I get asked about this a lot. The mission of the oncology team is to ensure that you get the appropriate treatment that will get rid of the tumor and reduce your risk of getting cancer again. But sometimes a patient can make choices that make this outcome harder to achieve.

Here are two scenarios that would be considered overtreatment:

• Your doctor informs you that you're a good candidate for lumpectomy but you want a mastectomy; that is, you want to be rid of every trace of breast tissue, when in fact only a small portion of it needs to be surgically removed.
  
• Your doctor tells you that your tumor type puts you in a gray area as far as needing chemotherapy. A "gray area" means that the six to eight months of chemo may only add 1 percent to your survival curve, while filling those months with severe and long-lasting side effects. You sign on for the full eight-months' worth.

These two would be considered undertreatment:

• Your doctor tells you that you must have radiation after lumpectomy but you refuse, insisting that, because the surgery removed all the cancer from the breast, radiation isn't necessary. She then tells you that, without the radiation, your odds of having the cancer return within two years are 40 percent. You don't believe her.
  
• Your doctor says that the best way to prevent recurrence is to take hormonal therapy in the form of tamoxifen. You take it for three months, detest the side effects, and stop taking the medication without even calling your doctor to discuss it.

Will those who ask to be overtreated actually live longer? Maybe. Will those who are undertreated shorten their lives? Maybe not, but undertreatment may significantly increase their risk of recurrence over the coming years.

I was with a young woman recently who three years ago was diagnosed with locally advanced breast cancer. She had surgery, refused chemotherapy, and went a holistic route. She now has stage IV breast cancer, is angry as heck, and wants to be cured. Sadly, that is no longer in the cards for her. Palliative treatment and end-of-life preparations will now be the agenda.

The message here is that your care providers do want you to participate in the decision-making about your treatment, but at the same time they want you to become extremely well-informed about all the possible medical consequences, should you choose not to take the advice of the breast cancer oncology experts.

You are not an expert. You need to make informed, wise decisions because, once you have made and implemented them, you won't be able to rewind the tape of your life and do them over.

So empower yourself with information. Get second opinions. Then choose wisely and confidently.