Melanie Cole (Host): Hearing a diagnosis of breast cancer is life changing. And can be terrifying when you don’t know where to turn or what to do next. My guest today is Dr. Jason Wilson. He’s a surgical oncologist with BayCare Health System. Dr. Wilson I’m so glad to have you on as this is a topic that so many women think about, fear, plan for, all of these things go through women’s heads every time we get our mammogram. So, if a patient gets her mammogram and she’s gone through the diagnostic and gets diagnosed with breast cancer; what is her first step, where does she turn?

Jason Wilson, MD, MBA, FACS (Guest): First, let me just say thank you for having me to talk about this important topic. The first thing is to seek out a program that is dedicated to taking care of patients with breast cancer and that are experienced at doing that. She wants to find a place that has multidisciplinary care and a place that just really proficient at taking care of patients with breast cancer.

Host: How does she know? How does she know that it’s a center that’s proficient in taking care of women with breast cancer? Should she be looking up reviews online or talking to other people? Is there a way to know?

Dr. Wilson: So, certainly one of the things that she can look for is that there are centers that are certified breast centers and so that information is available freely online. We see a lot of breast cancer in our facility and we are a certified breast center and so that’s also in a good starting point to know kind of where to get treatment.

Host: So, do you advise if she’s gotten that diagnosis getting a second opinion? And if a woman wants a second opinion, Dr. Wilson, do you doctors get offended at that?

Dr. Wilson: So, I always tell people you certainly have every right to get a second opinion and it is certainly reasonable to get a second opinion. I personally have never gotten offended by a second opinion. I always want the patient to do what they feel is right for them. In terms of pathology review; anybody that we see, that comes from a facility that’s not one of our facilities, we always ask for their pathology to be sent for our pathologist to review those slides to make sure that they agree with the diagnosis. And in general, any of our pathologists that are giving a diagnosis of breast cancer for the first time in general, will have a second pathologist look and make sure that they agree with that diagnosis. But no, I would never worry about offending anyone because you have to do what’s right for you in terms of making sure that you are getting appropriate care.

Host: So, when they start going for these appointments; tell us how that process works. Do you think they should bring somebody with them to their appointments, keep written questions that they want to ask, kind of have somebody there so that they can – because this could be swirling around in a woman’s brain, the whole time you’re talking.

Dr. Wilson: Absolutely. So, I would always encourage people to bring someone with them. It’s always good to have another set of ears because as you said at the beginning; this can be very overwhelming in terms of a diagnosis and so having a second set of ears to really listen to this conversation is critically important. People often will come in having researched online and I would never discourage that, but I always encourage people if you are going to go online, make sure you go to a site that’s reputable like the American Cancer Society or the American Society of Breast Surgeons has a page written for patients called Breast360.org and those are very helpful sites to kind of get some background baseline information.

When patients come to for example, our office for the first time, we often are seeing them as the first person to really talk about the diagnosis. So, we will in general, go through some medical history, we will examine the patient, sometimes in our office we like to do an ultrasound to confirm where in the breast the cancer is. That way we can have very thorough discussions about treatment going forward. And then we will often spend time – we like to spend time going over what is breast cancer, what is the stage of the breast cancer and then I typically like to outline what surgical options there are, what radiation options there are, and even talk about what chemotherapy or what kind of hormone therapies might be involved in the treatment of their breast cancer.

So, these are long conversations, often 45 minutes to an hour and having a second set of ears there is always a great idea. And I always love when patients come with questions so that they’ve already thought ahead of time what they want to ask, and I think a sign that they’ve really thought through this.

Host: So, tell us about the process at your comprehensive breast care center. Tell us about your multidisciplinary team and the people that are involved in this approach.

Dr. Wilson: Right. So, one of the benefits to coming to a program that takes care of a lot of patients with breast cancer and that really focuses on this is that every Friday, we have a multidisciplinary breast conference where pathologists, radiologists, plastic surgeons, surgeons, medical oncologists, radiation oncologists, our cancer patient support services who are our counselors as well as our dedicated breast cancer nurse navigator all meet and then we go over brand new breast cancers. So, we try to present as many of our new breast cancers in that conference as possible and we bring any that we have questions about and so that way, when you are coming for a diagnosis with breast cancer; you are not getting just my opinion, you are often getting the opinion of radiation and medical oncology specialists. And if there are questions, people can ask these questions to each other and so we are really kind of getting a comprehensive team approach to getting the breast cancer treated in as most efficient way as possible.

