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updated 10/8/2010 7:26:28 PM ET 2010-10-08T23:26:28

If you’ve just been diagnosed with breast cancer, or are close to someone who has, you probably have a lot of questions. Breast cancer surgeon Dr. Kristi Funk, also the director of the Pink Lotus Breast Center in Beverly Hills, spells out what you need to ask the doctor.

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Two words: “It’s cancer.”

What did the doctor just say? You’ve been diagnosed with breast cancer? Your worst fears scream through your mind. This can’t be happening — and yet, it is happening. Take a deep breath. Exhale, and think, “I will survive.” Most women with breast cancer do survive, you know — so why not you? I’m not minimizing the strength and endurance it takes to get from here to cure — but you must believe that you will get there!

Let’s talk about what you can expect between now and the day this journey becomes history. What follows are the answers to the top eight questions I hear — questions you need to ask your doctor to make sure you get the care you deserve.

1. What exactly is breast cancer?

I always use pictures to explain how breast cancer starts — even a cursory understanding of this process takes away some of the mystery cancer holds. Stripped of its mystery, cancer looks a little less daunting.

Image: Breast diagram
breastcancer.org
About 80 percent of breast cancer starts in ducts, 15 percent in lobules (broccoli-like bunches in the picture), and 5 percent is more unusual (but not necessarily more aggressive).

The majority of breast tissue is made up of milk-producing glands, called lobules (broccoli-like bunches in the picture), and the tubes that carry milk down and out the nipple, called ducts. About 80 percent of breast cancer starts in ducts, 15 percent in lobules, and 5 percent is more unusual (but not necessarily more aggressive).

Normal ducts and lobules are lined by a single layer of cells that all look similar to each other. When those cells proliferate for whatever reason (genetic mutations, estrogen stimulation ... no one knows exactly why), this is called hyperplasia, and we really don’t care about that common, benign finding. However, when those new cells become disorganized, creating multiple layers and changing their look, this is atypical hyperplasia and needs to be removed when identified. Once those atypical cells bridge across a duct or lobule, and nearly fill up the central spaces, it becomes carcinoma in situ (CIS) ductal DCIS, or lobular LCIS, depending on where it is located. When left unchecked, some CIS will break through the duct or lobule walls, invading the surrounding breast tissue. Once cancer becomes invasive, it has the potential to enter the lymphatics or bloodstream and travel to other organs (metastasize).

2. What stage is my cancer?

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Ranging from stages 0 to 4, each stage assesses whether the cancer is invasive or non-invasive, the size of the tumor, how many lymph nodes are involved, and whether the cancer has spread beyond the breast to distant organs. Your cancer stage provides a universal language for surgeons and oncologists. It indicates how far along your cancer has progressed, and helps guide the treatment process. The true stage can only be known once your tumor and lymph nodes are removed, and your body has been imaged; prior to then, doctors can predict your stage based on clinical findings.

STAGE 0: This stage is called DCIS (ductal carcinoma in situ) or LCIS (lobular carcinoma in situ). The cancer cells are still within the intact ducts or lobules of the breast, and therefore Stage 0 cancers have no ability to spread. Stage 0 is the most curable type of cancer, although DCIS generally requires more treatment than LCIS.

STAGE 1: In this stage, cancer cells have invaded the walls of the duct or lobule, but the total size is less than 2.0 cm, and cells have not yet spread to lymph nodes or anywhere else in the body.

STAGE 2: Cancers less than 5 cm in size that have spread to one to three axillary (armpit) lymph nodes, and cancers over 2 cm that have not spread to nodes and have not invaded the chest muscles or skin are all Stage II.

STAGE 3: Cancers of any size that have spread to four or more axillary (armpit) lymph nodes, the nodes around the clavicle (collarbone), and/or the nodes near the sternum (internal mammary nodes); cancers over 5 cm that spread to any number of nodes; and tumors that have grown into the chest wall or skin are all Stage III.

STAGE 4: This stage cancer has spread beyond the breast and nearby nodes, and has metastasized to other organs or distant nodes. The most commonly involved areas are liver, lung, brain, and bone.

