Something can be done! This is a difficult problem, but it is possible to deal with it. A program can be devised that will help. Breast cancer is certainly not an illness one would choose to have, but it does respond to treatment. The most productive attitude for both the doctor and the patient is to approach the illness with a determined and optimistic pragmatism. After the shock, faced with the knowledge that you have breast cancer, you have to be as smart as you can be. First, consider again whether the doctor who has presented you with the diagnosis is the right one to continue taking care of you. At this point, many insurance companies require a second opinion, before any further surgery. Even if your policy does not have that restriction, you should consider whether you want to seek that second opinion.

Find someone whose attitude, skill, and compassion allow him to say to you, verbally or through his reputation and demeanor, "I care about you. I am here to help you. I can do it well. There is hope."

You should feel, after your search, your consultation, and your deliberation, "You are the one I have decided to trust. I will participate in all decisions, but I want you to be my ombudsman, an expert with whom I can share the responsibility for evaluating and treating my illness." If you cannot enter into a relationship with a doctor feeling confident about both those declarations, look elsewhere.

Some of the considerations here are psychological, some medically significant. Whichever factors you want to assess, you should move with all deliberate speed - but you should not, even at this point, rush into a hasty decision.

A sensible goal is to have treatment under way within three to four weeks after diagnosis. Is it dangerous to wait that long? The answer is straightforward: Though growth rates for different types of breast cancer can vary, there is no evidence of a measurable change for any of them in a period of three or four weeks.

If you have selected a surgeon and then are told he cannot operate for a week or two, that is probably fine. Most surgeons will try to schedule your procedure as soon as possible. Excellent surgeons are bound to be busy, but it is almost certainly worth waiting a short time for a surgeon with both superior technical skill and sound judgment.

In fact, there is a tricky point to consider: If a breast specialist can take you right away, it is legitimate to wonder if he is busy enough to be the right person for you. Surgeons who have excellent track records, judgment, and experience are almost certain to have crowded schedules, and will rarely be able to operate immediately. Under most circumstances, they are also worth waiting for, not only because, in the language of the trade, they know "how to cut," they also know "what to cut."

Scheduling an operation may also take a little longer if two surgeons are needed, as when reconstruction is done immediately after a mastectomy. Nonetheless, getting through the waiting period, or the period in which you are making your choices and decisions, can be very difficult. Some women rush to action. They want to get the whole thing over with, to get the cancer out of their bodies as quickly and thoroughly as possible. Other women can get stuck in conflicting advice, getting so much information that they unnecessarily complicate what might otherwise be a fairly simple procedure.