A National Cancer Institute-designated Comprehensive Cancer Center

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Breast Cancer

Approximately one in eight women will be diagnosed with breast cancer during her lifetime. While the disease can have a profound impact on the patient and her loved ones, it is also one that can be effectively treated with surgery, radiation therapy, hormone therapy and chemotherapy.  

City of Hope’s breast cancer program offers a uniquely patient-centered approach for women diagnosed with breast cancer. Our expert team of doctors and researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact our patients today and in the future. We also focus on treating the whole person, addressing physical, emotional, psychosocial and spiritual issues that a breast cancer diagnosis can bring for the patient and loved ones.
 
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute , City of Hope is acknowledged as a leader in the research and treatment of breast cancer. With our decades of experience, specialized therapy protocols and extensive program of clinical trials, newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their needs and gives them the best chance for survival. U.S.News & World Report also named City of Hope as one of the top cancer hospitals in the country for the 11th year.
 
City of Hope’s breast cancer program is comprised of a multidisciplinary team of surgeons, medical and radiation oncologists, nurses, genetic counselors, social workers and supportive care professionals. Together, they provide coordinated, compassionate care tailored to the individual patient.

Highlights of our treatment program include:
 
  • We are constantly developing and evaluating drug and hormone regimens, surgical procedures and radiation techniques that can more effectively target and treat breast cancer at multiple stages, from pre-malignant to metastatic disease.
  • A broad range of breast-preserving treatments, including skin- and nipple-sparing surgeries as well as plastic and reconstructive procedures; individually and combined, they can effectively treat breast cancer while minimizing impact to physical appearance.
  • State-of-the-art imaging methods and technologies that can rapidly and accurately diagnose breast cancers, which means patients can be treated more effectively with less delay.
  • Our cancer genetics program provides comprehensive consultations in cancer screening and prevention by assessing the breast cancer risk for individuals and families based on their genetic profiles.
  • All breast cancer patients and their families can participate in the Partners Clinic, a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together.
  • All breast cancer patients can participate in the survivorship program: Our care does not end after completion of treatment. Our doctors and researchers are working to develop resources to help improve the quality of life for survivors.
 
In collaboration with other departments and cancer centers, City of Hope’s breast cancer program has an active portfolio of breast cancer clinical trials studying novel treatments, including trials of new surgery, radiation and chemotherapy regimens that are more effective against the disease and/or less harmful to the patient. Many of these promising therapies are only available to patients being treated at the City of Hope.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Team

About Breast Cancer

Breast cancer is classified based on where in the breast the disease started and how the disease grows.
 
  • Non-invasive or in situ breast cancer: Also known as “Stage 0” breast cancer, the abnormal cells stay within the breast duct, lobule or nipple and do not invade surrounding tissues. However, in situ breast cancers can become invasive in the future.
  • Invasive ductal carcinoma: This is the most common type of breast cancer, beginning in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple).
  • Invasive lobular carcinoma: This cancer originates in the lobules (milk glands) of the breast. It is found in both breasts more often than other types of breast cancer.
  • Inflammatory breast cancer: In this uncommon type of cancer, the breast becomes red, swollen and tender with an orange peel-like skin texture.
  • Recurrent breast cancer: This is cancer that returns after it has been treated. It may come back in the breast or in other parts of the body.
  • Metastatic breast cancer: This is a breast cancer that has spread to sites and organs outside the breast and regional lymph nodes.
 
Breast cancers are also classified by the receptors on their cell surface, such as estrogen, progesterone and HER2 receptors. The presence or absence of these receptors can guide treatment planning by indicating whether the cancer is sensitive or resistant to hormone and drug therapies.

Signs and Symptoms of Breast Cancer

Symptoms of breast cancer can include:
 
  • A lump or mass in the breast, particularly those that are painless and firm with irregular edges
  • Swelling of all or part of a breast (even if no distinct lump is felt)
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Redness, scaliness or thickening of the nipple or breast skin
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes in the breast area

If your or a loved one are experiencing these symptoms, please contact a physician for further evaluation.

Breast Cancer Risk Factors

Risk factors associated with breast cancer include the following:
 
  • Age: Your risk of developing breast cancer increases as you get older, and half of all breast cancers are diagnosed in women older than 60.
  • Reproductive and menstrual history: Women who have never had a full-term pregnancy or who had their first after age 30 are at higher risk. Women who started menstruating before age 12 or who went through menopause after 55 are also at increased risk.
  • Breast density: Women with denser breasts are more likely to develop breast cancer.
  • Obesity: Being obese (having a body mass index of 30 or higher) increases your risk of breast cancer.
  • Alcohol: Excessive alcohol use — two or more drinks daily — is associated with a higher risk of developing breast cancer.
  • Physical Activity: Women who are sedentary or physically inactive have an elevated breast cancer risk.
  • Family history: Having a close blood relative such as a mother or sister who has had breast or ovarian cancer can increase your risk.
  • Personal history: Women who have had breast cancer have a slightly greater chance of developing another breast cancer.
  • Inherited factors: In some families, genetic mutations — such as those in the BRCA genes — may make some women more susceptible to developing breast cancer.
  • Radiation therapy: Women, who have had radiation to the chest area, particularly before age 30, may be at a higher risk of developing breast cancer.
  • Hormone therapy: Menopause hormone therapy combining estrogen and progesterone for more than five years is associated with an increased risk.
 
Note that many women may have one or more of these risk factors and never get breast cancer. Likewise, women (and men) may develop breast cancer without having any risk factors. If you suspect that you or a loved one may have an elevated risk of breast cancer, please consult with a doctor on preventive and early detection measures that are available.

If you have been diagnosed with breast cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Sources: American Cancer Society and National Cancer Institute

Diagnosing and Staging Breast Cancer

An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most advanced breast imaging technologies and laboratory techniques to guide your personalized treatment.

Breast Imaging

Imaging studies give your breast cancer team important information about changes that may be occurring in your breast tissue. Breast imaging is an important part of a woman’s health care, so that problems can be detected when they are most treatable.

Mammography
A mammogram is a safe and reliable low-dose X-ray exam that provides a view inside breast tissue. Mammography is appropriate and effective for routine screenings, women experiencing symptoms and women with a history of previous breast cancer.
 
  • Screening mammography: A compression paddle is lowered slowly onto the breast. This prevents any movement and allows the maximum amount of tissue to be examined. A series of images is taken and then checked for quality.
  • Diagnostic mammography: During a diagnostic mammogram, a number of X-rays are taken to obtain views of the breast from several angles. Areas may be magnified to produce a detailed picture that can help the doctor make an accurate diagnosis. A diagnostic mammogram takes longer than screening mammogram because more X-rays are needed to obtain varying views of the breast.
  • Digital mammography: This specialized form of mammography uses digital receptors and computers instead of X-ray film to help examine breast tissue for cancer.
 
