Breast Cancer

What is breast cancer?

Breast cancer is a disease in which breast tissue cells start growing abnormally and uncontrollably.

• The most common form of breast cancer is ductal carcinoma, which begins with cells in the breast ducts, tubes that carry breast milk to the nipple.
• Less common forms of breast cancer include lobular carcinoma, which begins in the lobules – tissues that make breast milk – and inflammatory breast cancer, which causes the breast to become red, swollen and abnormally warm.
• Rare forms of breast cancer include those in other types of cells (such as lymph/blood vessels or connective tissues within the breast) and breast cancer in men.
• Additionally, patients may also be diagnosed with ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) in which cells have undergone cancerous changes but are confined within the breast duct or lobule, respectively. DCIS and LCIS are also known as breast pre-cancers or “Stage 0 breast cancer.”

Types of breast cancer

• Invasive vs. in situ breast cancer: Invasive — or infiltrating — cancers spread into the surrounding breast tissue, while “in situ” breast cancers remain in their original location.

• What is ductal carcinoma and ductal carcinoma in situ? Ductal carcinoma is the most common form of breast cancer, accounting for about one in five new breast cancer cases. Tumors form in the cells of the ducts that carry milk to the nipples. Ductal carcinoma can be either in situ (remaining in the original location) or invasive (spreading to other parts of the body). When the disease is “in situ” (DCIS), it has not spread beyond the ducts, and has a very high chance of successful treatment. Because of the risk of DCIS later becoming an invasive cancer that spreads into the surrounding breast tissue, treatment is advised for all women with the condition. Choices include careful observation to detect any future signs of cancer, as well as strategies such as medications or surgery.

• What is lobular carcinoma and lobular carcinoma in situ? Each breast has 15 to 20 sections called lobes, and each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs, which produce the milk carried by the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma, and is more often found in both breasts than other types of breast cancer. Lobular carcinoma can be either in situ (remaining in the original location) or invasive (spreading to other parts of the body). When lobular carcinoma is “in situ,” it rarely becomes invasive cancer, but having LCIS in one breast increases the risk of developing invasive cancer in either breast. In invasive lobular carcinoma, cancer has spread from the lobules to surrounding normal tissue, and can also spread through the blood and lymph systems to other parts of the body.

• What is inflammatory breast cancer? Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer. It has some symptoms of inflammation, like swelling and redness, which are caused by cancer cells blocking lymph vessels in the skin. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam and may not appear on a mammogram. As a result, IBC often has already spread to distant parts of the body when it is diagnosed, making it harder to treat. However, it may be possible to see and feel the skin thickening that often happens with the disease. To diagnose IBC, doctors perform a biopsy of the suspicious tissue. If the biopsy shows that inflammatory breast cancer is present, additional tests will be conducted to determine how much of the breast tissue and lymph nodes are involved, and whether or not the other breast is affected.

• What is HER2 positive breast cancer? Some women have breast tumors with higher levels of a protein known as HER2. These tumors tend to grow and spread faster than other breast cancers. Finding out the HER2 status of a breast tumor is important because there are treatments specifically targeted to this type of cancer.

• What is triple negative breast cancer? Triple negative breast cancers (TNBC) are those that do not have estrogen or progesterone hormone receptors, and are also negative for the genetic HER2 marker. As a result, they can’t be treated with some of the common hormone therapies or drugs that target HER2, but chemotherapy can be helpful. TNBCs tend to occur in younger women and African-American women. They also tend to be more aggressive than other forms of breast cancer.

• What is Paget disease of the breast? Paget disease is a rare type of breast cancer, representing 1 to 4 percent of all breast cancer cases. It involves the skin of the nipple and usually the darker circle of skin around it, called the areola. Most people with the disease also have one or more tumors inside the same breast, either ductal carcinoma in situ or invasive breast cancer.

What is metastatic breast cancer?

Breast cancer usually begins in the ducts that carry milk to the nipple, and can metastasize — reach other parts of the body — when the cancer cells get into the blood or lymph systems. Most of the time, cancer cells die at some point in the process of trying to spread. But, if conditions are favorable for the cancer cells, some of them are able to form new tumors in other parts of the body. Metastatic cancer cells can also remain inactive at a distant site for many years before they begin to grow again, if at all.

• What is metastatic breast cancer to the bone? Cancer can spread to any bone in the body, but is most often found in bones near the core, especially the spine. Other common sites include the hip bone, upper leg bone, upper arm bone, ribs and the skull. Symptoms can include pain, swelling, or easy fracturing of the bones. Once the cancer is in the bone, it can rarely be cured, but treatments can shrink, stop, or slow its growth.
   
