Breast Cancer

 

Overview

When you are treated for breast cancer at UofL Brown Cancer Center, you benefit from the expertise of Kentucky’s first and longest-accredited program by the National Accreditation Program for Breast Centers - experience and expertise you will not find elsewhere in the city or region.

Our Multidisciplinary Breast Cancer Clinic includes top physicians dedicated to breast cancer treatment. Included are medical oncologists, surgeons, plastic surgeons and radiation oncologists who specialize in the treatment of breast cancer and collaborate on each patient to ensure treatment is the most up-to-date and appropriate for the best outcome.

Unlike elsewhere in the region, our doctors concentrate specifically on breast cancer, and therefore are able to offer the most up-to-date, personalized treatment options.

All breast cancer patients have their care coordinated among the physicians in our multidisciplinary breast cancer clinic. Our dedicated mammographers are skilled in the latest screening technology, and physician-directed ultrasound ensures the most accurate and least-invasive diagnostic options.

Our specialty trained pathologist’s level of expertise allows both in-depth diagnosis and the ability to identify specific genetic and pathological features that guide the team toward the most effective, targeted and least-invasive treatment options possible.

Our skilled plastic surgeons offer multiple reconstruction options, using innovative procedures that focus on quality of life. A specially trained support team, including nurses, dietitians and therapists, helps ensure personalized, coordinated breast cancer care.

Special clinics focus on caring for patients with particular needs, including women with inflammatory breast cancer and young women (HER program).

We also have extensive expertise in treating breast cancer during pregnancy and helping women preserve fertility after breast cancer treatment.

The Brown Cancer Center breast team includes top physicians dedicated to breast cancer treatment. Understanding a disease is the first step toward finding the right care. Get the facts about breast cancer, including the different types, how it starts and who’s at risk.

There are more than 2.8 million breast cancer survivors in the United States.

Breast cancer is the most common cancer in women and is second only to lung cancer as the leading cause of cancer deaths among women in the United States. It affects one of every eight American women.

The Centers for Disease Control and Prevention estimates that more than 192,370 women are diagnosed with breast cancer each year, and the number of new cases has declined over the past decade. More than 40,000 women lose their lives to this disease annually.

Men can develop breast cancer, but it happens much less often than in women. Nearly 2,000 men are diagnosed with breast cancer each year.

Types of Breast Cancer

There are several different types of breast cancer. Breast tumors may have a single type, a combination, or a mixture of invasive and noninvasive (in situ) cancer.

Ductal carcinoma

This is the most common form of breast cancer. Tumors form in the cells of the milk ducts, which carry milk to the nipples. Ductal carcinoma can be invasive with the potential to spread or non-invasive (also called ductal carcinoma in situ or DCIS). About one in five new breast cancer cases are DCIS. The chance for successful treatment of DCIS usually is very high.

Lobular carcinoma

Lobular carcinoma is the second most common type of breast cancer. This diseaseoccurs in the lobules, which are the milk-producing glands. Lobular breast cancer can be non-invasive (in situ or LCIS, also called lobular neoplasia) or invasive (have a tendency to spread).About one in 10 breast cancer cases are invasive lobular cancer.

Inflammatory breast cancer

Inflamatory breast cancer, or IBC, is a rare, aggressive form of breast cancer that affects the dermal lymphatic system. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam. Read more about Inflammatory Breast Cancer.

Triple-negative breast cancer

Also rare, triple-negative breast cancer is usually an invasive ductal carcinoma with cells that lack estrogen and progesterone receptors and do not have an excess of HER2 protein on their surfaces. These types of breast cancers tend to spread more quickly and do not respond to hormone therapy or drugs that target HER2.

Recurrent breast cancer

This is a cancer that has returned after being undetected for a time. It can occur in the remaining breast tissue or at other sites such as the lungs, liver, bones or brain. Even though these tumors are in new locations, they still are called breast cancer.