Breast MRI
Magnetic resonance imaging (MRI) combines magnetic fields, radio waves and a computer system to obtain cross-sectional images in all three dimensions. Breast MRI is often performed once a woman has been diagnosed with breast cancer to determine the extent of disease for surgical planning. It can also be used for screening women with an extremely high risk of developing breast cancer (such as a genetic mutation). This test does not use radiation.

Diagnostic ultrasound
An ultrasound uses high-frequency sound waves to create an image of the breast tissue on a viewing screen. An ultrasound may be used to distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

Biopsy
 
A biopsy is a test in which a sample of breast tissue is obtained through a needle or by removing a piece of tumor. The removed tissue is then carefully examined, which can answer questions about cancer or other abnormality.
 
  • Fine needle aspiration biopsy: In this minor surgical procedure, a thin, hollow needle is inserted into a breast lump to take a small sample of cells that are examined under a microscope.
  • Needle-localized open surgical biopsy: This type of biopsy is performed when you have an abnormality that cannot be felt but is visible on a mammogram. A local anesthetic is administered and a small needle is inserted into the breast to mark the area to be sampled. Mammogram images are then taken to confirm the needle is correctly positioned. A guide wire is then inserted through the needle to show the surgeon exactly where to take the biopsy.
  • Stereotactic biopsy: This type of biopsy uses a computer and X-rays to locate the abnormal breast tissue. A sample of tissue is then removed using a fine needle aspiration biopsy.
  • Ultrasound-guided biopsy: During ultrasound-guided biopsy, your doctor will use ultrasound to guide the needle to the appropriate area. The sample of tissue or fluid then is evaluated in the laboratory.
  • MRI-guided biopsy: MRI-guided biopsy is used when an abnormal area cannot be visualized well by mammogram or ultrasound or when an abnormality can only be seen on an MRI scan.
 
Stages of Breast Cancer

To properly plan for treatment, breast cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:
 
  • Size of the tumor
  • If the tumor have grown into the chest wall or skin
  • Whether the cancer has spread to nearby lymph nodes and how many lymph nodes are affected
  • If the cancer has metastasized to distant organs, such as the bone, liver, brain or lung
 
Based on these factors, patients are staged according to their risk level, with higher risk patients typically requiring more intensive treatments.

Additional information about staging criteria is available on the National Cancer Institute’s website.
 

If you have been diagnosed with breast cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Treatment Approaches

City of Hope is at the forefront of breast cancer treatment. We take a comprehensive and aggressive approach to treatment offering state-of-the-art surgical, medical and radiation therapies, including many that are not yet available to the general public. Additionally, our supportive care and long-term follow-up programs to help patients and their families manage the process of treatment and recovery.

Surgery

City of Hope offers the latest advances in the surgical management of breast cancer provided by specialized surgeons. The scope of  surgery is determined by the size and extent of the breast cancer.

For patients with small tumors and early-stage breast cancer, breast-conserving surgery is a treatment option providing optimal cancer surgery while achieving excellent cosmetic outcomes. For patients with larger tumors, chemotherapy can sometimes be given before surgery to shrink the tumor, which can help make breast conservation an option.
 
Our surgeons also specialize in nipple-sparing mastectomies to help preserve breast appearance. This technique can be used for breast cancer patients or as “risk reduction” surgery in patients who are at very high risk for developing breast cancer.

Patients who are not candidates for breast conservation or who elect to undergo a total mastectomy with removal of all breast tissue may still have reconstructive surgery, either immediately or at a later time.

Reconstruction can be performed either using implants or the patient’s own tissue to create the most natural breast possible. Our surgeons also specialize in secondary reconstructive surgery when initial procedures prove unsatisfactory. At City of Hope, our plastic and reconstructive surgeons have developed a novel technique to recreate the nipple and areola, providing better cosmetic results with minimal scarring.

Chemotherapy

Chemotherapy are drugs that can fight cancer throughout the body, slowing or stopping their growth and spread.

Patients with small tumors or early-stage breast cancer may receive chemotherapy alone, neoadjuvant chemotherapy, or drugs given before surgery to help shrink the tumor and/or adjuvant chemotherapy, drugs given after surgery to eradicate remaining cancer cells.

Patients with large primary tumors may be considered for neoadjuvant treatment. Patients with more advanced disease may also be candidates for new strategies developed to slow the spread of cancer. These may include combinations of standard medicines, targeted therapies or investigational drugs that are still being studied.

Hormone Therapy

Approximately two-thirds of breast cancers are reliant on hormones (estrogen and/or progesterone) to fuel their growth and spread, so drugs that decrease hormone production can help slow or halt the disease. It is most often used as adjuvant therapy (given after surgery) to reduce likelihood of cancer recurrence, but may be used in other settings as well.

Additionally, for pre-menopausal women with estrogen-sensitive breast cancers, the ovaries may be shut down (either through surgical removal or drugs suppress ovarian function) to further reduce hormone levels in the body.

Radiation Therapy

Radiation therapy is often used in treating breast cancer. It may be employed as a stand-alone treatment or in combination with surgery and other treatments to treat the disease and to help reduce likelihood of recurrence.

Radiation therapies available at City of Hope include advanced partial breast irradiation techniques. These focus radiation only on the affected area, rather than the entire breast.

Types of radiation therapies offered at City of Hope include:

External Beam Radiation Therapy: External Beam Radiation Therapy is the most common form of radiation therapy, where radiation is directed at the tumor from outside the body.

Intensity Modulated Radiation Therapy (IMRT): IMRT targets tumors with smaller beams of radiation, which can be sculpted to precisely match the tumor’s contours. This allows for a higher dose of radiation to be delivered directly to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.
 
Intra-operative Radiotherapy (IORT): Select breast cancer patients at City of Hope may be able to receive radiation therapy during surgery. This technique enables many women to receive their entire course of radiation on the same day as their surgery, rather than stretching out radiation treatment over six to eight weeks.

Become a Patient

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Breast Self-exam

 
Breast Self-Exam: What Every Woman Needs to Know

All women are at risk for breast cancer — one out of eight women will be diagnosed with this disease during their lifetime. But thanks to better, more advanced treatments, many of those diagnosed with breast cancer will go on to live full, active lives.

Early detection is important, because when a cancer is diagnosed in its earlier stages, treatments can be more effective and outcomes are generally better. One of the easiest detection methods you can do is the breast self-exam (BSE), a physical examination of your own breast tissue.

The BSE is something you can do by yourself, in private, on your own schedule. By getting to know how your breasts normally look and feel, the BSE can be an added defense against breast cancer through early detection. In fact, eight of 10 breast lumps are found by women themselves.

When and How Often Should I Perform My Breast Self-exam?

According to the guidelines set by the National Comprehensive Cancer Network, you should perform a breast self-exam each month. By becoming more familiar with your normal breast tissue and appearance, it may make it easier for you to notice changes if and when they occur.

The ideal time for a BSE is seven to 10 days after the first day of your menstrual period. Your breasts are naturally less lumpy and tender at this time. The same is true if you have breast implants.

