treatment. Speak to your specialist or GP.