Host: And tell us about the process as it goes through treatments. How is it individualized? Because not every woman’s cancer is the same. Do you base these treatments on the stage of the cancer, it’s biology and even patient preferences maybe they want reconstruction after mastectomy, maybe they – maybe there are certain other factors, fertility, any of these things that might come into play. Tell us how that discussion goes with a patient about the treatment options available for that woman.

Dr. Wilson: Absolutely. There are lots of different factors that go into creating kind of what the ideal is for any patient. So, certainly number one is we want to treat the cancer the way it needs to be treated. So, certain cancers need certain types of chemotherapy, some don’t need any chemotherapy at all, other than potentially hormone blocking pills, some are going to need kind of standard radiation that is six weeks of radiation, sometimes that radiation may be able to be cut down to three to four weeks. Sometimes we are able to do a five day treatment of radiation where we are able to do the catheter and all of that is highly dependent on the type of the breast cancer, the size of the breast cancer, the different biologic factors of the breast cancer and so those are all very individualized decisions.

But beyond just the biology of the cancer, certainly patient preferences are extremely important and that’s part of why I will kind of make sure if it’s something that is visible on ultrasound, I’ve looked with the ultrasound and I’ll talk to the patient about this is where I would be planning to put an incision. Patients may have a choice of doing a lumpectomy or doing a mastectomy and their family history or genetics or patient preference related to previous mammograms, there are a lot of different factors that may go into that decision for any individual patient about why they may choose to have a mastectomy or do a lumpectomy instead.

And then the reconstruction decision is a very personal decision as well. Or I have plenty of patients that will tell me that they don’t want to have a reconstruction and then I have patients that will tell me that it’s very important to them to do that. And so we work closely with plastic surgeons to be able to offer that and often to be able to offer at least the first part of it at the time of our mastectomies as long as they are good candidates based on the biology of their cancer.

Host: And then as treatment progresses, women have other worries Dr. Wilson, financial worries, dealing with insurance, life after breast cancer and that worry, and stress will it come back. Tell us how your center can help women navigate those waters after the treatment or during the treatment, all of the other things that come into play. Kind of give us your best advice picture.

Dr. Wilson: Right, so we have nurse navigators that are particularly attuned to making sure that as people go through treatment, they can get to where they need to go, get any of the tests they need to get and make sure that things are progressing along from the healthcare standpoint. In terms of financial impact, emotional impact, we have dedicated counselors that are our cancer patient support service that is a completely free service that helps to address any of these issues. They can help with financial resources. They are very attuned to what kind of financial resources that are available. They are very attuned to the emotional aspects of all of this care and they are a wonderful resource that we have here.

In terms of going forward, once people are through with the treatment, kind of a big emphasis in people that are taking care of cancer is what is called survivorship where we are really trying to make sure that any of those needs are met after care. And so, usually within a year of completing the last treatment, we try to have people come back to the office and kind of go over everything that has happened and talk about what the plan is going forward. Whether it be mammograms once a year or whether there is something about this particular case that would make us think that we should be getting MRIs or whether it’s just an exam in the office. We try to also individualize based on each individual patient how we are going to go forward in terms of doing surveillance in the future.

Host: What great information. What a comprehensive program. Dr. Wilson, best advice what you would like women to know that are newly diagnosed with breast cancer that scary, spinning world when we hear those terrifying words; what would you like them to know about the hope and on the horizon?

Dr. Wilson: I would say the main thing is that particularly with mammograms and surveillance and screening; most breast cancers are found early and most of the time people do very, very well from their breast cancers. And make sure you find a place where not only do the physicians take care of a lot of patients with breast cancer, but make sure you find a place where you are comfortable, and you feel like you are being taken care of.

Host: That’s great information. Thank you so much Dr. Wilson for coming on today and sharing your expertise and telling women that there are treatment options and hope out there. Thank you again. That wraps up this episode of BayCare HealthChat. Head on over to our website at www.baycarecancer.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.