If you are pregnant, or no longer have menstrual cycles, you can perform your BSE at any time, but make it the same time each month.

If you are breast feeding, you should perform your monthly BSE at the same time each month after you have fed the baby.

How Do I Perform My Self-exam?

Your breast self-exam will only take a few minutes, but it is best to choose a time when you have some privacy and will not be disturbed.
 
  1. Stand undressed from the waist up in front of a full length mirror with your arms relaxed at your sides. If you cannot stand comfortably, you can do this part sitting down. Get to know how your breasts look. Even a small visual change may be a significant early sign of a problem.

  2. Compare your breasts while turning from side to side. Look for any changes in breast size, shape, skin texture or color including redness, dimpling, puckering or retraction (pulling back of your skin).

  3. Notice any nipple changes, such as scaliness, a pulling to one side, or a change in direction.

  4. Place your hands on your waist and press inward, then turn from side to side to note any changes. If you cannot place your hands on your waist, try clasping your hands together in front of you, to tighten the chest muscles.

  5. Tightening the chest muscles beneath the breasts in other ways can also help you notice changes. Try different positions, such as putting your hands above your head and turning side to side as you look.

  6. Place your hands at your waist and bow toward the mirror, letting your breasts fall forward. Note any changes in breast shape.

  7. Nipple discharge can be a sign of a problem. Look for any discharge in your bra or clothing, but do not squeeze the nipple or try to expel any secretions.

  8. Feel above and below your collarbone for pea- and bean-sized lumps or thickening. Applying skin cream or lotion can make this easier.

  9. Check for lumps or thickening under your arm while relaxing your arm at your side. Reach across with your other hand to feel the area. Check deeply up and down the inside of the armpit, and up and forward toward your chest. Note any changes from previous self-exams. For the next steps, lie down. The bed is okay.

  10. Place a pillow or folded towel under your left shoulder. This helps your breast tissue spread evenly across your chest wall. Bend your left arm behind your head and reach across with your right hand to your left breast. A little skin cream or lotion on your fingers will make them more sensitive.

  11. Begin the exam at the armpit. Move your three middle fingers together using light, medium and deep pressures.

  12. Your hand should move in straight rows to cover all the breast tissue from the line where your blouse seam would fall (midaxillary line) to the bra line, the breastbone (sternum) and collarbone (clavicle).

  13. Repeat steps 10 to 12 with the opposite breast and arm.

What if I Find Something?

Most commonly, lumps are benign and are usually not a serious health problem. However, always report any changes in appearance or texture in your breasts, as well as any nipple discharge, to your health care provider. He or she may then perform additional tests to determine the presence or absence of breast cancer.

Remember, breast tissue can vary in density naturally. Your breasts may change during different times of the month if you are still menstruating. Breast tissue also changes with age.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Research and Clinical Trials

There is extensive collaboration between breast cancer clinicians and researchers develop and evaluate new therapies designed to improve survival and quality of life outcomes. City of Hope patients have access to a wide variety of clinical trials ranging from new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques and new radiation approaches — all focused on enhancing breast cancer treatment, detection and prevention.

Some of our current research projects include:
 
  • Decoding breast cancers’ resistance mechanisms to hormone therapy or chemotherapy so that they can be overcome, enhancing treatment effectiveness.
  • Identifying and isolating compounds in natural products , such as mushrooms, pomegranates and blueberries, which have breast cancer fighting properties.
  • Examining the role of PARP inhibitors, a class of drugs that can block a cancer cell’s ability to self-repair DNA damage caused by chemotherapy and radiation therapies.
  • Studying the role of STAT3, a protein highly activated in cancer cells, in breast cancer and developing drugs that can target this protein.
  • Better understanding how genetic mutations and how they interact with one another and the environment to affect breast cancer risk.
  • A population study involving more than 100,000 women to examine various lifestyle factors’ link to breast cancer risk.
  • Improving counseling and other support services for women with a high breast cancer risk who make the difficult decision to undergo prophylactic mastectomies, hysterectomies and oophorectomies.
  • Studying survivorship with a focus on quality-of-life issues, the prevention of cancer recurrence or secondary cancers, and other survivorship concerns.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Living with Breast Cancer

In addition to curative treatments, City of Hope breast cancer patients have access to the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help patients and loved ones with a variety of care and wellness issues including:

  •  Managing side effects, including incontinence and impotence
  •  Pain management
  •  Navigation through the health care system
  •  Coping and maintaining emotional/social/spiritual well-being
  •  Staying healthy and active during/after treatment
  •  Guidance on eating and cooking well
  •  Healing arts
  •  Building caregivers’ skills
     

The Sheri & Les Biller Patient and Family Resource Center is the heart of the Department of Supportive Care Medicine, integrating City of Hope's support services under one umbrella. The Biller Resource Center provides a warm and welcoming space where patients, families and caregivers can access the resources, education and support they need to strengthen and empower themselves, before, during and after treatment.
 
Our team of supportive care experts includes clinical social workers; pain and palliative care physicians and nurses; psychologists, psychiatrists; patient navigators; health educators; spiritual care chaplains; child life specialists and more. The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
 
Breast cancer affects the whole family, causing stress in relationships, among family members, and in your work and home life. A united team can help effectively manage these disruptions. The Partners Clinic is a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together. Designed specifically for newly diagnosed breast cancer patients and their partners or families, the clinic offers communication training and gender-based problem-solving led by board-certified counseling experts. This session, which occurs at the initial surgical visit, provides patients and their families with the necessary tools to communicate honestly and directly with each. It actively encourages the sharing of emotional concerns and fears in a way that helps everyone manage their unique situations.
 
Additional Resources
 

Breast Cancer Videos
City of Hope experts cover prevention, screening, treatment and breast cancer reconstruction in a series of informative videos.

Breast Cancer Program
 
 
Laura Kruper, M.D., Head, Breast Surgery and Co-director of the Breast Cancer Program talks about breast cancer treatments such as IORT and the latest in breast cancer research.
 
 
Breast Cancer Facts: What You Need to Know
 
 
Learn about risk factors, common misconceptions, and warning signs of breast cancer.
Prevention
 
 
Leslie Bernstein, Ph.D., professor and director of City of Hope's Division of Cancer Etiology, talks about some lifestyle factors that can influence a woman's breast cancer risks, based on findings from the California Teachers Study—which Dr. Bernstein leads—and other research.
 
Screening
 
 
Laura Kruper, M.D., discusses current breast cancer screening guidelines for women at normal and high risk for the disease.
     
Reconstruction
 
 
Mark Tan, M.D., assistant clinical professor and staff surgeon at City of Hope's Division of Plastic Surgery, talks about breast reconstruction options available to breast cancer patients who underwent a mastectomy or lumpectomy.
 
Step-by-Step Instructions for Breast Self-Exams
 
 
Follow step-by-step instructions for breast self-exams. The video is part of the Style Network's "Fight with Style" initiative, dedicated to educating women on the importance of early detection and self-exams.

