It is one of the most common and deadly cancers among women worldwide. According to the World Health Organization, breast cancer caused 685 000 deaths worldwide in 2020.
In order to improve survival and quality of life for breast cancer patients, early detection and treatment are crucial. However, many women face barriers to accessing timely and affordable treatment, such as lack of awareness, stigma, cost, distance, or inadequate health care systems.
For a fixed monthly fee, direct primary care (DPC) provides personalized, comprehensive, and accessible health care to patients. Since DPC practices do not accept insurance or third-party payments, they can reduce administrative burdens and focus on providing patient care.
DPC can offer several benefits for breast cancer patients, such as:
DPC practices can provide regular breast exams, mammograms, genetic testing, and risk assessments for breast cancer. They can also teach patients how to perform self-exams and recognize warning signs. Besides advising patients on maintaining a healthy weight, exercising regularly, limiting alcohol consumption, and avoiding tobacco use, DPC doctors can also advise them on lifestyle changes that can reduce the risk of breast cancer.
Diagnosis and treatment: DPC practices can facilitate timely diagnosis and referral for breast cancer patients. Ideally, they can coordinate with specialists, oncologists, surgeons, radiologists, pathologists, and other healthcare providers. A DPC doctor can also assist patients in navigating the complex and sometimes confusing process of choosing the right treatment options for their breast cancer type and stage. Additionally, DPC doctors can monitor the effectiveness and side effects of treatments such as surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy.
In addition to breast cancer survivorship and follow-up, DPC practices can provide regular physical examinations, mammograms, blood tests, and other tests to check for recurrence or metastasis of the disease. Also, they can help manage the chronic or late effects of breast cancer or its treatment, including menopause symptoms, sexual dysfunction, bone loss, heart problems, cognitive impairment, lymphedema, pain, fatigue, depression, anxiety, or post-traumatic stress disorder. Patients can also benefit from DPC doctors' support in coping with the emotional and social impact of breast cancer on their self-image, relationships, work, and daily activities.
Some of the benefits that DPC can offer for breast cancer patients are:
You spend more time with your doctor: DPC practices typically have fewer patients than traditional practices, so they can spend more time with each patient. As a result, you will be able to talk to your doctor about your breast cancer for longer periods of time and more frequently. The doctor can also be reached by phone, email, text message, or video chat whenever you need him or her.
Personalized care: DPC practices can customize their care to meet your individual needs and preferences. You can have more input and control over your health care decisions if your doctor gets to know you better as a person rather than only as a patient. You can also collaborate with your doctor to design a personalized treatment plan that meets your goals and values.
DPC practices can offer more affordable breast cancer care by eliminating insurance fees and overhead expenses. You can pay a flat monthly fee that covers most primary care services. A doctor can also offer lab tests, imaging studies, medications, procedures, or referrals at discounted rates by negotiating direct contracts with other providers. A traditional health care setting often involves surprise bills or hidden charges.
The following hypothetical scenarios illustrate how DPC can provide personalized breast cancer management for different patients:
Scenario 1: Mary is a 45-year-old woman who has a family history of breast cancer. She has been a member of a DPC practice for two years. She visits her doctor every six months for a physical exam and a mammogram. Her doctor also performs genetic testing for BRCA1 and BRCA2 mutations that increase the risk of breast cancer. The test results show that Mary has a BRCA1 mutation. Her doctor explains the implications of this finding and discusses the options for risk reduction, such as prophylactic mastectomy, oophorectomy, or chemoprevention. Mary decides to undergo a bilateral mastectomy with breast reconstruction. Her doctor coordinates the surgery with a trusted surgeon and plastic surgeon and provides preoperative and postoperative care. Her doctor also monitors her recovery and adjusts her hormone replacement therapy as needed.
Scenario 2: Anna is a 35-year-old woman who notices a lump in her left breast during a self-exam. She contacts her DPC doctor, who sees her the same day. Her doctor performs a clinical breast exam and orders an ultrasound and a biopsy of the lump. The results confirm that Anna has invasive ductal carcinoma, a common type of breast cancer. Her doctor explains the diagnosis and the staging of the cancer, which is stage II. Her doctor also performs molecular testing of the tumor to determine its hormone receptor status and HER2 status, which are important factors for choosing the best treatment. The test results show that Anna has estrogen receptor-positive, progesterone receptor-positive, and HER2-negative breast cancer. Her doctor discusses the treatment options with Anna, which include lumpectomy with radiation therapy or mastectomy with or without reconstruction, followed by hormonal therapy for five years. Anna opts for lumpectomy with radiation therapy. Her doctor arranges the surgery with a reputable surgeon and the radiation therapy with a skilled radiologist. Her doctor also prescribes tamoxifen, a hormonal therapy drug that blocks the effects of estrogen on breast cancer cells. Her doctor follows up with Anna regularly to check her response to treatment and to manage any side effects or complications.
Scenario 3: Lisa is a 55-year-old woman who has been diagnosed with metastatic breast cancer that has spread to her bones and liver. She has been receiving chemotherapy and targeted therapy for six months at an oncology center, but her cancer is not responding well to treatment. She feels exhausted, nauseated, and in pain most of the time. She joins a DPC practice to receive palliative care and support. Her DPC doctor works closely with her oncologist to coordinate her care and to ensure that her treatment goals are aligned with her wishes. Her DPC doctor also provides symptom relief and comfort measures, such as pain medication, antiemetics, nutritional supplements, and complementary therapies. Her DPC doctor also helps Lisa cope with the emotional and spiritual aspects of living with terminal cancer. Her DPC doctor also helps Lisa plan for end-of-life care, such as hospice care, advance directives, or funeral arrangements.
Millions of women worldwide are affected by breast cancer, a serious and life-threatening disease. There are several benefits to a DPC model of health care delivery for breast cancer patients, including prevention and screening, diagnosis and treatment, survivorship and follow-up, more time with your doctor, more personalized care, more affordable care, and more peace of mind. Depending on the risk factors, type and stage of cancer, treatment options, goals and values, symptoms and complications, and end-of-life preferences of each patient, DPC can provide personalized breast cancer management. In addition to physical aspects of breast cancer, DPC can also address emotional, social, and spiritual aspects of the disease.
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