How treatment is planned

A group of healthcare professionals will develop your treatment plan. But the decision to start treatment is yours.

A team of specialists including surgeons, cancer specialists and breast care nurses will meet to discuss your treatment options. This is called a multidisciplinary team (MDT). They will look the stage and grade of the cancer, and whether it has hormone or HER2 receptors. This will help decide which treatment is best for you.  You may also have a test to find out the risk of  breast cancer coming back.

Your specialist will discuss the advantages and disadvantages of treatments with you and you may be given a choice of treatment. You may find it useful to have a relative or friend with you to help you remember what you speak about. It can also help to have a list of questions to ask your doctor.

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 will need to give permission (consent) before doctors can start your treatment.

How treatment is planned

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 specialises in x-rays and scans
  • a pathologist, who specialises in studying tissue samples and cells.

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
  • if 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 specialist nurse will talk to you about the best treatment for you.

Specialist doctors or nurses may sometimes use an online tool such as PREDICT or Adjuvant! Online. These can help to show how much some treatments may reduce the risk of the cancer coming back. You might find this helpful, especially if your doctor has asked you to make a decision about whether to have chemotherapy.


Gene expression tests

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

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.

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.


Fertility

Some treatments for breast cancer can affect your fertility. This may be temporary but for some women it can be permanent. Before treatment starts, your doctors and nurses will talk to you about this. If any of the treatments you are having could affect your fertility, they will explain what may be done to help preserve it.


Giving consent

Before you have any treatment, your doctor will explain its aims. They will 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.

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.


Second opinion

Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you. You may also find it helpful to have a list of questions ready so that you can make sure your concerns are covered during the discussion.

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.

Making a complaint

Talking to your healthcare team can make it easier to cope. If you find talking difficult, there are things you can do.