 
Survivor Stories
In our 'My Cancer Diagnosis: What I wish I’d known' series, former patients reflect upon their experience. Read their inspiring stories and advice.
 

Sterling Abbott

Sterling Abbott discovered a lump in her breast while breast-feeding her baby. She thought it would go away. It didn’t.
 

Kommah McDowell

Kommah McDowell’s diagnosis at age 28 came with the prediction that she had only a 5 percent chance of surviving two years. She’s now 37, with a son.
 
 
Luisa Najera was twice told that the lump she felt was just a cyst, even though her sister had died of breast cancer at age 38. Finally, she  came to City of Hope.
 
 
Stephanie Hosford first learned that she was pregnant -- then learned she had triple-negative breast cancer. She was advised to have an abortion. Instead, she came to City of Hope.
 
Candida Orosco defeated an aggressive form of breast cancer. Now she’s determined to make a difference in the world.
 
 
Don Hoffman noticed that the nipple on his left breast was suspiciously flat. He had a hunch it might be breast cancer. He was right.
 
 
Julie and Ed Rodriguez learned how to fight her breast cancer as a team. Now they have advice for other couples.
   
 

Breast Cancer Frequently Asked Questions

How do I conduct a Breast Self-Exam (BSE)?

The key to doing a BSE is knowing your own breast. Please review our Breast Self-exam page and ask Breast Center staff if you need additional instruction.

Should I get a screening mammogram every year?

Mammography is the most beneficial and reliable screening test of all cancer screening. Although not the perfect test, a mammogram can detect cancer growing long before any type of physical examination allows a growth to be felt. City of Hope follows the American Cancer Society guidelines and the National Cancer Center Network (NCCN) in believing that yearly mammograms are necessary for women over 40.

What should I do if my mammogram is abnormal?

Your doctor will receive a report outlining the concerns and conditions noted on the abnormal mammogram. Included in the report will be recommendations for further diagnostic evaluation and studies. You should follow the recommendations as closely and quickly as possible. Upon additional reviews and a more comprehensive evaluation, most suspicious areas are found to be benign.

Can I get additional imaging at City of Hope?

At City of Hope, we have the ability to do additional mammographic film views of the breast, as well as ultrasound and MRI scanning, should there be any concern with initial findings.

Can I get a biopsy at City of Hope?

All types of minimally invasive biopsies are available and can be performed at City of Hope. By offering on-site services such as these, we let you have the biopsy scheduled and learn the results more quickly.

Do you offer pap smears or gynecologic exams?

City of Hope does not offer routine pap smears. However, a referral can be made to our gynecology department if you are: already a patient, at high risk, taking Tamoxifen with irregular bleeding, or having abnormal side effects from other hormonal therapy.

Is digital mammography better than regular mammography?

A recently completed study concludes that digital mammography is more effective for detecting cancer in younger women and those with dense breast tissue. For other women, there was no significant difference between digital and conventional mammography. This large multi-institution study, sponsored by the American College of Radiology, was the first to show superiority of digital mammography. Prior smaller studies had shown the two methods to be equally effective in finding cancer.

Should I only have my mammograms performed at a facility that offers digital mammography?

The majority of hospitals and breast imaging centers do not yet offer digital mammography, so your provider options will be more limited. If you are in one of the groups for which digital mammography may be more effective (under age 50, have dense breasts, or are pre-menopausal), you may want to consider having your mammogram at a facility that offers digital mammography. Otherwise, there is no reason for you to choose digital over conventional mammography.

Does City of Hope offer digital mammography?

Yes, City of Hope offers digital mammography and also computer-assisted detection software to further aid radiologists in detecting cancerous changes on mammography. We hope this information helps you to make an informed decision about mammography that is right for you. If you have any other questions, please feel free to speak to one of our imaging technologists at the Women's Health Center.

Breast Cancer Survival

For women who have been diagnosed with breast cancer, we’re ahead of the curve in providing better options that can lead to higher survival rates.  These options include surgical, medical and radiation therapies.
 
City of Hope is one of the few hospitals providing the latest advances in radiation therapy for breast cancer patients — intraoperative radiation therapy, or IORT. During surgery, patients receive a concentrated dose of precise radiation, rather than the normal follow up plan of six to eight weeks of daily radiation treatments.  IORT allows one day as opposed to six to eight weeks of daily radiation, with the exact same excellent results.
 
In addition, we have an extensive research program for women with breast cancer with more than 20 clinical trials, to help women find the right treatment for them.
 
A national database of cancer outcomes is maintained jointly by the American Cancer Society and the American College of Surgeons’ Commission on Cancer.  Each year, the National Cancer Database (NCDB) provides data to hospitals to allow each institution to compare its results with those obtained nationally.
 
The chart below compares survivorship over a five year period for City of Hope patients, who have had breast cancer and were treated by surgery, with patients nationally who have had the same treatment for the same stages of their disease.
 
At City of Hope, our survivorship exceeds the survival rates for patients treated at other cancer programs that report to the Commission on Cancer (CoC). 
Data include both patients diagnosed at City of Hope and those who visit post-diagnosis as well as initial treatment elsewhere.   Higher curves for City of Hope indicate better survival results, reflecting excellent care at City of Hope.  Although some variation between the curves may also be due to timing of referral to City of Hope, and other details of the patients’ situations.
 
 

Support this program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 

Breast Cancer

Breast Cancer

Approximately one in eight women will be diagnosed with breast cancer during her lifetime. While the disease can have a profound impact on the patient and her loved ones, it is also one that can be effectively treated with surgery, radiation therapy, hormone therapy and chemotherapy.  

City of Hope’s breast cancer program offers a uniquely patient-centered approach for women diagnosed with breast cancer. Our expert team of doctors and researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact our patients today and in the future. We also focus on treating the whole person, addressing physical, emotional, psychosocial and spiritual issues that a breast cancer diagnosis can bring for the patient and loved ones.
 
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute , City of Hope is acknowledged as a leader in the research and treatment of breast cancer. With our decades of experience, specialized therapy protocols and extensive program of clinical trials, newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their needs and gives them the best chance for survival. U.S.News & World Report also named City of Hope as one of the top cancer hospitals in the country for the 11th year.
 
City of Hope’s breast cancer program is comprised of a multidisciplinary team of surgeons, medical and radiation oncologists, nurses, genetic counselors, social workers and supportive care professionals. Together, they provide coordinated, compassionate care tailored to the individual patient.

