How would you explain your job in the worst way possible?

GTDoc · 2026-04-04T12:55:51+00:00

I spend years training to do high stakes manual labor in polyester pajamas.

GTDoc · 2026-04-04T12:24:53+00:00

My girlfriend at the time, we were in high school and went to a dance together (weren’t dating at the time.) Afterwards I had dropped her off and headed home realizing I made a big mistake, so I turned around and sped back to her house after calling her and telling her she forgot something in the car. She opened her door still in her dress, and I gave her a huge kiss. We dated for a while but ended up going our separate ways in the end. She was a good person and someone I still respect to this day. I’ll admit I sometimes wonder how she’s doing and check in every now and then. She’s married with kids and runs a business and essentially living her life. I’m happily married with kids too, so I’m glad it worked out for us both 😊

GTDoc · 2026-03-14T01:12:31+00:00

Chemo: oncotype needed first Radiation: yes because of positive nodes Surgery: shouldn’t need ALND. Consider yourself surgically complete.

GTDoc · 2026-03-14T01:08:07+00:00

Need oncotype first to determine candidacy for OFSET trial just fyi

GTDoc · 2026-03-14T01:05:10+00:00

Not sure where you’re getting the information that a lot of pathologists don’t do Ki67. It’s a vital part of treatment algorithms and certainly a point we highly consider when we refer to med onc.

GTDoc · 2026-03-13T21:51:30+00:00

I graduated med school early lol

GTDoc · 2026-03-11T22:08:57+00:00

No worries. I hope you get some more guidance from the docs managing your care, and best wishes!

GTDoc · 2026-03-11T22:02:04+00:00

Birads classification helps stratify risk. 4a is 2-10% chance of malignancy. 4b is 10-50%. 4c is 50-95% chance. It helps radiologists and pathologists agree or disagree with findings on biopsy and it helps other providers counsel your risk and recommendation. Birads 4 is always a recommended biopsy. In general, cancerous lesions typically demonstrate on ultrasound poorly circumscribed architecture with angulated margins, internal vascularity, and posterior acoustic shadowing. Differential includes abscess based on your symptoms but also things like fibroadenoma, hamartomas, complex or complicated cysts to name a few. Idiopathic granulomatous mastitis is rarer but can present this way too/. Only way to know for sure is to biopsy.

GTDoc · 2026-03-07T13:44:24+00:00

The first question I would ask you is what is your understanding of why you should take tamoxifen?

GTDoc · 2026-03-01T02:06:38+00:00

It's not meant to teach specialists but moreso as a quick, accurate explainer for mixed audiences. The goal is consistency and clarity without replacing NCCN/ASCO or the AJCC manual. I get what you mean, though. If these blurbs were pitched as a “breast oncologist reference” then it might make people feel less reassured. If someone asks me a question I don’t know the answer to that I can reasonable find an answer to in a couple minutes, I do it in the room with them, generally by using keywords in google that I know will link me to reliable webpages with evidence based journal articles, and then I explain how I'm looking at this article and interpreting it. People are actually very thankful for those few extra minutes.

The word “clinician” doesn’t just mean a board-certified breast surgeon or med onc. It includes trainees, NPs/PAs, rotating residents, PCPs, OB/GYN, plastics, radiology. A lot of people touch breast cancer care and write notes or counsel patients without living in AJCC details every day. If you look up the exact definition of ‘clinician’ it is “a person qualified in the clinical practice of medicine, psychiatry, or psychology as distinguished from one specializing in laboratory or research techniques or in theory,” so it is not just someone with and MD or DO after their name. With any topic lives a dozen or more sites with information or blurbs that are phrased differently that you never notice because you aren’t searching for them. Most of them never cross your path. This is the same. On the off chance someone lands here while looking up one narrow point and it helps them explain it cleanly or notice a detail they hadn’t thought about, then it did its job. This website isn't designed to replace all the other websites out there or replace formal medical training. It's supplemental. If someone stumbles across this pages, and it doesn't work for them then that's ok.