• What is metastatic breast cancer to the brain? When breast cancer spreads to the brain, it tends to occur a few years after the cancer is first detected. The two most common symptoms are headaches and seizures. Generally, brain metastases are often found in younger and premenopausal women. They are also more common in women with triple negative or HER2/neu positive breast cancer. Consultation with a neurosurgeon, radiation oncologist, or medical/neuro-oncologist will determine if surgical removal or other treatment is the best choice to relieve symptoms and prolong life.
   
• What is metastatic breast cancer to the liver? Symptoms of breast cancer that has spread to the liver can include yellowing of the skin or eyes, itchy skin or rash, abdominal pain, appetite loss, nausea and vomiting. While medical care may not result in a cure, a variety of treatments are available to improve the quality and length of life.

What is male breast cancer?

Breast cancer in men is very rare, with less than 1 percent of all breast cancers found in men. The risk increases for older men and those with high estrogen levels, low male-hormone levels or a family history of breast cancer. Increased risk is also associated with those who have been exposed to radiation, heavy drinkers, and those with liver disease or who are obese. Treatment options include surgery, radiation therapy, chemotherapy, hormone therapy and drugs that target genetic changes in cells that cause cancer.

What are the symptoms and signs of breast cancer?

The most common symptoms of breast cancer include:

• Feeling a lump in the breast area, with or without pain
• Change in breast shape or size
• Dimple or puckering in breast
• A nipple turning inward into the breast
• Nipple discharge other than breast milk, especially if it is bloody
• Scaly, red, darkened or swollen skin in the breast area
• Itchy, scaly sore or rash on the nipple
• Dimple, pitted appearance or feel (similar to an orange peel) in the breast area
• Swollen or enlarged lymph nodes around the breast area, including the collarbone and armpits

Although these symptoms can be caused by other conditions, you should check with a doctor — preferably a breast health specialist — so they can make a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

What increases your risk of breast cancer?

Factors that can elevate risk breast cancer risk include:

• A personal or family history of breast cancer, including DCIS and LCIS
• Inherited genetic predispositions, most commonly with BRCA1 or BRCA2 gene mutations
• Elevated lifetime estrogen exposure, including:
  • Early onset of menstruation (before age 11)
  • Late onset of menopause (after the age of 55)
  • Older age of first childbirth (after age of 30) or never having given birth
  • Taking estrogen and progesterone after menopause
• Having dense breast tissue
• Obesity
• Prior radiation therapy to the chest area
• Consuming alcohol, especially in excess of two drinks a day
• Age: Two-third of invasive breast cancers are found in women 55 or older.
• Race and ethnicity: Caucasian women are more likely to be diagnosed with breast cancer, but African-American women are more likely to die from this disease. African-American women are also more likely to be diagnosed at a younger age (under 45).

Research has also shown that a healthy lifestyle and maintenance of a normal weight, including a well-balanced diet and regular exercise, may reduce breast cancer risk.

Breast cancer risk may also be reduced by prophylactic methods, such as taking estrogen blockers, and undergoing a mastectomy and/or oophorectomy (surgical removal of the breasts and ovaries, respectively.) These methods are typically for women with a greatly elevated risk of developing breast cancer, such as BRCA mutation carriers.

Sources: National Cancer Institute and American Cancer Society

LEARN MORE ABOUT BREAST CANCER RISK REDUCTION
 

Breast Cancer Screenings: What You Should Know

What should you know about breast cancer screening? Whatever your risk level, it’s important to know your options so you can spot abnormalities early and treat them properly. City of Hope's Monique White-Dominguez, D.O., discusses the current options and recommendations.

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If your monthly breast self-exam happens in the shower — sporadically — and involves a quick once-over of your breasts, you may be missing some important elements of an effective exam. City of Hope breast surgeon Laura Kruper, M.D., M.S., offers tips for a more effective exam.

Six things women can do to reduce their risk for breast cancer

There are many factors for breast cancer that can be reduced through simple lifestyle and behavior changes. Joanne Mortimer, M.D., encourages women to take the following steps to minimize their chance of getting breast cancer.

Insulin and breast cancer risk? Connection may be stronger than weight

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Diagnosing breast cancer

Precise breast cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of breast cancer.