Highlights of our treatment program include:
 
  • We are constantly developing and evaluating drug and hormone regimens, surgical procedures and radiation techniques that can more effectively target and treat breast cancer at multiple stages, from pre-malignant to metastatic disease.
  • A broad range of breast-preserving treatments, including skin- and nipple-sparing surgeries as well as plastic and reconstructive procedures; individually and combined, they can effectively treat breast cancer while minimizing impact to physical appearance.
  • State-of-the-art imaging methods and technologies that can rapidly and accurately diagnose breast cancers, which means patients can be treated more effectively with less delay.
  • Our cancer genetics program provides comprehensive consultations in cancer screening and prevention by assessing the breast cancer risk for individuals and families based on their genetic profiles.
  • All breast cancer patients and their families can participate in the Partners Clinic, a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together.
  • All breast cancer patients can participate in the survivorship program: Our care does not end after completion of treatment. Our doctors and researchers are working to develop resources to help improve the quality of life for survivors.
 
In collaboration with other departments and cancer centers, City of Hope’s breast cancer program has an active portfolio of breast cancer clinical trials studying novel treatments, including trials of new surgery, radiation and chemotherapy regimens that are more effective against the disease and/or less harmful to the patient. Many of these promising therapies are only available to patients being treated at the City of Hope.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Team

Breast Cancer Team

About Breast Cancer

About Breast Cancer

Breast cancer is classified based on where in the breast the disease started and how the disease grows.
 
  • Non-invasive or in situ breast cancer: Also known as “Stage 0” breast cancer, the abnormal cells stay within the breast duct, lobule or nipple and do not invade surrounding tissues. However, in situ breast cancers can become invasive in the future.
  • Invasive ductal carcinoma: This is the most common type of breast cancer, beginning in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple).
  • Invasive lobular carcinoma: This cancer originates in the lobules (milk glands) of the breast. It is found in both breasts more often than other types of breast cancer.
  • Inflammatory breast cancer: In this uncommon type of cancer, the breast becomes red, swollen and tender with an orange peel-like skin texture.
  • Recurrent breast cancer: This is cancer that returns after it has been treated. It may come back in the breast or in other parts of the body.
  • Metastatic breast cancer: This is a breast cancer that has spread to sites and organs outside the breast and regional lymph nodes.
 
Breast cancers are also classified by the receptors on their cell surface, such as estrogen, progesterone and HER2 receptors. The presence or absence of these receptors can guide treatment planning by indicating whether the cancer is sensitive or resistant to hormone and drug therapies.

Signs and Symptoms of Breast Cancer

Symptoms of breast cancer can include:
 
  • A lump or mass in the breast, particularly those that are painless and firm with irregular edges
  • Swelling of all or part of a breast (even if no distinct lump is felt)
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Redness, scaliness or thickening of the nipple or breast skin
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes in the breast area

If your or a loved one are experiencing these symptoms, please contact a physician for further evaluation.

Breast Cancer Risk Factors

Risk factors associated with breast cancer include the following:
 
  • Age: Your risk of developing breast cancer increases as you get older, and half of all breast cancers are diagnosed in women older than 60.
  • Reproductive and menstrual history: Women who have never had a full-term pregnancy or who had their first after age 30 are at higher risk. Women who started menstruating before age 12 or who went through menopause after 55 are also at increased risk.
  • Breast density: Women with denser breasts are more likely to develop breast cancer.
  • Obesity: Being obese (having a body mass index of 30 or higher) increases your risk of breast cancer.
  • Alcohol: Excessive alcohol use — two or more drinks daily — is associated with a higher risk of developing breast cancer.
  • Physical Activity: Women who are sedentary or physically inactive have an elevated breast cancer risk.
  • Family history: Having a close blood relative such as a mother or sister who has had breast or ovarian cancer can increase your risk.
  • Personal history: Women who have had breast cancer have a slightly greater chance of developing another breast cancer.
  • Inherited factors: In some families, genetic mutations — such as those in the BRCA genes — may make some women more susceptible to developing breast cancer.
  • Radiation therapy: Women, who have had radiation to the chest area, particularly before age 30, may be at a higher risk of developing breast cancer.
  • Hormone therapy: Menopause hormone therapy combining estrogen and progesterone for more than five years is associated with an increased risk.
 
Note that many women may have one or more of these risk factors and never get breast cancer. Likewise, women (and men) may develop breast cancer without having any risk factors. If you suspect that you or a loved one may have an elevated risk of breast cancer, please consult with a doctor on preventive and early detection measures that are available.

If you have been diagnosed with breast cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Sources: American Cancer Society and National Cancer Institute

How We Diagnose Breast Cancer

Diagnosing and Staging Breast Cancer

An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most advanced breast imaging technologies and laboratory techniques to guide your personalized treatment.

Breast Imaging

Imaging studies give your breast cancer team important information about changes that may be occurring in your breast tissue. Breast imaging is an important part of a woman’s health care, so that problems can be detected when they are most treatable.

Mammography
A mammogram is a safe and reliable low-dose X-ray exam that provides a view inside breast tissue. Mammography is appropriate and effective for routine screenings, women experiencing symptoms and women with a history of previous breast cancer.
 
  • Screening mammography: A compression paddle is lowered slowly onto the breast. This prevents any movement and allows the maximum amount of tissue to be examined. A series of images is taken and then checked for quality.
  • Diagnostic mammography: During a diagnostic mammogram, a number of X-rays are taken to obtain views of the breast from several angles. Areas may be magnified to produce a detailed picture that can help the doctor make an accurate diagnosis. A diagnostic mammogram takes longer than screening mammogram because more X-rays are needed to obtain varying views of the breast.
  • Digital mammography: This specialized form of mammography uses digital receptors and computers instead of X-ray film to help examine breast tissue for cancer.
 
Breast MRI
Magnetic resonance imaging (MRI) combines magnetic fields, radio waves and a computer system to obtain cross-sectional images in all three dimensions. Breast MRI is often performed once a woman has been diagnosed with breast cancer to determine the extent of disease for surgical planning. It can also be used for screening women with an extremely high risk of developing breast cancer (such as a genetic mutation). This test does not use radiation.

Diagnostic ultrasound
An ultrasound uses high-frequency sound waves to create an image of the breast tissue on a viewing screen. An ultrasound may be used to distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

Biopsy
 
A biopsy is a test in which a sample of breast tissue is obtained through a needle or by removing a piece of tumor. The removed tissue is then carefully examined, which can answer questions about cancer or other abnormality.
 
  • Fine needle aspiration biopsy: In this minor surgical procedure, a thin, hollow needle is inserted into a breast lump to take a small sample of cells that are examined under a microscope.
  • Needle-localized open surgical biopsy: This type of biopsy is performed when you have an abnormality that cannot be felt but is visible on a mammogram. A local anesthetic is administered and a small needle is inserted into the breast to mark the area to be sampled. Mammogram images are then taken to confirm the needle is correctly positioned. A guide wire is then inserted through the needle to show the surgeon exactly where to take the biopsy.
  • Stereotactic biopsy: This type of biopsy uses a computer and X-rays to locate the abnormal breast tissue. A sample of tissue is then removed using a fine needle aspiration biopsy.
  • Ultrasound-guided biopsy: During ultrasound-guided biopsy, your doctor will use ultrasound to guide the needle to the appropriate area. The sample of tissue or fluid then is evaluated in the laboratory.
  • MRI-guided biopsy: MRI-guided biopsy is used when an abnormal area cannot be visualized well by mammogram or ultrasound or when an abnormality can only be seen on an MRI scan.
 
