•  Breast Cancer Center •  Doctors You'll Need for Breast Cancer Care •  What Do I Do Now? •  What to Look for in a Breast Cancer Doctor

A good doctor should be able to explain why he's proposing a particular course of action. This is the third article in a series on how to find the right breast cancer doctor for you.

How do you find a good cancer specialist? Try to investigate the problem through a variety of sources. Talk to friends, relatives, and colleagues about finding a doctor. You'll be amazed at how many people have firsthand experience either as patients themselves or with people close to them.

Keep a list of those doctors women liked and those they didn't. Pretty soon you'll notice that one or two names keep cropping up on the "good" side of your list. Get a sense from the people who mentioned them of what those physicians are like, their hospital affiliation, and their general approach to the illness. Use their names to start your quest.

Breast cancer is, unfortunately, common enough in most cities that there are doctors, particularly surgeons, who treat only that condition. They are, obviously, experienced in most of its aspects. Experience is a valuable asset. If you live in an area where there are no breast specialists, you should consider whether it is feasible to consult one in a nearby city. Even if, in the long run, you are going to have to rely on ongoing treatment from a doctor in your own area, I'd suggest that at the time of diagnosis, and of any surgery, you try to consult with such a breast cancer specialist.

What other steps can you take to find a good doctor?

•The National Alliance of Breast Cancer Organizations (NABCO) has compiled an excellent list of services and materials relevant to breast cancer. Their latest compilation of local support organizations can be found in the appendix of this book. Call the group closest to where you live for leads on finding a physician.

•Consult the telephone book or ask your county health department if there is a breast cancer hotline available in you area. Call the hotline for information about physicians in your community.

•The National Cancer Institute's (NCI) Cancer Information Service (1-800-4-CANCER) can give you the names of NCI-affiliated clinical or comprehensive cancer center in your state. Call and ask them for a referral, or if they are conveniently located, consider consulting a physician on their staff.

•Divisions and units of the American Cancer Society will often provide local referrals. You may also call the national office of the society at 1-800-ACS-2345 for such information.

•The American College of Surgeons (312-202-5000) will give you names of surgeons specializing in breast cancer in your area.

•Find out if there is a local women's health group or women's center. Such groups often know of doctors in the area who specialize in women's health problems. They sometimes keep records of women's experiences -- good and bad -- with local doctors.

•Call the best hospital in your region and ask for the names of breast cancer specialists. If there are several such people on staff, you may simply be given the names of the people next in order on the hospital's list. Still this may be a useful place to start your search.

•Call your clergyman or a social worker at a mental health service. Such people may know the names of good physicians in the community or may know other cancer patients who have had the experience of looking for and finding a doctor.

One way to get started "checking out" a doctor is to consult the medical directories that are available at public libraries, at the county medical society offices, or at medical libraries. State medical societies usually publish annual or biannual listings that describe a physician's training, specialty, and current hospital affiliation. There is also a directory of medical specialists that will give you such information.

The first factor to consider is training. This is one of the simplest pieces of your detective work. If you are in the doctor's office, she may have her diplomas and degrees on the wall. Take note of what institutions they are from. If you don't see these documents, ask the doctor where she trained, or else consult one of the directories or listings described above. The medical school a physician attended is often less important than where she took her postgraduate or specialty training. The best training is usually at large, university-affiliated hospitals (often called teaching hospitals). Institutions like these treat many patients and they also maintain high standards. There is usually additional training available specifically in cancer surgery and other cancer treatment.

The next factor to concern yourself with is experience. This is not to say that a smart young doctor, fresh out of training at a great institution, very sharp about the latest techniques, can't do a good job. There is, however, for better or worse, a demonstrable correlation, between, for example, the outcome of the surgery and the surgeon's experience in doing the procedure. The frequency of postoperative complications often is related to how many times the surgeon has performed a particular operation.

Hospital affiliation is another crucial issue. Make sure that the physician is on the staff of a hospital known to have both very high standards and good support services for the treatment of breast cancer patients. This is important not only because you want to be treated at the best possible institution, but also because the fact that physician practices at such a hospital shows that the best doctors in the community acknowledge his qualifications by accepting him as a colleague.

Peer recognition -- what his colleagues think of a doctor's abilities -- is harder to find out, but a very useful piece of information. Doctors, as all nondoctors recognize, are reluctant to say directly unfavorable things about their colleagues. You may need to make such inquiries more subtly. For example, ask several doctors in the community who they think is the best breast surgeon in town. The same names will probably recur. If the physician you're investigating isn't mentioned, you already know a lot, but you might want to push a little further by asking, "Do you think Dr. Jackson is in the same league?" You may have to watch closely here for the slight shake of the head, or put your ear tightly to the phone receiver to hear the meaningful pause or clearing the throat. Though there aren't too many doctors who will be immediately forthcoming, responsible physicians will try to protect you from people, particularly surgeons, whose work is not first-rate.

As alluded to before, the opinion of other women who have had breast cancer is invaluable. This includes former patients of the physicians you are considering. Many of my patients point out that they often get phone calls from women who have heard through the grapevine that they had cancer. These people call and ask, "Whom did you go to?" "What kind of operation did you have?" and similar questions. A former patient's opinion should probably not be the only basis for making a decision to go to a particular doctor. If, however, a few women tell you of unpleasant or bad experiences with a doctor, that is a good reason not to go to him, or, at the very least, to do a lot more investigation.

One of the hardest questions to judge when you have breast cancer is whether the treatment being proposed is the right one for you. This is especially difficult because individual women may have specific goals of their own and may not know how to reconcile them with what they are being told is the proper course to follow.

A woman may say, "The most important thing for me is to preserve my breast." Another, perhaps expressing her hope for a normal, unimpaired life, will say, "I want to be able to go on playing tennis." Another will say, "The only thing that matters to me is survival. Cut off my breast tomorrow if that means I'll be safe."

These are important concerns, though obviously the primary factor that should determine treatment is the extent and nature of the illness. Given a particular patient's situation, however, there may be differences of opinion among physicians on what the treatment should be. A good doctor should be able to explain to you the principle on which he wishes to proceed and the interpretation that has led him to propose a course of action.

Why, given a certain condition, wouldn't every physician you see suggest the same treatment plan? Some women report running into doctors who seem to have a bias toward one treatment or the other; who, despite recent research and clinical experience, are slow to change; or who are especially cautious. Women have told me that such doctors have said, for example, "I never do lumpectomies. They're risky."

Nonetheless, there are genuine differences in how to "call" a case. Suppose removing the entire breast in one circumstance would result in a one hundred percent chance of success, while doing a wide excision (lumpectomy) followed by radiation would yield a ninety-seven percent success rate. In such a case, the advice of two different physicians might legitimately differ.

If an opinion does not seem reasonable to you or if you are particularly anxious about a recommended course of treatment, consult another doctor (as your insurance company may require you to). The second physician may confirm that what is being planned is the only sound course of action; or you may have to choose between two conflicting opinions, or even seek a third specialist's advice. Even though this sounds troublesome, you owe it to yourself to be as sure as possible before you undergo an extensive procedure.

Click here to read Part One.

Click here to read Part Two.

-- Adapted from BREAST CANCER: THE COMPLETE GUIDE by Yashar Hirshaut, MD, FACP; and Peter I. Pressman, MD, FACS; © 1992 by Yashir Hirshaut. Used by permission of Bantam Books, a division of Random House, Inc. For online information about other Random House, Inc. books and authors, see the Internet Web Site at http://www.randomhouse.com.

First published May 17, 2001
Last updated March 17, 2008

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