The Breast Cancer Program
Specializing in breast cancer, focusing on you.
Breakthroughs in breast cancer are being made everyday. The progress over the last decade has been tremendous. Treatments that were once considered impossible are now saving lives as a matter of course.
CentraState’s breast cancer experts are keeping pace with this progress. They provide the most advanced treatment options for breast cancer along with the ongoing care and support you need to stay strong—body, mind and spirit.
Breast Cancer Symptoms
Knowing the signs of breast cancer and detecting them early can help increase a person’s survival rate. The increased use of mammograms has increased the number of breast cancers found before they cause symptoms, however no screening tool can provide one hundred percent accuracy. Therefore, it is important to also be aware of the signs of breast cancer:
- A new lump or mass (a lump that is painless, hard, and has uneven edges is more likely to be cancer, but some breast cancers are tender, soft and rounded)
- Swelling of all or part of the breast
- Skin irritation or dimpling
- Breast pain, nipple pain, or nipple turning inward
- Redness, scaling or thickening of the nipple or breast skin
- A nipple discharge other than milk
- A lump or swelling under the arm, which could indicate breast cancer has spread to the lymph nodes, even before the tumor is large enough to be felt in the breast
Many patients find early signs of breast cancer by being proactive and diligent about their clinical breast exams, mammograms, and breast self-exams.
Early signs should NOT be ignored and should be checked by a physician as soon as possible.
Breast Cancer Risk Factors
It’s important to note: Having a risk factor for breast cancer, or even several, doesn’t mean that a person will get breast cancer. Some people who have one or more breast cancer risk factors never get the disease. And many people who do get breast cancer don’t have any risk factors. Some breast cancer risk factors have a greater impact than others, and your risk can change over time because of, for example, aging or lifestyle. The following are risk factors for breast cancer:
Gender—Being a woman is the main risk for getting breast cancer, though men can get breast cancer as well.
Age—The chance of getting breast cancer increases with age. Two out of three women with invasive breast cancer are 55 or older when the cancer is found.
Genetics—About five to 10 percent of breast cancers are possibly connected to inherited changes (mutations) in certain genes.
Family history—Breast cancer risk is higher among people whose close blood relatives have this disease. The relatives can be from either the maternal or paternal side of the family. Having a mother, sister or daughter with breast cancer about doubles a person’s risk. However, keep in mind that over 85 percent of women who get breast cancer do not have a family history of this disease.
Personal history of breast cancer—A person with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (recurrence).
Race—Caucasian people are slightly more likely to get breast cancer than African-American women. Asian, Hispanic, and Native American people have a lower risk of getting and dying from breast cancer.
Dense breast tissue—People with more gland tissue and less fatty tissue have a higher risk for breast cancer because it’s harder for physicians to detect problems on mammograms.
Combined hormone therapy (HT)—Use of combined hormone therapy (progesterone and estrogen) after menopause increases the risk of getting breast cancer. It also increases the risk of dying from breast cancer. Five years after stopping HT, the breast cancer risk seems to drop back to normal.
Lifestyle—Poor diet, lack of exercise, being overweight, smoking and alcohol appears to increase risk.
Breast Cancer Diagnosis & Staging
If screening tests indicate that you could have cancer, the next step is to have a biopsy. During this test, cells from the area of concern are removed so they can be studied in the lab.
There are several types of biopsies. Your physician will determine which one is best for you. Biopsies are performed at The Star and Barry Tobias Women’s Health Center at CentraState by specially trained radiologists or surgeons and an all-female team of nurses and clinicians.
Stereotactic Needle Biopsy (STNB)
STNB is a core biopsy that uses X-rays and computer coordinates. STNB procedures are performed in an outpatient setting using local anesthesia. During this procedure, small samples of tissue are removed for analysis using a hollow needle. This diagnostic procedure is less invasive, less painful, and less costly than traditional surgical biopsy.
Breast Needle Localization
Prior to surgery, a radiologist localizes the area in the breast to be biopsied by inserting a guidewire. The guidewire “hooks” around the area to be biopsied. The patient is then immediately transported to the Operating Room, where the surgeon makes an incision following the guidewire and accurately excises (removes) the targeted tissue.
Ultrasound-Guided Breast Biopsy—This type of biopsy is useful when suspicious changes are detected through mammograms and ultrasounds, but no abnormality can be felt during an exam. The procedure is minimally invasive and involves no exposure to radiation. It is performed in an outpatient setting, and takes less time than a traditional surgical biopsy.
Sentinel Lymph Node Biopsy—A sentinel lymph node biopsy is a way of pinpointing the first few lymph nodes into which a tumor drains (called the “sentinel” node). This helps doctors remove only those nodes that are most likely to contain cancer cells, since the sentinel nodes are the first place cancer is likely to spread. It also helps to alleviate the need for additional nodes to be removed if the sentinel node is negative.