Breast cancer risk factors

If you have any of the risk factors listed below, talk to your doctor about getting these tests more often and adding more tests, including breast MRI (magnetic resonance imaging) and genetic testing. If you are concerned about inherited family syndromes that may cause breast cancer, we offer advanced genetic testing to let you know your risk.

Anything that increases your chance of getting breast cancer is a risk factor.

These include:

  • Age: While most cases occur in women 50 or older, breast cancer sometimes develops in women in their 20s. Age is the main risk factor.
  • Family history (especially mother, sister, daughter) of ovarian and/or breast cancer
  • Hormones/childbirth: Your risk of breast cancer is higher if you:
    • Had your first period before age 12
    • Began menopause after age 55
    • Never had children
    • Had your first child after age 30
    • Used hormone therapy after menopause
    • History of radiation to the chest area
    • Previous abnormal breast biopsy results
    • Breast diseases such as atypical hyperplasia, or lobular or ductal carcinoma
    • Obesity or weight gain after menopause
    • Inherited susceptibility genes BRCA1 and BRCA2 account for about 5 to 10 percent of breast cancer cases. Tell your doctor if other women in your family have had breast cancer

Other breast cancer risk factors include:

  • Oral contraceptive use (birth control pills)
  • Diet high in saturated fats
  • Not getting enough exercise
  • Drinking more than one alcoholic drink a day

Not everyone with risk factors gets breast cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Breast cancer symptoms vary from person to person. The best thing to do is to be familiar with your breasts so you know how “normal” feels and looks. If you notice any changes, tell your doctor. However, many breast cancers are found by mammograms before any symptoms appear.

Breast cancer symptoms may include:

  • Lump or mass in your breast
  • Enlarged lymph nodes in the armpit
  • Changes in breast size, shape, skin texture or color
  • Skin redness
  • Dimpling or puckering
  • Nipple changes or discharge
  • Scaliness on the breast
  • Nipple pulling to one side or a change in direction

These symptoms do not always mean you have breast cancer. However, it is important to discuss any symptoms with your doctor, since they may also signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

If you have symptoms that may signal breast cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history. One or more of the following tests may be used to find out if you have breast cancer and if it has spread.

Biopsy: A small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies for breast cancer may be done in one of the following ways:

Surgical biopsy: An incision (small cut) is made in the breast. Surgeons find the tumor by touch or with a CT (or CAT, computed axial tomography) scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, part of the tumor is removed.

Fine needle aspiration (FNA): A thin, hollow needle is inserted into the breast. Fluid and cells are removed from the tumor and looked at with a microscope. While this test can help to determine if breast cancer is present, it cannot determine if the cancer is invasive. Additional biopsies may be needed if breast cancer is found.

Core biopsy: A thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.

Sentinel lymph node biopsy: Lymph nodes are olive-sized glands that are part of the lymphatic system that circulates lymph fluid throughout the body. The lymphatic system also can carry cancer cells from the tumor site to other areas of the body. In breast cancer, the first nodes to be affected are under the arms.

In a sentinel lymph node biopsy, a radioactive blue dye is injected into the area before surgery. The dye shows up in cancerous lymph nodes. The node with the highest amount of blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye.

Sentinel node biopsy can spare healthy lymph nodes, which results in fewer side effects such as lymphedema. UofL Brown Cancer Center has special expertise in this type of biopsy for breast cancer, which often helps preserve function and health.

Imaging tests, which may include:

  • CT or CAT (computed tomography) scan
  • Mammogram or MRI (magnetic resonance imaging) scan
  • Ultrasound

Breast cancer staging

Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor decide the best type of treatment for you and the outlook for your recovery.

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select the treatment for breast cancer based on your diagnosis and disease stage.

We customize your care so you receive the most-advanced, least-invasive treatments with the fewest side effects. In addition to treatments you might find at most breast cancer centers, we offer specialized therapies available at only a few centers in the nation.

