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Topic: Recommendation of oncologist at Princess Margaret or Sunnybrook

Forum: Canadians Affected by Breast Cancer —

Canadian health care, clinical trials, and life in general in the north.

Posted on: Mar 26, 2021 06:39PM - edited Mar 31, 2021 08:59AM by pchyen

pchyen wrote:

Wife may have breast cancer, waiting to find out biopsy result, and we are preparing to try and get referrals to either Princess Margaret or Sunnybrook. Does anyone have recommendations of oncologist and surgeon at either hospitals? Thank you


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Mar 26, 2021 06:51PM Beesie wrote:

If you can get in to see him, I'd recommend Dr. McCready at PMH. He's the head of the breast centre and their most senior breast surgeon, so I'm not sure of his current availability. If your wife's biopsy is being done somewhere else, I don't think PMH will take the referral until the diagnosis is confirmed. At PMH, once your wife has a surgeon, the surgeon will set up the appointment with the MO either prior to surgery (if necessary based on the biopsy diagnosis) or after surgery (for a more simple early stage diagnosis).

When did your wife have her biopsy? And what did the imaging say about the area of suspicion? Was it highly likely to be cancer? Most biopsies (70%-75%) turn out to be benign but obviously some biopsies are more concerning and higher risk than others.


Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Mar 26, 2021 07:23PM pchyen wrote:

@Beesie, thank you so much for fast reply, didn’t think I would get a response until tomorrow.

Biopsy was done on Wednesday at Waterloo Wellington breast clinic. Was told result will be 5-7 business days. The surgeon at the breast clinic suspects Paget’s disease and imaging shows a large tumor ~6cm. Wife is 40 yrsold. If it is Paget’s disease caused by an underlying cancer I think PMH or Sunnybrook would be our choice for treatment.

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Mar 26, 2021 08:14PM Beesie wrote:

pchyen, if you don't live in Toronto, I don't know if PMH will accept a referral. They do accept patients from anywhere, but this is usually for cases that are complex or that can't be adequately treated somewhere else. For more standard diagnoses, I think in the past they might have accepted patients from outside Toronto but I don't know if they do that anymore - there is just too much demand. A couple of years back I recall someone from Hamilton who had a recurrence and wanted to get a second opinion at PMH but they didn't accept the referral.

I don't know about Sunnybrook but they may have the same policy. Of course there is no harm in having your doctor send in the referral but be prepared that it might not be accepted.



Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Mar 26, 2021 08:31PM pchyen wrote:

Thanks Beesie. We live in Milton, wife was from KW area and kept her family doctor in KW. Best hope is that the biopsy shows no cancer. Will update when we have more info.


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Mar 30, 2021 09:13AM Shar2020 wrote:

Pchyen, I hope your wife gets a good result and does not have cancer.

However, if needed, I will second Beesie’s recommendation for Dr. McCready. Everyone I know gives glowing reviews about him. I requested a referral to him last year when I was diagnosed, but he was not accepting new patients at that time because of pandemic restrictions and changes. Dr. Wey Leong at Princess Margaret is very good.

At Sunnybrook, Dr. Clare Holloway is outstanding.

Dx 6/1/2020, IDC, ER+/PR+, HER2+
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Mar 30, 2021 11:53AM - edited Mar 30, 2021 06:49PM by pchyen

Thank you Shar for the well wishes and recommendation. Still waiting for results but my wife's family doctor has sent out the referral forms. Hopefully Dr. McCready has opening


Peter

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Mar 31, 2021 09:15AM pchyen wrote:

Quick update: bone scan done yesterday came back clear, no uptake anywhere, that’s a bit of good news. Still waiting for biopsy results, local general surgeon booked a follow up next week to review results.

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Mar 31, 2021 11:25AM Beesie wrote:

A bone scan was ordered prior to a breast cancer diagnosis? That's unusual... they often aren't done even after a diagnosis. Great news that it was all clear!

If you have to stay local with the surgeon, if you have not already done so, look up the surgeon on-line to see his or her areas of specialty. "Breast Surgeon" is not an official designation, so many surgeons who specialize in breast cancer surgery use the title of General Surgeon or Surgical Oncologist. By looking at a surgeon's info on-line, you can see whether they specialize in breast surgery versus truly being a "general" surgeon. It's preferable to have a surgeon who focuses on breast cancer surgery, maybe not exclusively but primarily, and/or did a fellowship in breast surgery.


Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Mar 31, 2021 11:35AM pchyen wrote:

Hi Beesie, We pushed for whole bunch of scans done. It’s lesson learned and taught by a good late friend of ours that we need to advocate for ourselves and push hard to get what we want. Our late friend passed away from BC reoccurrence just recently and did make a few critical mistakes along the way(too long of a story).

We are still looking to go to PMH with the referral. The consult with the local surgeon is to review biopsy results. Did look up the surgeon and he is not a breast cancer focused surgeon (much like our late friend’s surgeon)


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Apr 5, 2021 07:44AM - edited Apr 5, 2021 08:23AM by pchyen

Just heard back from the family doctor who got the pathology report. Not the news we wanted to hear. IDC and it is in the lymph node(s).


Edit: Just got the report ER-/PR-/HER2+. Not going to be a fun ride with that report

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Apr 5, 2021 08:22AM Beesie wrote:

I'm sorry to hear that your wife has been diagnosed.

It is normal for the pathology lab to test for ER, PR and HER2 but sometimes it takes a bit longer to get those results, particularly the HER2. Without that information, you really can't go forward even with surgery because depending on the ER,PR and HER2, in some cases chemo will be recommended prior to surgery.

I hope that your wife is able to get into PMH - I really don't know if they will accept patients from outside of the city of Toronto unless there are circumstances which require their expertise.

Please keep us in the loop.

Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Apr 5, 2021 08:24AM pchyen wrote:

just got the report. ER-/PR-/HER2+. From my limited reading... Looks like chemo first

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Apr 5, 2021 08:30AM Beesie wrote:

Yes, I agree that it's most likely chemo first, given the hormone status and the positive node. So rather than a surgeon, your wife needs to see a Medical Oncologist. Surgeons operate; MOs are responsible for everything else.


Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole
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Apr 7, 2021 03:51PM - edited Apr 7, 2021 03:55PM by pchyen

An update: wife has an appointment at PMH next Monday at 1:30pm with Dr. McCready.

CT scan is clear.

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Apr 7, 2021 06:19PM Beesie wrote:

Great news on the CT scan. And good that your wife got the appointment!

Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole

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