What I Wish I Knew About the Emotions in Managing Early-Stage Breast Cancer

Approximately 266,000 people are diagnosed with breast cancer in the U.S. each year. Most of these people are diagnosed with early-stage breast cancer, meaning the cancer has not spread beyond the breast or nearby lymph nodes.

Stephanie Bernik, MD, the chief of Breast Service at Mount Sinai West in New York City, manages people with early-stage breast cancer. Dr. Bernik told Health that emotions can be high when working with her patients—both for the people she treats and herself. “I’m very emotionally attached to my patients,” she said. “I became a doctor because I want to help people.”

But medical school didn’t cover much about managing the emotional side of working with people with early-stage breast cancer, according to Dr. Bernik. Instead, she had to pick up those skills along the way. Here’s what she wishes she had known earlier about the emotional aspect of her job. 

What do you wish you had known about the emotional toll that managing patients with early-stage breast cancer would take on you?

Stephanie Bernik, MD: With time, you get a little better at managing this. I used to sometimes walk out of a room and cry. Now, I won’t say that I don’t get upset—I’m still very emotionally attached to my patients—but I have a little more control. 

You know people can do well, and you’re unsure of the prognosis when you’re younger. As you’re in the field more, you see people who don’t end up doing well, but you do know that most are going to be fine. You learn to transfer that feeling of hopefulness. 

Some medical schools are now incorporating that into their training, but we didn’t have that when I was in school.

My husband is a physician as well and, if I have a case that’s really weighing on me, I have someone to talk to. I also have a great team at work I can talk to. It’s not so easy to compartmentalize when you have a case where you know someone may not do well.

What do you wish you had known about having to reveal an early-stage diagnosis to a patient?

Dr. Bernik: I’ve learned that you can be upset for a patient but, at the same time, you have to present the positives. In today’s world, we have so many treatments, and most people do really well. 

Early on in practicing medicine, you almost focus on the gravity of the possibility of a person not doing well instead of focusing on the fact that they likely will do well. Our treatments are now better, we’re able to be less aggressive with chemotherapy. Things on the horizon look really good with breast cancer, and I try to stress that to my patients.

What do you wish you had known about helping your patients with early-stage breast cancer make the emotional decision between breast-conserving surgery and mastectomy?

Dr. Bernik: With time, you develop a better understanding of how to do this. It’s important to shift the conversation to the personality of the patient. Some patients don’t want to hear the negatives—they just want to hear the positives. You can then slant your discussion in that way. Other patients want to know the worst-case scenario and make their decision based on that. The patients really guide you—you just need to learn how to shape your conversation based on their needs and present the information in the best manner for them. 

It’s a very emotional time, and it’s very hard to talk to [people who] potentially have to lose their breast. Some patients don’t want any change, and that’s understandable. It’s a part of their body that’s visible and tied to sexuality. It’s understandable to be upset about that. You have to put yourself in their position to an extent and try to really understand what they’re going through.

What do you wish you had known about discussing prognosis with these patients?

Dr. Bernik: I’ve learned that you have to take your life experiences and bring them to the table. You’re also dealing with different personalities. I’ve learned to be open to asking patients, ‘How can I help you through this?’ Sometimes they need to tell you what they need. Early on, I didn’t know that it was OK for a patient to tell me what they need from me. I don’t always know. I’m still learning—that’s the bottom line. You have to still be learning, because no one knows it all. You can learn from every patient.