Highlights of our screening and diagnosis services include:

• 3-D mammography to better detect and locate breast cancer
• Genetic screening, testing and counseling for women with high breast cancer risk
• MRI (magnetic resonance imaging) and ultrasound for women with dense breasts or elevated risk
• Stereotactic biopsy, which uses computer-assisted imaging to accurately guide removal of suspicious tissue

Many of these tests are conveniently offered at our Women’s Center.

How is breast cancer detected?

Once you notice changes in your breast, or as part of a routine breast screening, your doctor may use the following tests to look for breast cancer:

• Physical exam
• Clinical breast examination
• Mammogram: An X-ray of the breast
• Ultrasound: Imaging the breast using high-energy sound waves
• MRI: Imaging the breast using radio waves, magnetic fields and computer imaging; more powerful and detailed than a mammogram, this test is recommended for women with above-average breast cancer risk
• Biopsy: Surgical removal of suspicious tissues for further examination
• Genetic screening: Women with elevated risk factors (such as a family history of breast cancer) may undergo genetic screening to see if they have mutations that put them at higher risk for developing the disease.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

• Receptor testing: These tests examine the cancerous tissue to see if the growth of the cancer is driven by hormones, estrogen and progesterone, or the growth factor called HER2/neu, or if it is nonresponsive to all three (also known as triple negative breast cancer). The results can then be used to determine what hormone or drug therapies are most effective against the disease.
• Genetic testing: When a family’s history suggests that an individual may be at a high risk for breast cancer, they are often urged to seek counseling about whether to get tested for gene mutations that might further raise the risk for them and other relatives. Tests consist of analyzing a blood or saliva sample for any genetic abnormalities. If abnormalities are detected, a genetic counselor can offer possible next steps, including increased screening, risk-reducing hormonal therapy or, in some cases, risk-reducing surgery.
  • BRCA1 and BRCA 2 - About 5 to 10 percent of breast cancer cases are thought to result from gene defects – or mutations – that are passed down from a parent. The most common and highest-risk types are inherited mutations in the BRCA1 and BRCA2 genes. Usually, these genes help prevent cells from growing abnormally. However, mutated versions of these genes cannot stop abnormal growth, which can lead to cancer. Cancers linked to BRCA1 and BRCA2 mutations are more often found in younger women and in both breasts. There is also a higher risk of developing other cancers, particularly ovarian cancer.
• CT (computed tomography) or CAT scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and number. Special dyes may be used to enhance this scan.
• Lymph node biopsy: Removal and examination of lymph nodes near the breast to see if the cancer has spread.
  • Axillary lymph node dissection: There are three levels of axillary lymph nodes — the nodes in the underarm or "axilla" area of a woman’s body. In a traditional axillary lymph node dissection, the first two levels of nodes are surgically removed. Once removed, they are dissected and examined to determine whether the cancer has spread and to what extent. For women with invasive breast cancer, this procedure accompanies a mastectomy. For those undergoing a lumpectomy, it may be done during or after the procedure.
  • Sentinel lymph node biopsy: Another method of determining if the cancer has spread to the lymph nodes is a sentinel lymph node biopsy. First, the surgeon identifies the sentinel lymph node (or nodes) closest to the tumor by injecting a dye or radioactive substance into the tissue near the tumor. During surgery, the marked lymph nodes will be removed and checked for the presence of cancer cells.
• Chest X-ray: An X-ray of the chest area to determine size, location and number of tumors
• Bone scan: A procedure using a small amount of radioactive material to determine if breast cancer cells have spread to the bones
• Positron emission tomography (PET) scan: A test that uses a small amount of radioactive glucose material and a PET scanner to locate cancer cells throughout the body.

Based on the results of these tests, the breast cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs.

Care for high-risk breast cancer patients

The majority of breast cancers occur because of a combination of risk factors. Increasing age is one important element, with most breast cancers occurring in women 55 years of age and older. Other factors include early onset of the first menstrual period, a late first pregnancy and no pregnancy at all. Also heightening the risk are taking prescription estrogen replacement (especially after menopause), high alcohol consumption, obesity, low amounts of exercise and dense breast tissue. Women with these risk factors need to consult with their physicians about how often to be screened for breast cancer and by which methods.

Those with a family history of breast or ovarian cancer should discuss genetic counseling and testing with their doctors. As much as 10 percent of breast cancer cases are linked to inherited genetic mutations, such as those on the BRCA1, BRCA2 or PALB2 genes. A cancer risk counselor with training in cancer genetics can advise these patients about testing and treatment options. If genetic mutations are found, some patients choose to take drugs that block estrogen in breast cells, while others may choose to have surgery to remove their breasts and ovaries in order to significantly reduce the risk of developing breast or ovarian cancer.