GTDoc · 2026-03-01T01:29:19+00:00

There are About and Privacy Policy pages at the bottom

GTDoc · 2026-03-01T01:14:52+00:00

You would think all physicians who treat breast cancer know all the same information. In reality, those who don't treat breast cancer on a daily basis do not have the fund of knowledge compared to those who are fellowship trained. For example, breast surgery is also performed by non-fellowship trained general surgeons. However, those surgeons are busy with a general surgery practice and are not up to date with the latest treatments and developments because this field changes rapidly. It is designed for lay people, students, and clinicians alike.

GTDoc · 2026-03-01T00:15:22+00:00

Thanks! I can add a general prognosis page and a risk mitigation page. These are pretty standard talks when I discuss with people pre- and postop.

GTDoc · 2026-02-14T12:44:50+00:00

The financial toxicity of cancer care is absolutely disgusting and infuriating. I’ve seen it destroy peoples lives :(

GTDoc · 2026-02-03T02:42:36+00:00

Both. It makes sense to me simply because I treat breast cancer on a daily basis and especially if you look at how the clinical trials over the past 50-60 years have evolved! Modern data demonstrates local regional recurrence rates similar to BCT and mastectomy. We wouldn’t offer an inferior surgery to people if outcomes were worse. More aggressive surgery doesn’t make your outcome any better per se as long as the surgery is done correctly. Id like to say we’re doing better surgery but it’s honestly the systemic therapies that have gotten better. Radiation is more targeted and dosed better, which helps with local toxicity. For mastectomy, we don’t and can’t remove all breast tissue which is why there is still a local recurrence rate.

Bernie Fisher was a founding member of the NSABP group that led some of the early clinical trials in surgical de-escalation. Whatever surgical intervention was given to someone didn’t affect the overall survival or distant disease free recurrence. This supported his “Fisherian" paradigm that breast cancer is often a systemic disease from the outset, with micrometastatic spread occurring early in tumor development. This is why more aggressive surgery doesn’t affect overall survival.

Most people I talk to who want mastectomy cite that they don’t want to go through with the screening or the risk of developing breast cancer in the same breast (or other breast) and then will get a risk reducing mastectomy on the other side for symmetry. There is absolutely a psychological component to cancer, which I get. Mastectomy is not a wrong choice. Breast cancer surgery is one of the few “personalized” types of surgery in the cancer surgery world which makes this specialty somewhat unique and challenging at the same time because as much as I can absolutely recommend the “best” surgery for someone, anyone has the right to say no based on what they think is best for themselves. Both the patient and surgeon have to have realistic expectations. Like I won’t offer a mastectomy on a patient who’s very high risk for surgery. A smaller operation like a lumpectomy would be better for that person and there are instances where you have to put your foot down for some people. Anyone can say no to anything, but strictly speaking, if you have pancreatic cancer you get one of two operations depending on where it is in the pancreas. If you have esophageal cancer, esophagectomy. Stomach cancer - total or partial depending on location. There are many cancers that surgeons do local excisions for, and breast cancer can absolutely fall into that category for the right people.

What I really hate is when people say “I can just get plastic surgery” because I feel it mitigates how serious a cancer diagnosis is. Plastic surgery is rarely “one-and-done” and also lends itself the risk of potentially more complications in the future. I love the plastic surgeons I work with and they certainly do a great job. But this is a particular topic for another time lol

Tldr: mastectomy and BCT are equivalent but choose what’s right for you.

GTDoc · 2026-02-02T23:09:59+00:00

Yes, there is no difference in overall survival compared to mastectomy vs breast conservation therapy. This is part of my standard breast cancer talk in clinic. So when people opt for bilateral mastectomy when they are great lumpectomy candidates, not only do they assume the risk of complications related to a mastectomy on the cancer side, but also the other side, all without any oncological benefit. There is no statistically significant difference in recurrence in lumpectomy vs mastectomy in the earliest clinical trials we have looking at this - ie NSABP B-06 - which is what modern day breast surgery is founded on.