3. What kind of operation is best for me?

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A lumpectomy removes the cancer with a rim of healthy breast tissue surrounding it. A mastectomy removes all of the breast tissue. Remember this: Your chances of survival, and your chances of cancer recurrence (with a single cancer site in your breast) are identical whether you choose to have a lumpectomy followed by radiation, or a mastectomy. Shocking, right? You can keep your breast and not sacrifice your chance of cure! Make sure your surgeon is offering you options tailored to you.

Here are six reasons why you might choose mastectomy, even though at first it might seem like a drastic measure:

1. Small breast/large cancer. Lumpectomy will be significantly deforming, whereas mastectomy with reconstruction actually looks much better.

2. More than one cancer in different parts of the breast.

3. Not interested in radiation after lumpectomy, for whatever reason.

4. Already had radiation for a previous breast cancer in the same breast.

5. BRCA genetic mutation, or strong family history of breast cancer — you might consider removing the other breast as well.

6. Personal preference: “It’s my breast and I just don’t want it.”

4. Do I have a choice about radiation?

Well, yes and no. Lumpectomy without radiation leads to a cancer recurrence rate in the breast tissue of about 40 percent. If you add radiation to “sterilize” the breast after lumpectomy, recurrence drops to 4-8 percent. So if you choose lumpectomy, you really need radiation. However (here’s your choice!), you might be a great candidate for APBI, accelerated partial breast irradiation. Standard radiation is Monday through Friday, every day for about 33 treatments, taking 6.5 weeks. APBI takes 5 minutes, twice a day for 5 days, and you’re done!

Video: Your breast cancer concerns addressed (on this page)

Ask your surgeon about APBI. If you are over 45 years old, your cancer is under 3 cm with clear margins, the lymph nodes are negative (no cancer), and the type of cancer is not lobular, you might save yourself 6 weeks of heat!

5. If I get radiation, do I need chemotherapy?

People often don’t realize the distinction between chemotherapy and radiation. Chemo is all about killing rogue cells that are “out there” floating in the bloodstream, trying to land (or those that have already landed) in a distant organ. Radiation is only about reducing the chances of cancer coming back in the breast, chest wall, or breast skin. Chemo causes hair loss and nausea. Radiation causes skin redness and fatigue. Radiation and chemotherapy target totally different cancer issues — having one therapy does not mean you can avoid the other.

6. Will chemotherapy really help me?

The absolute benefit of chemo varies from one woman to the next. Wouldn’t it be great to know if your cancer really needs to be treated with chemo or not? Well, guess what? We have a new tool to assess how beneficial chemo will be for you, fighting against your cancer. Tests such as Oncotype Dx® and MammaPrint® are valid for Stage 1 and 2 cancers that have not gone to lymph nodes. (Stage 0 never needs chemo.) These tests evaluate the biologic activity of your cancer by measuring a number of different markers that either increase or decrease the likelihood of distant metastases (remember, it’s these metastatic cancer cells that are life threatening and are the target of chemotherapy).

If, for example, the test shows that you have a 30 percent chance of distant recurrence (e.g., cancer showing up in your liver), but if you do chemo, that number becomes 15 percent, wouldn’t you be motivated to do the chemo? On the other hand, if the test shows a recurrence rate of 10 percent and chemo will bring this to 8 percent, maybe that benefit isn’t enough to make you brave baldness.

Ask your surgeon and medical oncologist about these tests to help determine whether or not chemo is “worth it.”

7. How do I best weigh my options?

Arming yourself with information specific to your situation allows you to explore choices. I believe that having a choice about your treatments empowers you, and makes you calmer as you march into battle. Many survivors have chosen different paths, and yet they are all alive.

Team up with your doctors to discuss the pros and cons of each treatment option. Understand how the stage of your cancer, your age, and your family history might make certain choices more appropriate than others. Consider the opinions of your partner, supportive family, and trusted friends. Talk to survivors who have traveled this road before you.

Slideshow: Famous breast cancer survivors (on this page)

Above all, remember this: Your cancer treatment is ultimately a personal decision, and it has to be one you can live with — figuratively and literally.

8. What should I expect?

Expect a struggle. Surgery and treatment can be difficult; you will need a strong support system. Lean on the love of your family, partner and friends.

Expect to grow old! There are two good reasons why we live in a world with over 2.5 million breast cancer survivors: earlier detection, and better treatment options. One thing is for sure: the earlier one catches cancer, the better. The 5-year relative survival rate of Stages 0 and 1 breast cancer is 98 percent! No matter what your cancer stage, every stage has hope.

