How to Make Hard Choices Under Pressure After Breast Cancer Diagnosis

Written by Keri Wiginton
Medically Reviewed by Poonam Sachdev on September 16, 2025
9 min read

If you’ve just been diagnosed with early-stage HR+/HER2- breast cancer, know that you almost always have some breathing room. 

“Understandably, patients feel a tremendous emotional urgency to start treatment immediately or to get the cancer out,” says Rachel A. Greenup, MD, co-director of the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center in Connecticut. “But even in cases of high-risk disease, it is safe to wait a few weeks to make good decisions prior to starting treatment.”

You’ll meet the main doctors who’ll guide your care. They usually include a surgeon, a medical oncologist, and sometimes a radiation oncologist. Together, you’ll map out what’s next.

“For most people, surgery is the first step,” Greenup says. “That usually takes place within three to four weeks of diagnosis.”

You may need a lumpectomy (removing the tumor and some surrounding tissue) or a mastectomy (removing the whole breast).

If breast reconstruction is part of your plan, that can mean extra scans or consults. In some HR+/HER2- breast cancers, chemo might be given first to shrink the tumor before surgery.

Your doctor may also go over national benchmarks that help keep care on track, such as:

  • Surgery within two to three months of biopsy 
  • Chemotherapy or radiation within about three months of surgery
  • Hormone therapy soon after chemo or radiation ends

Why do these milestones matter? Research shows that starting treatment within these windows lowers the chance of the cancer spreading or coming back. Accredited cancer centers use these agreed-upon standards for specific types of cancer, and you should ask your doctor if they’re following them. 

You may feel like this is way too much to take in all at once. But Hatem Soliman, MD, a medical oncologist specializing in breast cancer at Moffitt Cancer Center in Tampa, Florida, says you don’t need to plan the whole path right away.

“I paint a high-level picture of the overall journey, and then refocus attention on the decision at hand,” Soliman says. “I’ll tell patients, ‘This is the next step we need to take together. Let’s table the other 70 until later.’” Breaking the process into small chunks makes it easier to move forward. 

Cancer survivor and licensed psychologist Jordie Poncy, PhD, agrees. He says it helps to think of treatment as an ongoing process, not a one-time choice. 

“You have to learn to adapt to a lack of certainty,” says Poncy, who also works for Moffitt Cancer Center. “And to let go of the pressure to make a right or wrong decision.”

You may wonder why your doctor isn’t telling you exactly what to do. It’s not because they’re unsure. It’s because your values and goals matter.

“The whole process of shared decision-making is not to burden patients,” Greenup says. “It is to make decisions about cancer treatment a collaborative process, and to help them feel empowered to participate.”

Some people want their doctor to be clear and say, “Here’s what I’d recommend.” Others like to do research or get another opinion before deciding. And yes, second opinions come up often. Poncy stresses they’re standard. 

“Every provider should support that unless it’s a true emergency,” Poncy says.

Ultimately, establishing relationships with providers who understand your decision-making style is key.

“If there’s a mismatch, that’s going to be really tough,” Poncy says.

Your team may suggest genetic testing early on. This looks for inherited changes (mutations), such as BRCA1 or BRCA2, that raise the risk of breast or ovarian cancer. Results can also shape treatment. For example, some people with BRCA mutations choose surgery on both breasts (also called a mastectomy) over a lumpectomy.

Guidelines recommend testing if you’re under 50, have a strong family history, or meet other criteria. Your doctor can tell you if you qualify.

“Patients should never be shy about asking for genetic testing as part of their care,” Greenup says.

If you want kids in the future, it’s best to discuss before starting treatment. Chemo and hormone-blocking drugs can affect fertility. A reproductive endocrinologist can explain options such as egg or embryo freezing, which often takes about two to three weeks to complete. Men and people assigned male at birth may want to consider sperm banking.

Sooner is better, but you can bring up family planning at any point.

“It’s never too late to meet with a fertility specialist — at any stage — if that’s important to you,” Greenup says.

After you’ve talked through the usual treatments, it’s smart to ask about trials. Some start early, even before your first round of care. And they’re not just for people who’ve run out of options or have advanced disease. Some are just for those with early-stage HR+/HER2- breast cancer.

“I advise my patients to think about a trial at every fork in the road,” Soliman says. “If you have a decision point like X or Y, ask if there’s a Z, which might be a clinical trial.”

If the idea makes you nervous, know that you’ll always get real treatment. Breast cancer trials typically compare the best-known care with that care plus a new option.

“You’re not getting a sugar pill,” Soliman says.

Alongside medical care, you may also need to adjust parts of daily life. For some, that means stopping or changing hormone-based meds, such as birth control or hormone replacement therapy. Your doctor will guide you if that applies.

Lifestyle choices also include how you care for your mental health. You may worry about the role stress plays in your illness. Timothy Pearman, PhD, director of supportive oncology for Robert H. Lurie Comprehensive Cancer Center in Chicago, hears this often.

“People come in and say, ‘I got divorced and lost my job before I was diagnosed.’ But I tell them breast cancer doesn’t work that way. That’s not why you got this,” Pearman says. 