Geriatric breast cancer care

A diagnosis of cancer is difficult at any age, but older patients face unique challenges, including increased risk of drug reactions and the presence of additional health conditions. Serious health conditions that are more common in adults over 65 and factor into cancer care include high blood pressure, heart disease, lung disease, diabetes, kidney disease and arthritis. These chronic health problems may affect or be affected by breast cancer treatment in the following ways: reactions between cancer drugs and other medications; cancer or cancer treatment making chronic health problems worse; chronic health problems interrupting cancer treatment or forcing a change in cancer treatment; and slower recovery from cancer treatment due to another health problem.

City of Hope has developed a questionnaire that assesses older patients’ functional age so that cancer-treatment recommendations can be tailored to each individual. In addition to consulting with doctors, pharmacists and other medical professionals while receiving cancer treatments, older patients should seek support from family members and social service agencies when needed to help manage cancer care, other medical conditions and activities of daily living.

Young adult breast cancer care

While most breast cancers are found in women age 50 or older, according to the Centers for Disease Control about 11 percent of all new cases of breast cancer in the United States are found in women younger than 45 years of age. Younger women may be at higher risk for the disease if they have close relatives who were diagnosed with breast or ovarian cancer (particularly at age 45 or younger), have changes in certain breast cancer genes (BRCA1 and BRCA2), are of Ashkenazi Jewish heritage, were treated with radiation therapy to the breast or chest in childhood or early adulthood, or previously have had breast cancer or other breast health problems.

Diagnosing breast cancer in women under 40 years -old is often more difficult because their breast tissue is generally more dense than that of older women. The disease may also be more aggressive in younger women, and therefore difficult to treat. Women who are diagnosed with breast cancer at a younger age are more likely to have an altered BRCA1 or BRCA2 gene.

Younger women who have breast cancer can face additional challenges, including issues related to sexuality, fertility and pregnancy after breast cancer treatment. As with older women, treatment is based on the extent of the person's disease, the woman's general health and personal circumstances.
 

Who should get screened for breast cancer?

The current American Cancer Society screening recommendations for women with average breast cancer risk are:

• Women between ages 40 to 44 should consider beginning annual mammograms.
• Women between ages 45 to 54 should get annual mammograms.
• Women age 55 or older should switch to mammograms every two years, or have the choice to continue annual screening.

For women with high breast cancer risk, the American Cancer Society recommends:

• Beginning annual screening mammograms at an earlier age
• Screening with MRI in addition to annual mammograms

LEARN MORE ABOUT BREAST CANCER SCREENING
 

Breast Cancer Screenings: What You Should Know

What should you know about breast cancer screening? Whatever your risk level, it’s important to know your options so you can spot abnormalities early and treat them properly. City of Hope's Monique White-Dominguez, D.O., discusses the current options and recommendations.

Men and Breast Cancer: Should You Be Tested?

What many people don’t realize is that men, too, can experience breast cancer. Though much rarer in men than in women, about 2,470 new cases of male breast cancer will be diagnosed in 2017, according to the American Cancer Society.

5 Steps to a Better Breast Self-exam (w/Video)

If your monthly breast self-exam happens in the shower — sporadically — and involves a quick once-over of your breasts, you may be missing some important elements of an effective exam. City of Hope breast surgeon Laura Kruper, M.D., M.S., offers tips for a more effective exam.

Six things women can do to reduce their risk for breast cancer

There are many factors for breast cancer that can be reduced through simple lifestyle and behavior changes. Joanne Mortimer, M.D., encourages women to take the following steps to minimize their chance of getting breast cancer.

 

Breast cancer treatment options

City of Hope provides leading- edge, compassionate treatment with a team approach where the patient and her family are at the center of the team.”  Joanne Mortimer, M.D., Director, Women’s Cancers Program

Your breast cancer is every bit as unique as you are, and that is why breast cancer treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat breast cancer include:

Surgery

Not only do I help women take care of their breast cancer, but I also try to make it look like no one has been there.”  Laura Kruper, M.D., M.S., Head, Breast Surgery Service

Surgery is a common treatment option for most breast cancer patients. Depending on the tumor’s size, location and spread, the procedure performed may be a

• Lumpectomy (removal of the tumor, surrounding breast tissue and possibly nearby lymph nodes). Often an option for women with small, early-stage tumors, lumpectomy seeks to conserve as much of the breast as possible. The part of the breast containing the cancer is removed, as well as some surrounding normal tissue and sometimes the lymph nodes. Afterward, radiation therapy is recommended for most women, and some may receive other treatments as well, such as hormone therapy or chemotherapy.  
• Mastectomy (removal of one or both breasts, along with nearby lymph nodes). Mastectomies may also be performed as a risk reduction procedure for women with a high risk of developing breast cancer.