Lab results are analyzed to determine if the tissue is benign (non cancerous) or cancerous. If it is cancer, then the biopsy can help define what type of cancer it is and whether or not it is invasive.
Other clinical tests may be needed to determine the stage (extent) of the cancer. For example, is it confined to the breast or has it spread? Once the stage is determined, an appropriate treatment plan can be developed.
Breast Cancer Treatment
Surgical Options for Breast Cancer:
- Breast Conserving Surgery—With this type of surgery, the breast is not removed.
- Lumpectomy—This surgery removes only the breast lump and some normal tissue around it.
- Partial (segmental) mastectomy or quadrantectomy—This surgery removes more of the breast tissue than a lumpectomy.
Radiation treatment is usually given after both of these surgeries. If chemotherapy is also going to be used, the radiation may sometimes be planned for after the chemo is finished. Also, in both lumpectomy and partial mastectomy, if cancer is found at the edges of the tissue that was removed, the surgeon may need to go back and take out more tissue.
For most patients with Stage I or II breast cancer, breast-conservation therapy (lumpectomy/partial mastectomy plus radiation therapy) works as well as mastectomy. Survival rates of patients treated with these two approaches are the same.
- Mastectomy — Mastectomy is surgery to remove the entire breast. All of the breast tissue is removed, sometimes along with other nearby tissues.
- Simple (also called total) mastectomy—In this surgery, the entire breast is removed, but not the lymph nodes under the arm or the muscle tissue beneath the breast. Sometimes both breasts are removed. For some patients who are planning on having reconstructive surgery right away, a skin-sparing mastectomy can be performed. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. Although this approach has not been used for as long as the more standard type of mastectomy, many patients prefer it because there is less scar tissue and the reconstructed breast seems more natural.
Another option for some patients is the nipple-sparing mastectomy. This procedure is more often an option for patients who have a small early stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple.
- Modified radical mastectomy—This surgery involves removing the entire breast and some of the lymph nodes under the arm.
- Radical mastectomy—This is a major operation where the surgeon removes the entire breast, underarm lymph nodes, and the chest wall muscles under the breast. This surgery is rarely done now because modified radical mastectomy has proven to work just as well. It may still be done for large tumors that are growing into the muscles and under the breast.
- Reconstructive or breast implant surgery—After having a mastectomy (or some breast-conserving surgeries) a patient may want to have the breast mound rebuilt. These operations are done to restore the way the breast looks. If you are having breast surgery and are thinking about having breast reconstruction, we can arrange for you to talk to a plastic surgeon before your operation.
Radiation Therapy for Breast Cancer
Therapeutic Radiation approaches for breast cancer include EBR, brachytherapy, mammosite, and prone breast radiotherapy.
External beam radiotherapy (EBR)
Uses a special machine (linear accelerator) to deliver high doses of radiation to the site while limiting exposure to healthy tissues and organs and minimizing side effects.
- 3-D conformal radiotherapy
- Intensity-modulated radiation therapy (IMRT)
- Image-guided radiation therapy (IGRT)
Internal radiation which includes High Dose Rate (HDR)
Places the radiation source inside the lumpectomy cavity (the space left when the tumor is removed). This delivers radiation to the area where the cancer is most likely to recur. This therapy is highly targeted, so you can be done with radiation in five days versus several weeks. It is an outpatient procedure.
Prone breast radiotherapy
Women are positioned on their stomachs during radiation therapy to minimize potentially unnecessary radiation to the heart and lung.
Proton therapy can be used to treat non-metastatic breast cancers that are stages I—III after mastectomy or lumpectomy.
Radiation therapy is administered at CentraState’s Karen Olbis Radiation Oncology Center. Our Radiation Oncology Center has earned full accreditation by the American College of Radiology for expertise in Radiation Therapy.
The center is fully equipped with state of the art equipment, plus highly trained and experienced physicians, physicists, dosimetrists, therapists and oncology certified nurses
Chemotherapy for Breast Cancer
Chemotherapy uses medicines that kill or halt the growth of cancer cells. This approach is generally used in three ways:
- Adjuvant chemotherapy—Chemotherapy is given after surgery to patients whose cancer does not appear to have spread.
- Neoadjuvant chemotherapy—Chemotherapy is given to patients before surgery to help shrink large cancers so they are small enough to be removed by lumpectomy instead of mastectomy.
- Chemotherapy for advanced breast cancer—Chemotherapy can also be used as the main treatment for women with cancer that has already spread outside the breast and underarm area at the time it is found, or if it spreads after the first treatments.
Chemotherapy is provided at the Jean Mehr Infusion Therapy Center offered through CentraState Medical Center’s Pharmacy Department and administered by Magnet-designated nurses credentialed in chemotherapy and certified in cancer care.
Clinical Trials for Breast Cancer
Some patients may be eligible to participate in breast cancer clinical trials in which they receive an emerging breast cancer treatment before it becomes publicly available. Talk to your oncologist or surgeon to learn more. You may also want to speak with your cancer navigator.