Cancer is a major life change, and it’s normal to feel anxious. The key is not to add more pressure by stressing about stress. Letting go of guilt and blame also frees you to focus on healthy habits that can support your body during treatment and recovery.

Greenup notes her top tips: Stay active, quit smoking, limit alcohol, and eat well. But don’t cut calories.

“Nutrition is critically important for healing after surgery and keeping the immune system strong during chemo,” Greenup says.

Exercise may be one of the best tools you have. Doctors usually want you to keep it up throughout treatment. Research shows that women who exercised during chemo had less fatigue, better fitness, and improved quality of life, even years later. Ask your doctor what’s safe for you.

“I really encourage people to maintain an exercise regimen if they have one, or start one brand new if they’ve been sedentary,” Pearman says.

A breast cancer diagnosis doesn’t just affect your health. Treatment, relationships, finances, and even your day-to-day routines can all change at once. Here are some of the choices you may face:

Who to tell and when. Some people lean on family, friends, or colleagues right away. Others share more selectively. “I encourage people to kind of bubble wrap themselves a little bit, and share their cancer diagnosis with their trusted circle without feeling like this needs to be public news,” Greenup says.

How to manage work or school. You may need time off for surgery, recovery, or ongoing treatment. Social workers can help with medical leave, disability, or insurance details. Larger employers often have HR or disability teams. In smaller workplaces, you may need to explore your rights under the Americans with Disabilities Act (ADA).

Roles for your support team. Think about the kinds of help that would make life easier, then match those needs to people who can step in. Who can cover meals? Childcare? Insurance paperwork? Your social circle also matters. Some days, you may want advice, company, or simply a listening ear.

How to let go of stress. Find a safe place to process what you’re going through. Many people protect loved ones by holding back, but bottling stress isn’t good for your health. Talking with a therapist or friend can give you space to release those big feelings. “Emotions need motion,” Poncy says.

Hearing the words “You have breast cancer” can feel like the ground just shifted beneath you. Fear often comes first: fear of dying, how your body might change, and what this means for your identity. It helps to pause before you act.

“Allow yourself time to feel that shock and grief,” Poncy says. “Then lean heavily into self-compassion. Tell yourself: This is really hard, this is really scary. All I can do is my best.”

Poncy suggests these tips to avoid “analysis-paralysis.” 

  • Use trusted resources such as the National Comprehensive Cancer Network (NCCN) guidelines or the National Cancer Institute.
  • Focus on how treatment fits with your goals and needs.
  • Write down all your worries and go over them with your doctor.
  • Look for things that get you out of your head, such as exercise or a hobby.
  • Talk to a licensed mental health professional who focuses on cancer, sometimes called an onco-psychologist.

A licensed mental health professional can help you figure out which techniques work best for you. For example, cognitive behavioral therapy (CBT) can teach you how to identify unhelpful thoughts and reframe them more realistically. 

Many centers offer decision aids, like booklets, videos, or online guides, which can be useful. National groups like the American Society of Breast Surgeons’ SHAIR Collaborative also offer free resources online.

Peer support can make a big difference, too. Local or national cancer programs, such as Imerman Angels, can pair you with someone going through a similar situation.

“You can tell them who you are and what your diagnosis is, and they will match you to mentors with similar lives,” Greenup says. “My patients have found that really reassuring.”

Above all, don’t let anxiety rush you. “People make better decisions when they feel calm,” Greenup says. “There is time to choose the treatment that is right for you.”

Everyone’s path looks different, but here’s a general timeline with key questions to ask your doctor at each stage. Use this as a guide, not a rigid checklist. And remind yourself that you don’t have to have every answer on day one.

First few days after diagnosis

  • Process the diagnosis. Allow space for shock and grief.
  • Ask your doctor which decisions are urgent and which can wait.
  • Begin building your support team. 

One to two weeks after diagnosis

  • Meet your cancer care team. Review biopsy and imaging.
  • Discuss surgery options. Ask how long you have before you need to decide on surgery.
  • Ask if you need treatment before surgery if you decide to move forward.
  • Ask about genetic testing. 
  • Ask about resources for support (job, insurance, financial, mental health). 
  • Consider getting a second opinion.

First month after diagnosis

  • See a fertility specialist before treatment if you want to have children.
  • Ask about clinical trial opportunities. 
  • Schedule surgery or pre-operative therapy.
  • Keep a running list of questions. 
  • Create roles for your support network. 
  • Ask if you can be connected with peer support or a mentor. 

Two to three months after diagnosis

  • Follow up with an oncologist to plan next steps (chemo, radiation, hormone therapy).
  • Start hormone-blocking therapy after surgery/chemo if needed.
  • Expect to see your doctor every two to three weeks. 
  • Ask if you’ll need chemo after surgery, and why or why not. 
  • Ask when hormone therapy should begin?

Four months and beyond 

  • Continue hormone therapy or radiation if needed.
  • Revisit lifestyle habits and survivorship care.
  • Continue meeting with mentors, support groups, or a therapist.
  • Ask what your survivorship care plan should include.