A few years ago I discovered a lump in one of my breasts.  After visiting my doctor, she suggested an immediate mammogram. Because of the lump I had to have both a mammogram and an ultrasound at the Radiology Center, Austin Radiological Association, ARA,  in Austin Texas. When the radiologist’s report came back,  it was suggested that I simply wait and watch the lump, and have a repeat mammogram in another 6 months.

My OB/GYN at the time however, wasn’t satisfied with that recommendation and wanted me to visit a breast surgeon in Austin for a consult. So I packed up my records, gathered my mammogram films and saw the Austin Breast Surgeon. The Breast surgeon said that she disagreed with the radiologists’ recommendation and that a biopsy would be necessary just to rule out the possibility of any malignancies.  But because I was already scheduled to travel to the Mayo Clinic in Rochester, Minnesota, I elected to consult with a Mayo Clinic physician about the issue and if needed would have the biopsy there.

breastcancer_doctorThe doctors at the Mayo Clinic had reviewed my breast films, and determined that the quality of the initial mammogram film that had been done in Austin was suboptimal, and that there was another tumor on the opposite breast that was not ever mentioned or identified by any of the doctors whom I had seen in Austin. So my first step at the Breast Clinic at Mayo was to have another imaging study, but this time the breast imaging was done using a different technology.  There were a team of physicians who reviewed the results including not only a breast surgeon, but a radiologist. The Radiologist at Mayo was concerned because the second tumor that was detected was even more potentially “problematic” than the first one that I had been told needed biopsied.

I was promptly scheduled for the breast biopsy, and in less than two hours from my initial appointment, found myself laying on the table in the radiology biopsy room, after having been prepped by the technicians and after an in-depth discussion with the radiologist about the type of biopsy that they would be performing.

Because I had discussed the procedure in advance with the radiologist, I had asked if I could also watch the monitor while they were performing the breast biopsies, and I was able to see each part of the process as they moved forward. The radiologist took his time to explain each step and even showed me the tissue that he removed from the breasts, because I had specifically requested that I be informed about as many details as possible. There are some patients, said the Radiologist, that don’t want to know or see anything while they are doing the procedure.  So for those patients, don’t worry, you don’t have to discuss anything during the biopsy, and can close your eyes if you wish.

The team kept asking if I had any pain—which I did not at all. Therefore, I could devote my attention to the monitors and watch what was happening during the biopsies.
Being in the medical profession,  I feel better if I’m given all the details.  The more I know —-the better off I am with making good decisions and feeling comfortable with the medical providers performing procedures.

My other personal opinion is that you as the patient should tell your doctor in advance if you need to know LOTS of detail, or if you just want them to jump to the chase and give you an overview.  As patients we should take the lead and tell our providers how much information we want and need from them. Everyone’s different, so make sure that you let your medical team know –how much detail you want regarding your medical care.

For me, it turned out that both breast biopsies were negative.  Which was a huge relief. But what would I do if the news were different, and how does a woman make up her mind about what is the best option for her for breast cancer treatment?

There can be positives and negatives for getting care locally, or traveling elsewhere to get breast cancer care. I’m going to outline how I made the decision to go to the Mayo Clinic just so that all of you can see what elements were important to me when making my decision.

Here’s how I would evaluate my options again if I had to be in that position. Each person will have different positives/negatives for their own situation. This was just written to help you get started if you should find yourself needing to make a decision about Breast Cancer Treatment and Care.  Your reasons and needs will be totally different from mine—so customize your own list when making decisions about whether to seek care locally or travel elsewhere.

Positives: About Traveling to Mayo Clinic (My List)

* Mayo Clinic may have newer or more advanced diagnostic equipment than what you can find in your local area

* Team of Experts Available to Read Radiological or Other Reports You are Not Relying on Simply One Person’s or One Doctor’s Opinion

*  May be Offered Different Procedures in Terms of Surgery that potentially in some cases could be less invasive, or receive options or access to care that could potentially reduce the risk of recurrence

* Coordination of Care  – When you are at the Mayo Clinic, everything is coordinated and streamlined. All of your team has access to your medical records, your scans, your labs, etc. So when you visit another team member at Mayo you don’t have to worry that the details and specifics of your care have been communicated to the next doctor.

* Speed of Care: Because you can get see the breast surgeon, the oncologist, the plastic surgeon, the physical therapist, and the geneticist all under one roof and all in one place you can theoretically shave off days and/or weeks of time that it would take you in other places to see the various specialists you need.  *I was never kept waiting for results or appointments at Mayo Clinic.  Even on a Friday afternoon when I was not initially on the schedule to have a biopsy—they worked me in to get the biopsies I needed, and I didn’t have to wait for the testing to be done that I needed.

* Because of coordination, and the ability to communicate changes in your condition and care it is my personal opinion that the medical care is less fragmented, and when one has less fragmented care, it can lead to a lower likelihood of mistakes happening with regards to your care.

* Ease of Getting and Sharing your Medical Records

* Access to Research Protocols or Studies that May not be Accessible Elseswhere

Negatives About Traveling To The Mayo Clinic: (My List)

* Time and Costs – If you are not within driving distance, it does require the time and money needed to make an airline reservation and schedule the trip

* For certain conditions it may not be warranted to get another or 2nd opinion

* Leaving your family to receive care

* You may be able to find very qualified skilled physicians locally, and you may not think that a 2nd opinion is needed

The problem that some patients face is that sometimes we don’t yet know what we don’t know. Sometimes we go into an illness or condition and as time goes along—we later find out it was more complex than it first appeared or that we weren’t given all the options that we should have been given.  It isn’t always possible to find this out or to research these things in advance and going to a larger facility like the Mayo Clinic doesn’t necessarily mean that you’ll be given all the options either.  But my personal belief is that you are MORE likely to receive more options by visiting a medical facility like the Mayo Clinic than just relying on the resources available to your local doctor. Especially if you are in a medium sized town.

Sometimes when that happens we may want the resources of a larger team of Breast Cancer Specialists and/or the options that perhaps a place like the Mayo Clinic could offer that would not be offered using a local physician for your care.

There is no best choice—simply the best choice for you. Maybe the best thing for all of us is to give this some thought in advance of having to make such an important decision.

Here’s a video from Dr. Donald Northfelt, MD, the Associate Medical Director of the Breast Clinic at Mayo Clinic in Arizona. (I went to the larger Mayo Clinic in Rochester, Minnesota for my care, but this video with Dr. Northfelt, also details why the procedural aspects of the breast cancer care at Mayo Clinic MAY be different then what you can get in your own local area.)

Breast Cancer Care at the Mayo Clinic in Arizona