Stages of Breast Cancer

To properly plan for treatment, breast cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:
 
  • Size of the tumor
  • If the tumor have grown into the chest wall or skin
  • Whether the cancer has spread to nearby lymph nodes and how many lymph nodes are affected
  • If the cancer has metastasized to distant organs, such as the bone, liver, brain or lung
 
Based on these factors, patients are staged according to their risk level, with higher risk patients typically requiring more intensive treatments.

Additional information about staging criteria is available on the National Cancer Institute’s website.
 

If you have been diagnosed with breast cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Treatment Approaches

Breast Cancer Treatment Approaches

City of Hope is at the forefront of breast cancer treatment. We take a comprehensive and aggressive approach to treatment offering state-of-the-art surgical, medical and radiation therapies, including many that are not yet available to the general public. Additionally, our supportive care and long-term follow-up programs to help patients and their families manage the process of treatment and recovery.

Surgery

City of Hope offers the latest advances in the surgical management of breast cancer provided by specialized surgeons. The scope of  surgery is determined by the size and extent of the breast cancer.

For patients with small tumors and early-stage breast cancer, breast-conserving surgery is a treatment option providing optimal cancer surgery while achieving excellent cosmetic outcomes. For patients with larger tumors, chemotherapy can sometimes be given before surgery to shrink the tumor, which can help make breast conservation an option.
 
Our surgeons also specialize in nipple-sparing mastectomies to help preserve breast appearance. This technique can be used for breast cancer patients or as “risk reduction” surgery in patients who are at very high risk for developing breast cancer.

Patients who are not candidates for breast conservation or who elect to undergo a total mastectomy with removal of all breast tissue may still have reconstructive surgery, either immediately or at a later time.

Reconstruction can be performed either using implants or the patient’s own tissue to create the most natural breast possible. Our surgeons also specialize in secondary reconstructive surgery when initial procedures prove unsatisfactory. At City of Hope, our plastic and reconstructive surgeons have developed a novel technique to recreate the nipple and areola, providing better cosmetic results with minimal scarring.

Chemotherapy

Chemotherapy are drugs that can fight cancer throughout the body, slowing or stopping their growth and spread.

Patients with small tumors or early-stage breast cancer may receive chemotherapy alone, neoadjuvant chemotherapy, or drugs given before surgery to help shrink the tumor and/or adjuvant chemotherapy, drugs given after surgery to eradicate remaining cancer cells.

Patients with large primary tumors may be considered for neoadjuvant treatment. Patients with more advanced disease may also be candidates for new strategies developed to slow the spread of cancer. These may include combinations of standard medicines, targeted therapies or investigational drugs that are still being studied.

Hormone Therapy

Approximately two-thirds of breast cancers are reliant on hormones (estrogen and/or progesterone) to fuel their growth and spread, so drugs that decrease hormone production can help slow or halt the disease. It is most often used as adjuvant therapy (given after surgery) to reduce likelihood of cancer recurrence, but may be used in other settings as well.

Additionally, for pre-menopausal women with estrogen-sensitive breast cancers, the ovaries may be shut down (either through surgical removal or drugs suppress ovarian function) to further reduce hormone levels in the body.

Radiation Therapy

Radiation therapy is often used in treating breast cancer. It may be employed as a stand-alone treatment or in combination with surgery and other treatments to treat the disease and to help reduce likelihood of recurrence.

Radiation therapies available at City of Hope include advanced partial breast irradiation techniques. These focus radiation only on the affected area, rather than the entire breast.

Types of radiation therapies offered at City of Hope include:

External Beam Radiation Therapy: External Beam Radiation Therapy is the most common form of radiation therapy, where radiation is directed at the tumor from outside the body.

Intensity Modulated Radiation Therapy (IMRT): IMRT targets tumors with smaller beams of radiation, which can be sculpted to precisely match the tumor’s contours. This allows for a higher dose of radiation to be delivered directly to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.
 
Intra-operative Radiotherapy (IORT): Select breast cancer patients at City of Hope may be able to receive radiation therapy during surgery. This technique enables many women to receive their entire course of radiation on the same day as their surgery, rather than stretching out radiation treatment over six to eight weeks.

Become a Patient

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Breast Self-Exam

Breast Self-exam

 
Breast Self-Exam: What Every Woman Needs to Know

All women are at risk for breast cancer — one out of eight women will be diagnosed with this disease during their lifetime. But thanks to better, more advanced treatments, many of those diagnosed with breast cancer will go on to live full, active lives.

Early detection is important, because when a cancer is diagnosed in its earlier stages, treatments can be more effective and outcomes are generally better. One of the easiest detection methods you can do is the breast self-exam (BSE), a physical examination of your own breast tissue.

The BSE is something you can do by yourself, in private, on your own schedule. By getting to know how your breasts normally look and feel, the BSE can be an added defense against breast cancer through early detection. In fact, eight of 10 breast lumps are found by women themselves.

When and How Often Should I Perform My Breast Self-exam?

According to the guidelines set by the National Comprehensive Cancer Network, you should perform a breast self-exam each month. By becoming more familiar with your normal breast tissue and appearance, it may make it easier for you to notice changes if and when they occur.

The ideal time for a BSE is seven to 10 days after the first day of your menstrual period. Your breasts are naturally less lumpy and tender at this time. The same is true if you have breast implants.

If you are pregnant, or no longer have menstrual cycles, you can perform your BSE at any time, but make it the same time each month.

If you are breast feeding, you should perform your monthly BSE at the same time each month after you have fed the baby.

How Do I Perform My Self-exam?

Your breast self-exam will only take a few minutes, but it is best to choose a time when you have some privacy and will not be disturbed.
 
  1. Stand undressed from the waist up in front of a full length mirror with your arms relaxed at your sides. If you cannot stand comfortably, you can do this part sitting down. Get to know how your breasts look. Even a small visual change may be a significant early sign of a problem.

  2. Compare your breasts while turning from side to side. Look for any changes in breast size, shape, skin texture or color including redness, dimpling, puckering or retraction (pulling back of your skin).

  3. Notice any nipple changes, such as scaliness, a pulling to one side, or a change in direction.

  4. Place your hands on your waist and press inward, then turn from side to side to note any changes. If you cannot place your hands on your waist, try clasping your hands together in front of you, to tighten the chest muscles.

  5. Tightening the chest muscles beneath the breasts in other ways can also help you notice changes. Try different positions, such as putting your hands above your head and turning side to side as you look.

  6. Place your hands at your waist and bow toward the mirror, letting your breasts fall forward. Note any changes in breast shape.

  7. Nipple discharge can be a sign of a problem. Look for any discharge in your bra or clothing, but do not squeeze the nipple or try to expel any secretions.