Our treatments

If you are diagnosed with breast cancer, your doctor will talk to you about the best options for treating it. Your treatment will be customized especially for you, and it may include one or more of the following therapies.

Surgery

Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. Our breast cancer surgeons are among the most skilled and renowned in the world. They perform a large number of surgeries for breast cancer each year, using the least-invasive and most-effective techniques. If reconstructive surgery is needed, our experts use the most advanced procedures with extraordinary skill.

Surgery is the most common treatment for breast cancer. Procedures may include:

Mastectomy: This surgery removes one or both breasts. The entire breast is removed, along with any affected lymph nodes. In about 80% of mastectomies, breast reconstruction or implant surgery is done during the same procedure, after the breast is removed.

Breast-sparing surgery is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I and II) breast cancer. Breast-sparing techniques include:

Lumpectomy: The tumor and a small margin of healthy breast tissue are removed.

Partial mastectomy: The tumor is removed, along with a margin of healthy breast tissue. The lining of the chest muscles and any affected lymph nodes under the arm are removed also.

Breast reconstruction: using either breast implants or tissue from your abdomen or other parts of your body, the surgeon can recreate a breast either during the cancer surgery (immediate reconstruction) or after surgery (delayed reconstruction).

Radiation therapy

Radiation therapy uses high-energy beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allows doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Radiation therapy treatments include:

  • Intensity-modulated radiation therapy (IMRT): pioneered the use of this type of radiotherapy for breast cancer. IMRT may lead to improved outcomes and less impact on your body than other types of radiation therapy.
  • Accelerated partial breast irradiation (APBI): an internal, localized form of radiation treatment (brachytherapy) that involves the insertion of radioactive "seeds" to kill breast cancer cells that may remain after lumpectomy surgery. The catheter device that delivers the radioactive seeds remains in place during the course of APBI treatment, usually about 8-10 days, before the seeds are withdrawn.

Stereotactic radiosurgery

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, administers very high doses of radiation, using several beams of various intensities aimed at different angles to precisely target the tumor.

Women who have breast-sparing surgery and/or mastectomy may receive radiation afterward to destroy any lingering breast cancer cells. Radiation also can be used before surgery to shrink large tumors or to treat tumors in a difficult location.

Chemotherapy

In breast cancer, chemotherapy most often is given before or after surgery. It also may be the main treatment for cancer that has spread outside the breast.

We offer the most up-to-date and effective chemotherapy options for breast cancer. Our experts helped develop many drugs now used as standard care at other centers, as well as novel approaches to administer them.

We were among the first to demonstrate that chemotherapy can be safe to treat breast cancer after the first trimester of pregnancy. And we pioneered the use of chemotherapy before surgery to shrink breast cancer tumors, reducing damage to surrounding tissue.

Hormone Therapy

Hormone therapy sometimes helps prevent female hormones (estrogen, progesterone and estradiol) from fueling the growth of breast cancer. Hormone therapy can involve taking drugs by mouth or through an IV. Tamoxifen® is an example of a hormone therapy drug.

Surgery to remove the ovaries in women who have not yet reached menopause is another type of hormone therapy.

Targeted Therapy

Targeted therapies are drug treatments that help the body’s immune system fight cancer. Herceptin®is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in breast cancer treatment, visit the UofL Physicians web site here.

HER: Hope, Empower, RestoreHER program logo

Breast cancer in young women is biologically different than those who get it at an older age. Breast cancer in young women also typically comes with a worse prognosis and is diagnosed with a later stage of the disease. These women face a myriad of challenges, which often aren’t talked about prior to the initiation of treatment, such as the impact of treatment on fertility or the impact a cancer diagnosis has on the patient’s young children. The HER program at UofL James Graham Brown Cancer Center, which stands for Hope, Empower and Restore, addresses these challenges with regional experts in the management of breast cancer in young women.