When I started practicing Medical Oncology 30 years ago, the Internet had yet to be born. Patients listened to our recommendations, thanked us, and accepted their treatment trusting we knew what we were doing.

I specialize in breast oncology.  It is a full-time job keeping up with new biologic findings of this disease and the new drugs which have been developed. It has also become more challenging discussing treatment options with patients trying to incorporate them as part of the treatment team.

Mrs. T comes in to discuss her new breast cancer diagnosis. After spending an hour with her, painstakingly discussing treatment options and the reasons for my recommendations she states, “I will research this over the weekend and get back to you next week with my decision”. “Wow,” I thought. “So, I didn’t need to spend almost half a million dollars and 15 years in school?”

Mrs. O comes in for a second opinion after progressing through her first line treatment for metastatic breast cancer. I give her my treatment recommendations and reasoning. She wants to think about it and return next week. Upon return, she hands me an article outlining the study for which I had based my treatment recommendations. “There was this trial” she explains “where the drugs you recommended were studied. Perhaps you’ve heard of it.” “If I haven’t,” I replied, “you are in big trouble.” 

I also incorporate genetic counseling in my practice. My daughter called me one day to ask to have testing done. “Why do you think you need that”? I asked. She had been watching Keeping up with the Kardashian’s where one grandmother who had breast cancer was tested and found to be BRCA positive. The show went on to view how the rest of the family reacted to this. Being Jewish and having my mother with a history of breast cancer, my daughter was convinced she needed testing. 

Mrs. L comes into my office the next day and asks about genetic testing. When I started to discuss the show on the Kardashians, she got extremely excited and said, “Yes, it’s right here on my phone” and pulled up the episode.

There have been such advances in breast cancer, particularly in metastatic disease with the development of immunotherapy, biologics and mutations driving treatment decisions. Understanding that patients will go online, I try to counsel them about the most reliable websites. I also try to educate myself on what is going in the lay literature, so I am well informed about what my patients are seeing. 

Competition with the Internet for medical information is a constant struggle. And one I do not always win. 

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