Local vs Mayo for treatment or both?

@kimmccastle

Welcome to Mayo Connect. Where to go for which treatment depends on individuals. I know people who have done opposite, gone Mayo for initial evaluation and surgery and then have follow-up treatments like chemo at home.

Can you tell us more about your situation,
What type breast cancer do you have and the type surgery your considering?
Do you know what post surgery treatment plan is?

In 2019, when I was first dx w/Breast Cancer, I chose a major cancer center, good reputation for breast cancer, recommended by my PCP over the local hospital program. I still see them for my followup visits. I had other issues w/ a possible/probable kidney cx/mass and some cloudiness on my lung, likely following radiation. The same big cancer center wasn't so great in the kidney/lung area, so eventually I moved my Kidney Active Surveillance to a local hospital with a new cancer center; the lung issue I had looked at at the same local hospital with a new cancer center and now both of those are followed locally. The breast cancer is still followed at the major center.

My thoughts (then and now) were that I wanted to choose the BEST program for the cancer I knew I had. So for my Breast Cancer, I have stayed with the major facility and am very pleased with my care there.

For the other issues, it wasn't so great, so I switched to a local cancer center and that has worked out better.

What, IMHO, is the critical piece is that each of us, as a cancer patient, need to feel that we are comfortable and secure in knowing that the care we are getting is the BEST, and sometimes that may mean going to different facilities.

I developed lymphedema in my right arm after mastectomy and NOTHING helped. Compression, Therapy, Losing weight, exercising . . . my arm/hand continued to swell no matter what and it was only getting worse. I ended up finding out from my husband's co-worker who had a friend with lymphedema - same situation only in her leg, not getting better, etc - and she had surgery. No On Ever Mentioned Surgery for Lymphedema to me! After talking to her, I looked nationally for specialty cancer surgeons who performed lymphedema surgery (few and far between) and chose to visit an out of state facility (town where my son live) and that is where I had my surgery and continue to have my lymphedema managed and monitored.

So, it is good to make sure that you feel comfortable that you are getting the BEST care for each and every part of our bodies/cancer/treatment. I learned during my stay at Hope House during radiation (facility to live in at certain centers while getting chemo/radiation and live too far to commute) from other cancer patients who had many recurrences, surgeries, etc. that searching out the BEST facility for EACH condition was critical. Being good with Breast Cancer was no guarantee that the same center would be good with Kidney Cancer! When I asked if the facilities were OK with this and the patient told me "THIS IS EXACTLY WHAT DOCTORS WHO GET CANCER DO!" At that moment I "got it" . . . didn't need to make any changes then, but over a 5+ year window I have been able to negotiate changes when needed and fell confident that each and every member of MY team ( at 3 separate centers) make up MY Best Team Ever for my very complex medical condition(s).

Unless you have a fast growing cancer, you have time to make this decision. Before you have to travel a long distance to get treated, get a second opinion at the Mayo Clinic. At the very least, you will find out that what they would do is exactly the same thing as they would do in Louisville. If that is true, you have just saved yourself the expense of travel and housing while you go through cancer treatment. You will also have peace of mind, knowing your doctors in Louisville are provideing the same care you would get at Mayo Clinic. On the other hand, if you learn that Mayo Clinic suggests something different, then you can make the decision about going to Mayo Clinic.
A second opinion is always a good idea. Best wishes!

The one issue I see with doing surgery at one facility and changing medical care to another facility is that the breast tissue belongs to the first facility. Yes, they will share all findings, at your request, and even send the pathology tissue to the new facility for confirmation of cancer. But the tissue will be returned to the original facility. Sometimes a surgical hospital does not have the ability to do the intricate testing* the oncology facility can do if further testing is needed.

Maybe you could discuss the issue of pathology, testing, tissue handling with your local surgeon to assure that these issues can be managed?
It is important to manage your stress throughout it all, so do consider where it would be best for you to have it done. Which things stress you most? Location? Being in your own home? Medical efficiency?

For me, I was more stressed about how it was all done - and less stressed by not being at home.
I had my breast biopsy at a local facility. I did my surgery, reconstruction, oncology, and follow up survivorship and scans 3 1/2 hours away at a cancer center. After surgery I stayed in a nearby hotel for 3 nights - in the financial scheme of things I decided the extra cost would probably be minor considering the scope of it all. In some ways the hotel was easier. I focused on being comfortable (lots of pillows), not cooking, taking walks, no home-related concerns, and being minutes from the surgical care, if needed. We did need to kennel the dog and have a friend check on the cat - but there was plenty of time before the surgery date to set that all up.

* examples: p63, ecadherin, myoepithelial cells, Ki-67, immunohistochemistry
This is one of the most comprehensive lists of a variety of testing on breast cancer pathology that I’ve seen, although there are now probably new genetic tests to add to it:
https://www.sigmaaldrich.com/US/en/technical-documents/technical-article/clinical-testing-and-diagnostics-manufacturing/diagnostic-immunohistochemistry/immunohistochemistry-applications-breast-cancer

Ruby slippers.
Thank you for posting that link. Breast cancer pathology and genetic testing completely altered the original plan i was on. I read from a few people that they were put on letrozole to shrink their tumor? I did not know that is done. The Tustin Longevity Center in California is an Integrative Medicine Facility and one of the doctors said in a weekly U-Tube podcast that she does not believe estrogen has a bearing on breast cancer.
Once we open the door of our cancer journey, we find there will be many areas of treatment to explore.

I live in a big city with lots of healthcare options. I went to a local surgeon and did not feel at ease with her at all. I then flew to Mayo in JAX and met with Oncologist and surgeon. I was so impressed and felt so at ease with them. I ended up having my surgery at Mayo and have NO regrets. So professional and so well educated.

I had surgery, chemo and radiation in my local city but when I didn't feel my oncologist was helping me enough with my adverse side effects to the hormone blockers I switched to Dana Farber in Boston. Like meeshodge I was have been very impressed and far more comfortable with the staff their. It is a long trip for me but well worth it. Like you found at Mayo in JAX, I have found the Dana Farber to be patient centered and the staff highly professional. My only regret is that I didn't ask for a second opinion soon into my cancer care.

I got excellent care at the "big moment" -- but when it came to treatment after the surgery (stellar surgeon btw), chemo and radiation, I switched to Dana Farber in Boston for next steps, which in my case included Tamoxifen for only two years and an AI for an additional 8 years (age 69 at diagnosis, ILC Stage IIIc [5 tumors, 10/16 nodes diseased). It also included 3 years of Zometa in an effort to pull out all the stops. Last week (October 17) was my 5 year anniversary (marking initial treatment ending with the radiation). So grateful! I really feel like once the initial surgery and treatments are done it is important not to relax our concerns in getting the most effective post treatment care available.

Congratulations on being five years out! I agree with you about switching centers to get "most effective post treatment care available"

@kimmccastle, have you decided to consult with Mayo Clinic?