How to Find a Breast Cancer Surgeon

Choosing the Right Surgical Oncologist

Nurse comforting patient in waiting room
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If you have been diagnosed with breast cancer, often the first thing you will want to do find a surgical oncologist. A surgical oncologist (a.k.a. a breast surgeon) is trained to treat cancer by removing tumors and other cancerous tissues. They can also perform breast biopsies to confirm the diagnosis or stage the disease.

A surgical oncologist may be one of several doctors you will turn to when faced with breast cancer. Others may include a medical oncologist who treats cancer with medicine (and typically oversees care) and a radiation oncologist who treats cancer with radiation.

Value of Experience

Whatever the type or stage of breast cancer you have, choosing the right surgical oncologist is vital. Surgical proficiency not only translates to a better response to chemotherapy but may increase your survival time as well. Within this context, experience really counts.

According to 2016 study from Sweden, which looked at survival rates in people with esophageal cancer, surgical oncologists who performed 35 to 59 esophagectomies had far better long-term outcomes than those who performed 15 to 22. So important was the value of experience that the five-year survival rates were as much as 30 percent greater among the more experienced surgeons.

(Though this study was not on breast cancer, the translation of physician experience into better outcomes is widely accepted as true across the board.)

For this reason, it may not be in your best interest to let someone else choose your surgeon for you. While it is great to have faith in your doctor when it comes to referrals, you need to do your homework.

Remember that doctors will typically refer you to surgeons who are affiliated with the same hospitals in which they have privileges. This doesn't mean your doctor doesn't have your best interests at heart (or that the surgeon you're being referred to isn't excellent), but it does limit your choices and your ability to make an informed decision.

Specialties and Expertise

Unlike medical oncology, which is a specialty of internal medicine, surgical oncology is a specialty of general surgery. To become a surgical oncologist, you must first complete a five-year postgraduate residency in general surgery, after which you would embark on a three-year fellowship in surgical oncology.

After that, some surgical oncologists will pursue additional training to specialize in specific types of cancer, such as breast cancer. Some might even specialize in specific procedures.

Given these parameters, there can be a wide variation in the skills a surgeon (literally) brings to the table. You may be referred to a surgical oncologist who practices in different fields of oncology. In some hospitals, particularly smaller ones, procedures like a surgical biopsy or lumpectomy may be performed by a general surgeon.

This doesn't mean that these surgeons are any less capable of performing these procedures. What it does mean is that you may need to work twice as hard to determine how qualified they are to treat your cancer.

Compared to other surgeons, a surgical oncologist specializing in the breast is trained to perform a wide variety of procedures, both common and uncommon. These include, among other things:

  • Lumpectomy (removal of a tumor and some surrounding tissue)
  • Total mastectomy (removal of the entire breast, including the nipple and areola)
  • Quadranectomy (a partial mastectomy involving the removal of a quarter of your breast tissue)
  • Skin-sparing mastectomy (in which the skin of the breast is preserved but not the nipple or areola)
  • Nipple/areola-sparing mastectomy (removal of breast tissue through an incision that preserves the nipple and areola)
  • Sentinel lymph node biopsy (the minimally invasive removal of the first few lymph nodes in the underarm)
  • Axillary lymph node dissection (the removal of lymph nodes under the arm)

Some surgical oncologists are even skilled in performing reconstructive breast surgery, although, more often than not, a plastic surgeon would be tasked with the procedure.

How to Find a Surgeon

According to a study published in the Journal of Oncology Practice, there were roughly 14,000 oncologists practicing in the United States in 2011. Of these, less than 500 were surgical oncologists. Since then, the numbers have increased with between 800 and 900 surgical oncologists currently certified by the American Society of Clinical Oncology (ASCO).

Despite the increase, surgical oncologists remain in short supply and tend to be clustered in urban centers with major hospitals. According to ASCO, there is roughly one oncologist per every 20,000 people in urban centers, but only one per every 100,000 people in rural areas.

Finding a surgical oncologist can be difficult, but there are steps you can take:

  • Get a professional referral: Your doctor or medical oncologist will typically know qualified surgeons in your area. You can also do an online search by plugging your zip code into the ASCO doctor locator.
  • Check for certification: Once you have your referrals in hand, you can confirm a doctor's certification by calling the American Board of Medical Specialties (ABMS) at 215-568-4000 or using the online verification portal managed by the American Board of Surgery (ABS).
  • Read up on his or her background: Use the DocInfo website offered by the Federation of State Medical Boards, which can provide you details about a surgeon's education, active licenses in various states, and any disciplinary or legal actions filed against the physician.

After you've pared down your list, you can begin scheduling no less than two face-to-face appointments.

Word to the Wise

Asking for a referral from friends, even those who have had breast cancer, may be tricky since what they needed as patients may in no way align with your needs. Be cognizant of this when asking for advice.

Questions to Ask

When making an appointment, the first thing you need to ask is whether the office accepts your insurance. Alternately, you can contact your insurance provider to determine whether the surgeon in an in-network or out-of-network provider. This can make an enormous difference in how much you pay out of pocket.

If the surgeon does not accept your insurance or you don't have coverage, ask whether the office has a monthly payment plan or a discounted fee for an upfront payment. If not, the surgeon may be able to direct you to someone who is a provider with your insurance company, if applicable. Don't be afraid to ask.

If you decide to move ahead, make a list of all of the questions you need to ask in advance of your meeting. You should ever hesitate to ask about a doctor's qualifications no matter how intimidating it might seem.

Questions you might want to ask include:

  • How many times have you performed this procedure?
  • Do you only do breast surgery or other types as well?
  • What type of training have you had for this procedure?
  • Why is this surgery the right one for me?
  • Are there others I should be considering?
  • What success rate have you had with this surgery?
  • Can the procedure be done by a general surgeon? If not, why?
  • What can you do to minimize harm to the appearance of my breast?

It helps to have a basic understanding of your cancer and available treatments. This will help you discuss the various options and their advantages/disadvantages, instead of limiting the conversation to just one or two.

Other Considerations

Convenience should not be the deciding factor when choosing a surgeon, but it undoubtedly plays a part. Be sure to ask the surgeon if all of your pre-operative tests will be done in one facility or several. Whatever the response, check to see if the facilities accept your insurance. The same applies to your anesthesiologist who will be paid separately from your surgeon.

If a surgeon cannot provide you the answers you need or you feel uncertain about a recommended procedure, do not hesitate to get a second opinion or speak to office staff, as applicable. This doesn't mean you have to cut the surgeon from your list, just that you need more information to feel confident about choosing them.

While you certainly need to find a level of comfort in the surgeon you choose, do not mistake the likeability of a doctor for the ability of a doctor.

Rather than going with a lesser qualified surgeon who you like, focus first on a surgeon's skills, training, and qualifications. With that being said, if you don't have a voice in the direction of your treatment, expand your search to find a surgeon who you not only trust but trust hears you.

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