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Expect to give back! You will be so grateful for your journey that you will want to give back. We need to fund research because that’s how treatment options evolve. Research matters. Find an easy way to support the cause. I like simple programs that raise money for the cause, like Yoplait’s Save Lids to Save Lives, which raises funds through special pink lids on Yoplait yogurt cups for Susan G. Komen for the Cure, an organization that engages millions of citizens in fundraising. Another personal favorite is Pink Lotus Petals, a non-profit I co-founded that provides free breast cancer screening, diagnosis and treatment for low-income, uninsured women. Run a race. If that sounds exhausting, walk a walk. Buy a pink bracelet or ring. Encourage a newly diagnosed friend.

Expect to live! Statistics are just that — statistics. In fact, if you’ve been diagnosed and you’re reading this article now, you’re already a SURVIVOR. Welcome to the sacred sisterhood of survivors — find a sister, share a cup of coffee, and laugh together about how life is beautiful.

Editor’s note: Any ideas and/or suggestions in this article are not intended as a substitute for consulting your physician.

© 2013 MSNBC Interactive.  Reprints

Video: Your breast cancer concerns addressed

  1. Closed captioning of: Your breast cancer concerns addressed

    >>> this morning on daily dose, we're answering your questions on breast cancer , there's a lot of information out there and a lot of confusion about the best treatment options. a breast cancer expert has now released a sixth edition of her breast book. ladies, good morning to you. happy to have you here. 20 years since your book first came out, now in it's fifth edition, what has changed in breast cancer in that time?

    >> it's certainly gotten a lot fatter and things have gotten a lot more complicated. it used to be just radiation and mastectomy. now you have a lot more options. then when we get to the chemotherapy, the hormone therapy , the targeted therapy . so the nib umber of decisions women have to go through are enormous so hopefully we can guide them through it with this book.

    >> there's a lot more confusion and a lot more fear that they might be making the wrong choices but what we're learning is there's different kinds of breast cancer , so if you know what kind you have, you can match the treatment to your kind.

    >> first, lisa on skype from manhattan beach , california. lisa , what is your question? lisa , we're having problems with lisa , can we hear you? i'll tell you what i think her question is, we were able to talk with her before hand and she's asking, she's a survivor of breast cancer , many women are dying of breast cancer per day as was the case 25 years ago, what progress are we really making? what does the future hold?

    >> i think this is the issue, we have been doing breast cancer awareness month for 25 years and'reand we're aware, but we still don't know the cause of breast cancer and how to stop it. we still have 40,000 americans dying of breast cancer , and we have time to stop the complacency and getting back to the urgency of let's find the cause and let's stop it.

    >> do you think we're closer to getting to a cure?

    >> we talk about prevention, we talk about early detection, i think we get those buzz words . but what susan is saying, we have the pinking of america, we have moved the ball forward, but i don't think we're there yet.

    >> we have heather from baltimore sent us a little video clip, let's take a look.

    >> hi, i'm 22 years old and my patternal grandmother had cancer when she was in her 30s but she survived. i have no other history of breast cancer , my question is this, how can i be proactive now to keep myself healthy for the future.

    >> she said her patternal grandmother had breast cancer , she's only 22 years old. should she be checking herself for the gene?

    >> her father should test for the gene, and if he doesn't have it, it's unlikely. but also she should think about avoiding unnecessary radiation, that's one thing. if she has a choice, you want to have your kids at a young age, rather than at an older age.

    >> don't smoke, watch your weight.

    >> but also be aware of your breasts and exercise has shown to reduce the chances of getting breast cancer and of getting a recurrence.

    >> next we have an e-mail from heather, and heather asks, my question deals with mammograms, what is the risk of getting breast cancer from too much radiation exposure ?

    >> there's no risk factors , you can put off screening mammography to the age of 50 and i think it's misinformation because there is a cumulative radiation, if you have no risk factors and you dutifully get your mammogram every year, the reality is you have some radiation.

    >> and particularly in younger women, that the younger breast is more sensitive to the radiation. so from 30 to 40, if you get one every year, you may well cause more cancers than you cure. from 40 to 50, and after 50, definitely you cure more than you cause.

    >> so is it starting at age 35 to 40?

    >> if you have no family history , start at 50.

    >> if you do have a family history , start at 40. see how useful the test is for you and make a decision.