  8. Feel above and below your collarbone for pea- and bean-sized lumps or thickening. Applying skin cream or lotion can make this easier.

  9. Check for lumps or thickening under your arm while relaxing your arm at your side. Reach across with your other hand to feel the area. Check deeply up and down the inside of the armpit, and up and forward toward your chest. Note any changes from previous self-exams. For the next steps, lie down. The bed is okay.

  10. Place a pillow or folded towel under your left shoulder. This helps your breast tissue spread evenly across your chest wall. Bend your left arm behind your head and reach across with your right hand to your left breast. A little skin cream or lotion on your fingers will make them more sensitive.

  11. Begin the exam at the armpit. Move your three middle fingers together using light, medium and deep pressures.

  12. Your hand should move in straight rows to cover all the breast tissue from the line where your blouse seam would fall (midaxillary line) to the bra line, the breastbone (sternum) and collarbone (clavicle).

  13. Repeat steps 10 to 12 with the opposite breast and arm.

What if I Find Something?

Most commonly, lumps are benign and are usually not a serious health problem. However, always report any changes in appearance or texture in your breasts, as well as any nipple discharge, to your health care provider. He or she may then perform additional tests to determine the presence or absence of breast cancer.

Remember, breast tissue can vary in density naturally. Your breasts may change during different times of the month if you are still menstruating. Breast tissue also changes with age.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Breast Cancer Clinical Trials/Research

Breast Cancer Research and Clinical Trials

There is extensive collaboration between breast cancer clinicians and researchers develop and evaluate new therapies designed to improve survival and quality of life outcomes. City of Hope patients have access to a wide variety of clinical trials ranging from new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques and new radiation approaches — all focused on enhancing breast cancer treatment, detection and prevention.

Some of our current research projects include:
 
  • Decoding breast cancers’ resistance mechanisms to hormone therapy or chemotherapy so that they can be overcome, enhancing treatment effectiveness.
  • Identifying and isolating compounds in natural products , such as mushrooms, pomegranates and blueberries, which have breast cancer fighting properties.
  • Examining the role of PARP inhibitors, a class of drugs that can block a cancer cell’s ability to self-repair DNA damage caused by chemotherapy and radiation therapies.
  • Studying the role of STAT3, a protein highly activated in cancer cells, in breast cancer and developing drugs that can target this protein.
  • Better understanding how genetic mutations and how they interact with one another and the environment to affect breast cancer risk.
  • A population study involving more than 100,000 women to examine various lifestyle factors’ link to breast cancer risk.
  • Improving counseling and other support services for women with a high breast cancer risk who make the difficult decision to undergo prophylactic mastectomies, hysterectomies and oophorectomies.
  • Studying survivorship with a focus on quality-of-life issues, the prevention of cancer recurrence or secondary cancers, and other survivorship concerns.

If you have been diagnosed with breast cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Living with Breast Cancer

Living with Breast Cancer

In addition to curative treatments, City of Hope breast cancer patients have access to the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help patients and loved ones with a variety of care and wellness issues including:

  •  Managing side effects, including incontinence and impotence
  •  Pain management
  •  Navigation through the health care system
  •  Coping and maintaining emotional/social/spiritual well-being
  •  Staying healthy and active during/after treatment
  •  Guidance on eating and cooking well
  •  Healing arts
  •  Building caregivers’ skills
     

The Sheri & Les Biller Patient and Family Resource Center is the heart of the Department of Supportive Care Medicine, integrating City of Hope's support services under one umbrella. The Biller Resource Center provides a warm and welcoming space where patients, families and caregivers can access the resources, education and support they need to strengthen and empower themselves, before, during and after treatment.
 
Our team of supportive care experts includes clinical social workers; pain and palliative care physicians and nurses; psychologists, psychiatrists; patient navigators; health educators; spiritual care chaplains; child life specialists and more. The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
 
Breast cancer affects the whole family, causing stress in relationships, among family members, and in your work and home life. A united team can help effectively manage these disruptions. The Partners Clinic is a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together. Designed specifically for newly diagnosed breast cancer patients and their partners or families, the clinic offers communication training and gender-based problem-solving led by board-certified counseling experts. This session, which occurs at the initial surgical visit, provides patients and their families with the necessary tools to communicate honestly and directly with each. It actively encourages the sharing of emotional concerns and fears in a way that helps everyone manage their unique situations.
 
Additional Resources
 

Breast Cancer Videos
City of Hope experts cover prevention, screening, treatment and breast cancer reconstruction in a series of informative videos.

Breast Cancer Program
 
 
Laura Kruper, M.D., Head, Breast Surgery and Co-director of the Breast Cancer Program talks about breast cancer treatments such as IORT and the latest in breast cancer research.
 
 
Breast Cancer Facts: What You Need to Know
 
 
Learn about risk factors, common misconceptions, and warning signs of breast cancer.
Prevention
 
 
Leslie Bernstein, Ph.D., professor and director of City of Hope's Division of Cancer Etiology, talks about some lifestyle factors that can influence a woman's breast cancer risks, based on findings from the California Teachers Study—which Dr. Bernstein leads—and other research.
 
Screening
 
 
Laura Kruper, M.D., discusses current breast cancer screening guidelines for women at normal and high risk for the disease.
     
Reconstruction
 
 
Mark Tan, M.D., assistant clinical professor and staff surgeon at City of Hope's Division of Plastic Surgery, talks about breast reconstruction options available to breast cancer patients who underwent a mastectomy or lumpectomy.
 
Step-by-Step Instructions for Breast Self-Exams
 
 
Follow step-by-step instructions for breast self-exams. The video is part of the Style Network's "Fight with Style" initiative, dedicated to educating women on the importance of early detection and self-exams.

 
Survivor Stories
In our 'My Cancer Diagnosis: What I wish I’d known' series, former patients reflect upon their experience. Read their inspiring stories and advice.
 

Sterling Abbott

Sterling Abbott discovered a lump in her breast while breast-feeding her baby. She thought it would go away. It didn’t.
 

Kommah McDowell

Kommah McDowell’s diagnosis at age 28 came with the prediction that she had only a 5 percent chance of surviving two years. She’s now 37, with a son.
 
 
Luisa Najera was twice told that the lump she felt was just a cyst, even though her sister had died of breast cancer at age 38. Finally, she  came to City of Hope.
 
 
Stephanie Hosford first learned that she was pregnant -- then learned she had triple-negative breast cancer. She was advised to have an abortion. Instead, she came to City of Hope.
 
Candida Orosco defeated an aggressive form of breast cancer. Now she’s determined to make a difference in the world.
 
 
Don Hoffman noticed that the nipple on his left breast was suspiciously flat. He had a hunch it might be breast cancer. He was right.
 
 
Julie and Ed Rodriguez learned how to fight her breast cancer as a team. Now they have advice for other couples.
   
 

Breast Cancer FAQs

Breast Cancer Frequently Asked Questions

How do I conduct a Breast Self-Exam (BSE)?

