Minimise patient anxiety and provide options – Dr. Andrea Behr explains how

Throughout Breast Cancer Awareness Month we're speaking to a number of people who've been affected by breast cancer, hearing about their personal experiences and the breast cancer issues they feel passionately about.

Anxiety is something that affects a large amount of women diagnosed with breast cancer, with research showing that in some cases, up to 70% of patients experience overwhelming fear and stress.

We spoke with Dr Andrea Behr MD, a breast surgeon at SSM Health in St Louis to understand what we can do to reduce this anxiety – particularly against the backdrop of COVID-19 – and why access to treatment options plays such a significant role.

Q) What would you say to women feeling anxious about finding a lump in their breast?

AB: I think that there is always a lot of anxiety around feeling a lump in your breast or having an abnormal mammogram. But get in for that exam with a breast surgeon or get that biopsy scheduled – the majority of the time it will turn out not to be breast cancer.

Getting that answer, rather than delaying things or hiding, can really calm your fears and let you just go back to your normal life knowing that you’re OK.

AB: It’s certainly extremely stressful and very scary, and my priority is to get the patients into my office as soon as possible.

Once you’re able to sit down and talk about where you stand with your diagnosis, what stage you are and what your options are – which more and more are becoming vaster options for patients to choose from – they’re more comfortable.

I think a lot of that anxiety can be calmed after that first visit with your doctor.

Q) What are some of the treatment options you can now offer patients?

AB: Well historically we only had one option to offer, which was a mastectomy – and that did not include reconstruction.

Fortunately, now we have many options for patients, which still does include the mastectomy but also includes the option of offering reconstruction with a plastic surgeon. We also have the option of breast conservation or lumpectomy.

It’s important for people to understand – and it is a big portion of what we do talk about when we’re going over surgical options – is that the survival outcomes are the same for breast conservation as they are for mastectomy.

"So women can keep their breast and know that they're being treated just as appropriately as if they were to do a mastectomy or a double mastectomy."Dr Andrea Behr MD, Breast Surgeon at SSM Health

Q) How important is the cosmetic outcome, alongside the oncology outcome?

AB: The oncological treatment is the priority. We need to get the cancer out and be safe. But now we can often do that using different localizing devices through a hidden scar, which means that you don’t have a scar right over your tumor, wherever that may be.

We can hide the scar under the breast or around the areola or even up in the armpit. So you virtually can’t tell that you had surgery after a hidden scar lumpectomy, which is really nice to not have that reminder that you had to have that breast cancer surgery when you’re cancer free and just living your normal life.

Q) Which techniques do you offer to help reduce anxiety for patients on the day of surgery?

AB: The priority is to shorten the amount of time that they have to be there and to just get it done in the morning and get them back to the comfort of their own home.

We used to have patients arrive multiple hours before their surgery in order to have devices placed so that we could find the tumor in the operating room, as well as injections that allow us to identify the correct lymph nodes to remove.

Now with devices like Magseed and Magtrace, we eliminate that need for that early arrival. We can have a patient show up to the hospital and an hour later they’re in the operating room. And then an hour after their operation, they’re on their way home.

Q) What impact has COVID-19 had on both your practice and patient processes?

AB: We increased our already robust cleaning techniques and sterilization process and made things a lot safer in the operating room as well. Because in a time like this, we have to keep our breast cancer patients safe and we have to get them through treatment just as we would have during the pre-COVID era.

I think we all recognize that the only way to catch up on the time that we lost is to extend ours. So in particular, our breast center has extended its hours so that we can safely space out patients and catch up on those that did not get scheduled when they were supposed to be. And in the surgery office, we make the space and  find the room.

"We get patients in so that we can get them treated just as we would have before the COVID era."Dr Andrea Behr MD, Breast Surgeon at SSM Health

Q) Is it possible that by the end of this year you'll have treated as many patients as you did in 2019?

AB: That’s a really interesting question and it won’t depend only on the hours that we make ourselves available. It will depend on the comfort of patients in coming in to get mammograms because the majority of our breast cancer is detected through screening mammograms.

We want people to feel safe. We want them to get screened. We don’t want them to fear that they will get COVID by coming in for a mammogram. But in all honesty, it’s safer to come in for a mammogram than it is to be going to the grocery store.