Timeline After Breast Cancer Diagnosis

Receiving a breast cancer diagnosis can create many feelings and emotions. Since some breast cancer diagnoses come with a bleak outlook, it’s common to want to start a treatment plan as soon as possible.

This article is designed to give you a comprehensive understanding of which factors play a role in your prognosis and what you should expect in the coming days, weeks and months following your diagnosis.

What happens after you are diagnosed with breast cancer?

Once your doctor confirms you have breast cancer, there are several steps they take to determine how fast it is spreading, the stage, the grade and which hormones are affected.

Breast cancer tumor grade

Following a mammogram, your medical provider will take a biopsy of breast tissue to analyze the tumor.

Doctors give cancer cells a grade to help them determine how fast the cancer is growing. Three features are graded and added together to get a score between 3 and 9. 

• Grade 1: A score of 3, 4 or 5 means the cells are growing slowly.
• Grade 2: A score of 6 or 7 means the cells are growing moderately.
• Grade 3: A score of 8 or 9 means the cells are growing quickly.

Signs breast cancer has spread

Your doctor may use several imaging tests to determine if your cancer has spread. An ultrasound, CT (computerized tomography) scan or MRI are the most common tests to see if cancer has spread to other organs. You may also receive a chest x-Ray to see if the cancer has reached your lungs. 

For more advanced imaging, your doctor can order a PET (positron emission tomography) scan in which a radioactive sugar travels through your body before images are taken where the sugar collects. Similarly, a bone scan uses a radioactive substance to determine if cancer has spread to your bones. Bone scans can pick up cancer cells that may not show on other scans.

However, it is not uncommon to not need any additional imaging to check for tumor spread. You should work with your doctor to decide which imaging, if any, is best.

Hormones involved in breast cancer

The presence — or absence — of the hormones estrogen, progesterone and HER2 are critical in determining how to treat breast cancer.

Patients who test positive for these hormones often have a better prognosis because the cancer is easier to treat. The treatment involves hormone-blocking drugs that help stunt the growth and shrink cancer cells. In some cases, patients are negative for all three proteins, known as triple-negative breast cancer.

Breast cancer stages

Cancer stages are based on a scale of 0 through IV, with 0 being a positive prognosis and IV used to signify aggressive forms of cancer.

The staging helps doctors determine your outlook and how they can treat it. Three main factors help determine the stage: the size of the tumor, if it’s spread to nearby lymph nodes and if it has spread to distant sites.

Stage 0 breast cancer is also known as carcinoma in situ. In situ means “in its original place,” so carcinoma in situ is considered non-invasive because it hasn’t spread beyond the milk ducts.

Stage IV breast cancer is also known as metastatic breast cancer, meaning the cancer has metastasized and spread to other organs such as the brain or liver.

How long after cancer diagnosis does treatment start?

In general, most breast cancer treatments should start soon after a diagnosis. What does soon mean? This depends on the type of cancer, how aggressive it is, if additional testing is needed and if you plan to seek a second opinion.

A few days or a week may go by without treatment as your doctors put a plan in place. If this occurs, you may feel antsy and wonder if those lost days will cause your cancer to spread. Most cancers grow slowly, though, so waiting a short amount of time won’t typically alter the outcome.

How soon after a breast cancer diagnosis should you have surgery?

Breast cancer surgery is often the first course of treatment. In some cases, your doctor may recommend chemotherapy first (called neoadjuvant chemotherapy) to help shrink larger cancer cells.

Surgery should come within a few weeks of diagnosis. Research shows the sooner you receive surgery, the better the overall prognosis. For example, a study showed women ages 15 to 39 who had surgery within two weeks had a 84 percent five-year survival rate compared to a 78 percent five-year survival rate for women who waited six weeks or more until surgery. Overall, the optional time for surgery after diagnosis is less than 90 days.

Lumpectomy, mastectomy and lymph node removal are three common surgical procedures to treat breast cancer. A lumpectomy is a breast-conserving procedure in which only a part of the breast that contains cancer cells is removed. A mastectomy removes the entire breast. Some women also undergo a double mastectomy to remove both breasts.

How long is chemo for breast cancer?

Chemotherapy is often administered after surgery (called adjuvant chemotherapy) to remove any undetected breast cancer cells. Chemotherapy can also help reduce your risk of the cancer returning.

Chemotherapy should usually be given within 30 days of surgery and less than 120 days from the initial diagnosis. One study showed women who started chemotherapy two months after surgery had a 19 percent lower chance to survive compared to women who began chemotherapy a month after surgery.

Treatment comes in cycles that can occur once a week or once every three weeks. Following a period of recovery, this process can continue for up to six months. Women with more aggressive forms of cancer may receive chemotherapy for longer than that.

Not all stages of cancer require chemotherapy. Depending on the results of pathology from surgery, your doctor will decide the best plan for adjuvant treatment. You may also be a candidate for hormonal therapy.

How soon after breast cancer surgery do you start radiation?

How soon you start radiation depends on if you need chemotherapy. Radiation after surgery usually begins in three to eight weeks. For women undergoing chemotherapy, radiation will start about a month after. 

Depending on your prognosis, radiation can last for days or weeks. Many patients will receive daily treatment (Monday through Friday) for five or six weeks. However, women who don’t need radiation for lymph nodes may receive less than a month of radiation. Partial-breast radiation may last only a week.

Why you shouldn’t delay treatment

Being proactive with your health is important for many reasons, especially when it comes to breast cancer. Diagnosing cancer at an early stage will provide you with a better prognosis, as will receiving treatment in a timely manner.

A recent study from the Cleveland Clinic found an increase in survival rates when breast cancer treatments were completed within 38 weeks from diagnosis. Research for the study, which included more than 28,000 patients, found people who completed treatment within 38 weeks had a 90 percent five-year survival rate compared to an 83.3 percent five-year survival rate for people whose treatment lasted longer than 38 weeks.

Of course, sometimes delays in treatments are uncontrollable. You may need to schedule many appointments before treatment can begin, such as seeing a surgical oncologist or a medical oncologist followed by a radiation oncologist when it comes time for radiation.

Contact the INTEGRIS Cancer Institute if you or a loved one was recently diagnosed with breast cancer and want to learn more about the available treatment options. If you suspect you may have breast cancer or want to schedule a mammogram, call 1-855-MY-MAMMO (1-855-696-2666).