The key to doing a BSE is knowing your own breast. Please review our Breast Self-exam page and ask Breast Center staff if you need additional instruction.

Should I get a screening mammogram every year?

Mammography is the most beneficial and reliable screening test of all cancer screening. Although not the perfect test, a mammogram can detect cancer growing long before any type of physical examination allows a growth to be felt. City of Hope follows the American Cancer Society guidelines and the National Cancer Center Network (NCCN) in believing that yearly mammograms are necessary for women over 40.

What should I do if my mammogram is abnormal?

Your doctor will receive a report outlining the concerns and conditions noted on the abnormal mammogram. Included in the report will be recommendations for further diagnostic evaluation and studies. You should follow the recommendations as closely and quickly as possible. Upon additional reviews and a more comprehensive evaluation, most suspicious areas are found to be benign.

Can I get additional imaging at City of Hope?

At City of Hope, we have the ability to do additional mammographic film views of the breast, as well as ultrasound and MRI scanning, should there be any concern with initial findings.

Can I get a biopsy at City of Hope?

All types of minimally invasive biopsies are available and can be performed at City of Hope. By offering on-site services such as these, we let you have the biopsy scheduled and learn the results more quickly.

Do you offer pap smears or gynecologic exams?

City of Hope does not offer routine pap smears. However, a referral can be made to our gynecology department if you are: already a patient, at high risk, taking Tamoxifen with irregular bleeding, or having abnormal side effects from other hormonal therapy.

Is digital mammography better than regular mammography?

A recently completed study concludes that digital mammography is more effective for detecting cancer in younger women and those with dense breast tissue. For other women, there was no significant difference between digital and conventional mammography. This large multi-institution study, sponsored by the American College of Radiology, was the first to show superiority of digital mammography. Prior smaller studies had shown the two methods to be equally effective in finding cancer.

Should I only have my mammograms performed at a facility that offers digital mammography?

The majority of hospitals and breast imaging centers do not yet offer digital mammography, so your provider options will be more limited. If you are in one of the groups for which digital mammography may be more effective (under age 50, have dense breasts, or are pre-menopausal), you may want to consider having your mammogram at a facility that offers digital mammography. Otherwise, there is no reason for you to choose digital over conventional mammography.

Does City of Hope offer digital mammography?

Yes, City of Hope offers digital mammography and also computer-assisted detection software to further aid radiologists in detecting cancerous changes on mammography. We hope this information helps you to make an informed decision about mammography that is right for you. If you have any other questions, please feel free to speak to one of our imaging technologists at the Women's Health Center.

Breast Cancer Outcomes

Breast Cancer Survival

For women who have been diagnosed with breast cancer, we’re ahead of the curve in providing better options that can lead to higher survival rates.  These options include surgical, medical and radiation therapies.
 
City of Hope is one of the few hospitals providing the latest advances in radiation therapy for breast cancer patients — intraoperative radiation therapy, or IORT. During surgery, patients receive a concentrated dose of precise radiation, rather than the normal follow up plan of six to eight weeks of daily radiation treatments.  IORT allows one day as opposed to six to eight weeks of daily radiation, with the exact same excellent results.
 
In addition, we have an extensive research program for women with breast cancer with more than 20 clinical trials, to help women find the right treatment for them.
 
A national database of cancer outcomes is maintained jointly by the American Cancer Society and the American College of Surgeons’ Commission on Cancer.  Each year, the National Cancer Database (NCDB) provides data to hospitals to allow each institution to compare its results with those obtained nationally.
 
The chart below compares survivorship over a five year period for City of Hope patients, who have had breast cancer and were treated by surgery, with patients nationally who have had the same treatment for the same stages of their disease.
 
At City of Hope, our survivorship exceeds the survival rates for patients treated at other cancer programs that report to the Commission on Cancer (CoC). 
Data include both patients diagnosed at City of Hope and those who visit post-diagnosis as well as initial treatment elsewhere.   Higher curves for City of Hope indicate better survival results, reflecting excellent care at City of Hope.  Although some variation between the curves may also be due to timing of referral to City of Hope, and other details of the patients’ situations.
 
 

Support This Program

Support this program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 
Quick Links
Breast Cancer Videos
Get Involved
Join thousands and walk for women’s cancers, women’s cures, on Nov. 2, 2014 in Los Angeles. Event details »
Join our giving circle and help decide which breast cancer research programs to fund. Read more »
 
Low-dose Tamoxifen for Radiation-Induced Breast Cancer Risk Reduction Trial
 
A clinical research study is currently underway to see if low-dose tamoxifen can reduce the risk of breast cancer in childhood, adolescent, and young adulthood cancer survivors.
The Positive Image Center is where licensed cosmetologists support and assist patients with building and maintaining self-confidence in their appearance. Patients can access wig fittings and stylings and discuss cosmetic techniques.
 
Cooper Finkel Women’s Health Center
Many gynecological cancer and breast cancer  services at City of Hope are provided at the Rita Cooper Finkel and J. William Finkel Women's Health Center. Here, women receive the highest quality care, whether seeking prevention and screening services or coping with a cancer diagnosis.


NEWS & UPDATES
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  • The holidays can create an overwhelming urge to give to people in need — especially to sick children and families spending the holidays in a hospital room. That’s a good thing. Holiday donations of toys and gifts can bolster the spirits, and improve the lives, of people affected by illness, and hospitals ...
  • On Jan. 1, 2015, six City of Hope patients who have journeyed through cancer will welcome the new year with their loved ones atop City of Hope’s Tournament of Roses Parade float. The theme of the float is “Made Possible by HOPE.” The theme of the parade is “Inspiring Stories.” Here...
  • Cancer has a way of “talking” to the immune system and corrupting it to work on its own behalf instead of defending the body. Blocking this communication would allow the immune system to see cancer cells for what they are – something to be fought off – and stop them from growing. A breakthrough Scientists [R...
  • On Jan. 1, 2015, six City of Hope patients who have journeyed through cancer will welcome the new year with their loved ones atop City of Hope’s Tournament of Roses Parade float. The theme of the float is “Made Possible by HOPE.” The theme of the parade is “Inspiring Stories.” By V...
  • On Jan. 1, 2015, six City of Hope patients who have journeyed through cancer will welcome the new year with their loved ones atop City of Hope’s Tournament of Roses Parade float. The theme of the float is “Made Possible by HOPE.” The theme of the parade is “Inspiring Stories.” The ...
  • On Jan. 1, 2015, six City of Hope patients who have journeyed through cancer will welcome the new year with their loved ones atop City of Hope’s Tournament of Roses Parade float. The theme of the float is “Made Possible by HOPE.” The theme of the parade is “Inspiring Stories.” In 2...
  • You’ve done the easy stuff – braved the toy store and the Black Friday frenzy, stayed up all night trolling deals online, picked up gift cards for your colleagues at work. There’s just one gift left, the one you’ve been putting off and the one that means so much. What do you give your friend who […]