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Originally published October 9, 2024
Last updated October 9, 2024
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A breast cancer diagnosis can be scary. An estimated 1 in 8 women will develop breast cancer in their lifetime. However, you won’t face this challenge alone.
“We treat each patient like they’re part of our family, and we’re with them each step of the way,” says Michelle Antolin, OTR/L, CLT, an occupational therapist who cares for patients with breast cancer at Keck Medicine of USC.
Here’s a look at the different doctors and specialists patients can expect to work with during their journey with breast cancer.
After receiving a diagnosis, the first person a patient can expect to meet with is a surgical oncologist.
“The surgical oncologist initially directs the cancer care. They interpret the biopsy results and determine the type of cancer and the stage,” explains Emma Koesters, MD, a plastic surgeon who specializes in breast reconstruction at Keck Medicine of USC.
The surgical oncologist performs the surgery to cut the cancer out. The most common procedure is a lumpectomy, during which the doctor removes the tumor while preserving healthy breast tissue. Alternatively, mastectomy is a surgery to remove part or all of the breast. This doctor will also remove the patient’s lymph nodes when there is concern that the cancer has spread there.
Patients with breast cancer typically meet with a reconstructive surgeon early on to learn about their options. This doctor works closely with the surgical oncologist to determine what will give the patient the best results. Patients can usually expect both specialists to operate during the same procedure.
“After a lumpectomy, we can rearrange the remaining breast tissue to form a lifted, smaller breast,” says Dr. Koesters, who is also an assistant professor of plastic and reconstructive surgery at the Keck School of Medicine of USC. “After a mastectomy, we can reconstruct the breasts using implants or using tissue from other areas of the body, such as the abdomen or back.”
Dr. Koesters says she meets with patients at least twice before surgery to ensure they understand their options and feel comfortable with the surgical plan. “Even if a patient decides against having reconstructive surgery, I think everyone should know what’s available to them,” she adds.
Depending on the type and stage of cancer, the surgical oncologist may recommend chemotherapy, radiation therapy or both.
A medical oncologist is the specialist who administers chemotherapy, which involves using medications to target cancer cells. Patients may undergo chemotherapy before having surgery to shrink the tumor and make it easier to remove. Chemotherapy after surgery targets any cancer cells left behind.
A radiation oncologist uses high-intensity beams like X-rays to target cancer cells. Radiation therapy is often used after surgery to reduce the risk of recurrence.
During this time, a patient may also be encouraged to consult with a nutritionist to ensure they’re getting the proper nourishment to help their body manage the cancer treatments.
Patients can expect to meet with a genetic counselor soon after a breast cancer diagnosis. A genetic counselor will administer genetic testing to determine if the patient has a mutation in the BRCA1 or BRCA2 genes, which is associated with an elevated breast cancer risk.
Dr. Koesters says if a patient tests positive for one of these mutated genes, or if breast cancer is prevalent in their family history, those results can strongly impact treatment decisions.
For example, a patient with cancer in one breast may choose to undergo a double mastectomy as a preventive measure.
Patients who want to have children in the future may elect to meet with a fertility specialist before beginning breast cancer treatments.
“Chemotherapy can affect the patient’s ovaries and reproductive viability,” Dr. Koesters explains. “That’s why they may consider freezing their eggs before starting treatment.”
Patients can expect to meet with an occupational therapist following surgery. “Surgery like a mastectomy can impact range of motion in the shoulders, so we focus on building that back up,” Antolin says.
In addition, some patients require radiation treatment after surgery, a procedure that usually requires a patient to remain with their arms above their head for a few minutes. “Occupational therapists can help by prescribing exercises, stretching and soft tissue massage to decrease muscle and scar tightness in order to help patients position themselves comfortably,” she says.
Occupational therapists can also help patients improve their independence with activities of daily living such as dressing, grooming and completing household tasks. They can also help patients with pain and scar management post-surgery.
“For patients who also had lymph nodes removed, we’ll also watch for signs of lymphedema. We teach patients about how to manage the swelling and may recommend they see a certified lymphedema specialist,” she adds.
Finally, Antolin says a physical therapist may get involved to help address issues such as back pain or fatigue.
Patients can rely on a patient care or nurse navigator to help them keep track of all the various specialists and appointments throughout their breast cancer journey.
“We also have a weekly multidisciplinary breast clinic here at Keck Medicine of USC,” says Dr. Koesters. “It’s a one-stop shop where patients can meet with each specialty and get a sense of what to expect.”
“I’ve had breast cancer myself, and my doctors and the support staff were always right there with me making sure all the appointments lined up,” says Antolin, who is now cancer-free. “The teams at Keck Medicine are on top of it.”
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