    >> let's get a question from skype, rita. good morning to you, rita.

    >> good morning. i have a question, i was 45 years old, diagnosed with cancer. and i am about 5 1/2 years out. i had chemo, radiation, reconstruction and a double mastectomy. and i'm concerned about the lingering effects of the fatigue, the chemo brain and the body achings.

    >> i think we talk so much -- we don't talk once someone's cure about lingering effects. and keep me brain is something women really talk about.

    >> there's a lot of collateral damage from our treatments and it's something we don't talk about enough from the chemo, you can also have second cancers from the chemo, you can have heart disease from the chemo, you can have problems from radiation, from the surgery. and we have to go beyond the cures to the cause so we don't have to go through all these treatments and we don't

Photos: Famous breast cancer survivors

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  1. Christina Applegate

    For actress Christina Applegate, who was diagnosed with breast cancer in July, there was only one effective way to deal with her fear over her cancer treatment: Let it all out. "Sometimes, you know, I cry," she told "Good Morning America." "And sometimes I scream. And I get really angry. And I get really upset, you, into wallowing in self-pity sometimes. And I think that's all part of the healing." (Phil McCarten / Reuters) Back to slideshow navigation
  2. Dame Maggie Smith

    When the 73-year-old actress Maggie Smith was diagnosed with breast cancer in 2008, it was reported that she insisted on filming her sixth appearance as Professor McGonagall in "Harry Potter and the Half-Blood Prince" even while undergoing radiation therapy. The Academy Award winner had chemotherapy and radiation after having a lump removed. (Dave Hogan / Getty Images) Back to slideshow navigation
  3. Maura Tierney

    Best known for her role as medical resident Abby Lockhart in NBC's long-running hospital drama "ER", Maura Tierney confirmed in July 2009 she had a tumor in her breast and needed surgery. As a result, the actress had to leave the NBC fall drama "Parenthood." Tierney's rep said in a statement to Access Hollywood, "Ms. Tierney and her doctors remain confident that the outcome of her treatments will be positive." (Jason Merritt / Getty Images) Back to slideshow navigation
  4. Betsey Johnson

    After her diagnosis in 2002, designer Betsey Johnson tried to deal with the realities of the disease matter-of-factly, instead of obsessively. "I'm not the type of person who dwells too much on bad things," Johnson told USA Today. "I guess the only thing I've done differently is loosened up the reigns on my company and now I'm enjoying life more." (Bryan Bedder / Getty Images) Back to slideshow navigation
  5. Carly Simon

    Singer-songwriter and '70s icon Carly Simon found that her breast cancer diagnosis in 1997 gave her life a focal point. "I feel stronger and more vital than ever," she told the New York Daily News. "When you actually have a battle, it's better than when you don't know who to fight." (Jim Cooper / AP) Back to slideshow navigation
  6. Cokie Roberts

    Journalist Cokie Roberts' bout with breast cancer only reiterated what she already knew. "I had learned the life lesson that life is short and do the things that are important long before I had cancer," Roberts told Richmond (Va.) Magazine after her diagnosis in 2002. "I knew work is not important, family is, long before I had cancer." (Zack Seckler / Getty Images) Back to slideshow navigation
  7. Cynthia Nixon

    Cynthia Nixon understands the reason many women avoid mammograms: The results could be terrifying. "(T)he only thing to really be afraid of is if you don't go get your mammograms, because there's some part of you that doesn't want to know, and that's the thing that's going to trip you up," the actress, who was diagnosed with the disease in 2002, told "Good Morning America." "That's the thing that could have a really bad endgame." (Rick Maiman / AP) Back to slideshow navigation
  8. Edie Falco

    Actress Edie Falco found the best way to handle her battle with breast cancer was to play it close to the chest -- she even kept her 2003 diagnosis a secret from her "Sopranos" castmates. "I kept my diagnosis under the radar, even from the cast and crew, because well-meaning people would have driven me crazy asking, 'How are you feeling?'" Falco told Health magazine. "I would have wanted to say, 'I'm scared, I don't feel so good, and my hair is falling out!' "I bucked up, put on my Carmela fingernails, and was ready to work." (Peter Kramer / AP) Back to slideshow navigation
  9. Hoda Kotb