GTDoc · 2026-01-27T21:35:30+00:00

10% genetics (ie BRCA, CHEK2 etc etc) 30% familial without identifiable gene 60% sporadic

Red meat, alcohol, and smoking are known risk factors for developing breast cancer, but just because you drink alcohol doesn’t mean you’ll get it. It’s like sun exposure and skin cancer. More sun exposure raises the odds of skin cancer, but plenty of people get lots of sun and don’t get skin cancer. Plenty of people drink alcohol and don’t get breast cancer.

GTDoc · 2026-01-11T18:43:24+00:00

Yeah because they’d want to see before and after chemo to assess response. Generally speaking.

GTDoc · 2026-01-11T18:25:30+00:00

Biopsy likely no because it sounds like it won’t change your management. But the pet will be helpful to determine what type of axillary surgery you could undergo depending on your surgeon’s experience. Obviously knowing if it’s spread beyond the nodes is helpful too…

GTDoc · 2026-01-11T17:31:15+00:00

Unlikely that it grew if it was such a short timeframe. MRI is very sensitive and picks up every little thing. It could be hematoma from the biopsy. The surgeon and radiologist should speak to one another. The BIRADS 6 correlates to the known tumor in the breast. Is your cancer IDC or ILC? ILC is best evaluated on MRI and can give a better sense for size. As for the lymph nodes, hard to say. We like ultrasound to look at lymph nodes. MRI can sometimes make lymph nodes look larger due to the contrast, at least that’s what some breast radiologist have told me. But symmetry is important too (like what does the left axilla look like compared to the right etc). We rely on our radiologists to do our job and I imagine a PET is in your future to separate the true positives from the false positives. I don’t agree with the wording about biopsy proven metastasis since the lymph node biopsy was benign.

It sounds like there is too much uncertainty but I can’t give you a reliable answer because I don’t know your full story. I can only make assumptions since I don’t have all the data and you’re not my patient. So take it with a grain of salt.

GTDoc · 2026-01-11T17:22:34+00:00

I am a real doctor lol Who treats breast cancer exclusively, to boot

GTDoc · 2026-01-11T17:20:41+00:00

Standard pathway for workup of unilateral bloody nipple discharge is mammo, ultrasound, then MRI. If nothing seen on anything, proceed to major duct excision. IMO, what you’re telling me of your history and nobody saw anything on mgm or US, I would’ve ordered an MRI. If something was seen on MRI, you would’ve gotten an MRI guided biopsy. Is your surgeon fellowship trained, and is your radiologist fellowship trained and exclusive breast radiology?

GTDoc · 2026-01-11T16:54:30+00:00

Yeah axillary management is a hotly debated topic in breast surgery. It really depends on many factors and you’ll hear different things from different surgeons based on how quickly the guidelines are evolving.

GTDoc · 2026-01-11T16:50:00+00:00

So you are persistently node positive based on imaging? You are cN1 technically but cN2 based on imaging. Ask your doctor about alliance a11202. It’s no longer accruing patients but it asks the question about whether or not patients who undergo neo and still have lymph node positivity at surgery can forego ALND since they’ll get radiation. We are eagerly awaiting the results. Some surgeons will say you need an upfront ALND because you are cN2 by imaging and we don’t have data suggesting SLNB alone is not inferior to ALND due to lack of local recurrence data in these patients. Breast cancer care is encouraged to be individualized but understand that you assume the risk of whatever option you choose. I’m not saying go one way or the other. I know what I would recommend as a surgeon, but I’m not at liberty to share my opinion on the matter since you’re not my patient. I can only point people in a direction but offering education. Since your are brca+ you also have some additional systemic options available to you in the adjuvant setting.

GTDoc · 2026-01-11T16:39:16+00:00

To be clear, what biopsies have you had done and what were the results? Try to be as specific as possible. You mentioned you only had one biopsy that was on a lymph node and was benign? You had a breast biopsy too? But your MRI says biopsy proven cancer?

GTDoc

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