Treating breast cancer: Sarah's story

Advice from the oncologist
Dr Victor Barley is a clinical oncologist at the Bristol Haemotology and Oncology Centre and is a trustee of the Bristol Cancer Help Centre. He advises:

'Treatment depends on the type of tumour a woman has and how long she has had it. There are choices between conventional treatments and I like my patients to be involved in which way they go. Treatment should be tailored to individual circumstances and needs. Some women are frightened of radiotherapy and feel more comfortable with breast removal, while others prefer a more totalised treatment with radiotherapy and local removal.

Some patients are not sure and I arrange to see them in two weeks' time to give them more time to think about it. The most frequently asked questions are about side effects, and if the disease is incurable - 'How long have I got?'

Breast cancer usually involves surgery of some kind. Radiotherapy can be given on its own but the cure rate is not so good. In any case you cannot make a diagnosis without removing the lump. A biopsy only gives a clue.

Respecting decisions
'Women do have choices in their treatment. For example, a woman who wants to have children and whose fertility may be affected by chemotherapy might choose to forgo that treatment. Some women prefer to have chemotherapy first to shrink the tumour before surgery, rather than afterwards. I would like to think that most doctors would respect a woman's decision.

I'm uncomfortable with patients being whisked away and not being given time to consider the treatments on offer. Treatments are determined by the type of tumour and where it's at. If it's a big tumour, then a mastectomy is most effective. There are lots of different scenarios and in general women like to know what the options are and like to talk about them for a week with friends, doctors and family. One woman was told by the surgeon to have a mastectomy, but after a week of mulling it over she told him she wanted a lumpectomy. He didn't agree with this, but respected her wishes. She had radiotherapy afterwards and is now leading a full and normal life. But there are women who say, 'Just do what you have to do.' And that's their choice, too.'

Resources
Breast Cancer Care
Breast Cancer Campaign