    At times, the best way for Hoda Kotb to deal with the disease was to not deal with it. "Sometimes when things are way too big and I can’t control it, I do sort of a weird thing where I kind of check out a little bit,” she told Ann Curry on the "Today" show after her 2007 diagnosis. “It’s all about self-preservation for me. I couldn’t read the books. I didn’t Google it once. It’s like someone telling you what it’s like to jump out of a plane. I don’t want to know. I just want to jump.” (Stan Honda / AFP - Getty Images) Back to slideshow navigation
  10. Jaclyn Smith

    Diagnosed with the disease in 2002, Jaclyn Smith has this advice for anyone facing breast cancer: Don’t go it alone. "I believe in the power of girlfriends," Smith told Prevention magazine. "I believe that family and friends, and especially other women, can make a profound difference during cancer treatment." (Kevin Winter / Getty Images) Back to slideshow navigation
  11. Nancy Reagan

    After her breast cancer diagnosis in 1987, former First Lady Nancy Reagan chose to have a mastectomy. It was a controversial decision for the time, and although she received much criticism for it, she defended her choice. ''I couldn't possibly lead the kind of life I lead, and keep the schedule that I do, having radiation or chemotherapy,'' Mrs. Reagan said in a 1987 interview with Barbara Walters. ''There'd be no way. Maybe if I'd been 20 years old, hadn't been married, hadn't had children, I would feel completely differently. But for me it was right.'' (Robyn Beck / AFP - Getty Images) Back to slideshow navigation
  12. Olivia Newton-John

    Soon after Olivia Newton-John learned she had breast cancer in 1992, she began calling friends and family to tell them the news. "The second friend I called burst into tears, and I thought, 'I don't need this,'" she told CNN."So I had a sister and friends make the calls. That way I could focus on positive thoughts, instead of on the illness." (Ted Aljibe / AFP - Getty Images) Back to slideshow navigation
  13. Kylie Minogue

    Doctors initially misdiagnosed the breast cancer of Kylie Minogue, the Australian pop singer has said. Her condition was finally correctly identified in 2005. She had surgery to remove the lump, followed by chemotherapy. The 40-year-old singer is currently in remission and is preparing for her first U.S. tour for the fall of 2009. "It's amazing how many people are affected by cancer and it's definitely something that stays with you and you have a lot to think about and your life changes," she told the Associated Press. "I feel very fortunate." (Chris Jackson / Getty Images) Back to slideshow navigation
  14. Robin Roberts

    At first when she returned to work as a co-anchor for "Good Morning America," Robin Roberts wore a wig -- until one morning in April, when she abandoned it on-air. "I am not my hair," said Roberts, who was diagnosed with the disease in 2007. "I am the soul that lies within and that's it -- no more wig. That's it." (Neilson Barnard / Getty Images) Back to slideshow navigation
  15. Peggy Fleming

    The power of positive thinking helped ice skating icon Peggy Fleming win her battle against cancer after she was diagnosed in 1998. "I do remember the dark sides, but I try not to dwell on them," the Olympic gold medalist told the "Today" show. "There's nothing I can do about them anymore. I can change the future. I can't change the past." (Vince Bucci / Getty Images) Back to slideshow navigation
  16. Sheryl Crow

    After her diagnosis in 2006, Sheryl Crow surrounded herself with positive, uplifting people. "I think encouragement always goes a long way," the singer told CNN. "It is so scary ... but having the positive support of loved ones is invaluable." (Charles Dharapak / AP) Back to slideshow navigation
  17. Melissa Etheridge

    Somewhere along the road to becoming disease-free after her 2004 diagnosis, Melissa Etheridge knew she had to start removing the cancer in every area of her life. "I've changed my lifestyle," she told "Dateline NBC." "I have taken what I consider poisonous things out of my life. Out of my food, out of my work, out of my social circle, out of everything. Because I want a clean, cancer-free life. And I believe I can have that." (Kevin Winter / Getty Images) Back to slideshow navigation
  18. Suzanne Somers

    Three years after her diagnosis in 2000, actress Suzanne Somers went on "Larry King Live" to talk about her experience with the disease. "I look at everybody differently. I look at every child differently. I look at every flower differently," Somers said. "I'm grateful for every day. ... (I)t's like before and after. Once you've had (cancer), you just appreciate everything." (Evan Agostini / Getty Images) Back to slideshow navigation
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