Your Breast Cancer Treatment Questions, Answered

Lauren Mauro, MD, is a specialty care physician board-certified in internal medicine, medical oncology and hematology. She has a special interest in the management of breast cancer. She joins Inova Medical Group in April, 2019.

A breast cancer diagnosis is a frightening and overwhelming experience. If you or someone you love is facing breast cancer, you likely have a lot of questions. As a medical oncologist, my goal is to make sure my patients get the answers they need to feel good about their treatment plans.

These are some of the common questions I hear from my patients:

What’s involved in breast cancer diagnosis?

If you’ve had a suspicious mammogram or noticed a change in your breast (such as a lump, nipple discharge or skin change), the next step is to gather all the facts. Typically, your doctor will send you for more detailed imaging and a biopsy. If the results come back positive for cancer, you’ll be referred to a breast cancer specialist. For most women with breast cancer, this first stop will be a breast surgeon. The surgeon will order any additional studies that are needed and work with you and your treatment team to determine the next steps.

Do I have to have surgery?

At this time, surgery is needed in order to cure breast cancer. Therefore, patients who have curative breast cancers (stage I, II, and III cancers) will need surgery at some point during their treatment process. Usually, surgery comes first. But for some women, we recommend chemotherapy before surgery. Your breast surgeon will consult with medical oncologists to decide on the best treatment plan for your particular cancer. 

Will I need chemotherapy, radiation or other medications?

Treatment recommendations differ depending on the type of breast cancer, its stage and the patient’s specific medical history and situation. There are four main types of therapy used to treat breast cancer: surgery, chemotherapy, radiation and antihormone therapy. For some patients, surgery is the only treatment they need. Others will need one or more of the other options. 

Every breast cancer is different. My colleagues and I tailor treatment for each patient, taking a person’s biology and wishes into account. We then review the recommendations in detail to make sure patients and their families understand the plan.

What is “receptor status” of breast cancer, and why does it matter?

The ‘receptor status’ of a breast cancer is one of the main factors we use to determine a patient’s treatment plan. When a breast biopsy is done, we analyze the results to look for the presence (or absence) of three main proteins on the surface of the breast cancer cell: the estrogen receptor, the progesterone receptor and the HER2 receptor. We choose treatments depending on which receptors are present.

Is immunotherapy an option for treating breast cancer?

Immunotherapy is a treatment that increases the ability of the immune system to recognize and fight back against cancer. This new therapy is very effective in certain cancers, such as lung cancer and melanoma. It has been much harder to find a role for this type of therapy in breast cancer. We did see a breakthrough in 2019 when the U.S. Food and Drug Administration (FDA) approved the first combination therapy of chemotherapy plus immunotherapy for a subset of women with advanced breast cancer. Right now, that treatment is only available to a small portion of women with breast cancer. But many studies are testing immunotherapy drug combinations in other groups of patients with breast cancer, so we are looking forward to expanding the use of this therapy in the future. (In fact, some of that research is being done in breast cancer clinical trials at Inova.)

What should I know about treatment side effects?

Many of my patients are understandably concerned about side effects from cancer treatment. The good news is we’re doing a much better job managing those side effects than we did in the past. We have many more medications to prevent nausea and vomiting in people receiving chemotherapy, for example. Still, some side effects can’t be completely avoided — and I believe it’s important that patients know what to expect. For instance, antihormone therapy can cause side effects that mimic menopausal symptoms such as hot flashes, vaginal dryness and low libido. Immunotherapy can cause a rash, diarrhea and rare but potentially serious breathing problems or liver inflammation. It’s important to talk to your doctor about any symptoms you’re experiencing, big or small, so we can work together to manage them. Quality of life matters, and it’s our job help you manage side effects so you can feel more like yourself.

I strive to have a close patient-doctor relationship with my patients. I want you to be comfortable asking questions like these— whether it’s about understanding test results, managing side effects or exploring lifestyle changes to help you feel your best during treatment and beyond.

I’m excited to be joining the team at the Inova Breast Cancer Program. I look forward to working with Inova’s breast surgeons, radiation oncologists, medical oncologists and other breast specialists to provide the absolute best care to my patients.

Dr. Mauro will see patients in the Inova Schar Cancer Institute Fairfax location starting in late April and the Alexandria location starting in the summer of 2019. For appointments, please call 703-379-9111 (Alexandria) or  703-207-0733 (Fairfax).