City of Hope offers the latest advances in surgical approaches to treating breast cancer. Our leading-edge technology and our surgeons’ expertise means you can achieve outstanding outcomes that are not possible elsewhere. This includes breast cancer surgeries with fewer and smaller incisions, reducing discomfort and recovery time. Our minimally invasive approach also allows patients to be treated sooner with postsurgery treatments, such as follow-up radiation and drug therapy.

Our team is also experienced in breast-conserving surgery, which can remove early stage tumors while achieving excellent cosmetic outcomes. This procedure can be done with larger tumors as well, by shrinking the tumor with chemotherapy before the surgery.

For more extensive procedures, our breast surgeons will work in conjunction with our plastic surgery team. This includes combining skin- and nipple-sparing mastectomies with breast reconstruction in one operation, preserving or restoring breast appearance without compromising health outcomes.

What is a nipple-sparing mastectomy?

In this procedure, the cancerous breast tissue is removed, but the breast skin and nipple are left in place. Often, the surgeon also removes the breast tissue beneath the nipple along with the areola — the pigmented skin surrounding the nipple – to check for any remaining cancer cells. Sometimes the nipple tissue is given a dose of radiation during or after the surgery to reduce the risk of the cancer coming back. Breast reconstruction follows the surgery.

What is a skin-sparing mastectomy?

Seeking to preserve as much of the breast skin as possible, this technique removes the inner breast tissue and nipple, leaving an envelope of skin in place. The remaining shell is filled with the woman’s own tissue from other parts of her body or an artificial implant during breast reconstruction, which typically takes place during or soon after the mastectomy. 

Breast reconstruction

There are several options for breast reconstruction, which rebuilds the shape of the breast after a mastectomy. Some of these procedures are done, or started, at the same time as the mastectomy, and others are done later. Although the breast shape is restored, sensation in the breast and the nipple usually remains limited. In place of reconstruction, some women prefer to wear breast forms inside their bra or attached to their body, while others choose to have a flat chest.

• The uninvolved breast: When women have reconstruction on a cancerous breast following a mastectomy, sometimes plastic surgery is also performed on the healthy breast so that the shape of the two breasts will match.
   
• Oncoplastic and breast reconstruction: Oncoplastic surgery combines cancer surgery and plastic surgery techniques. This typically involves reshaping the breast at the time of the initial surgery, such as doing a partial breast reconstruction in conjunction with breast-conserving surgery. Others may choose a full reconstruction after mastectomy. It may mean operating on the other breast as well to make the breasts more alike.

Breast implant placement at the time of mastectomy

Patients who have sufficient breast skin remaining following mastectomy may be well suited for direct-to-implant breast reconstruction. With skin-sparing and nipple-sparing mastectomy techniques gaining popularity, more and more women are now good candidates for this approach.

For patients that are good candidates, direct-to-implant postmastectomy breast reconstruction allows our surgeons to place a breast implant immediately, avoiding the use of a tissue expander. This “one-step” approach can potentially allow patients to awaken from their mastectomy with a well-defined breast shape.

Our plastic surgery team offers reconstruction options with either implants or natural tissue to a wide range of breast cancer patients. These include:

• patients who have had mastectomies in the past
• patients with larger breasts or a higher body mass index, or BMI
• patients who are dissatisfied with their previous reconstructions

For patients with a high risk of developing breast cancer, these appearance-preserving or appearance restoring techniques may also be used after risk reduction surgeries.

LEARN MORE

Life After Breast Cancer

For breast cancer patients, the goal of returning to “normal life” can be a powerful motivating force. But getting back to a regular routine can pose challenges that many women don’t anticipate.

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Tissue-sparing surgery combines tumor removal with breast reconstruction

Not that many years ago, a breast cancer diagnosis inflicted a double shock: learning you had a deadly disease, then realizing how disfiguring the “cure” may be. We've come a very long way since then. Radical mastectomies are rarely performed today.

 

 

Postsurgical therapy/rehabilitation

To decrease the side effects of surgery and aid the return to normal activities, it’s very important that patients talk with their doctor about establishing a safe exercise routine tailored to their individual needs. The physician might suggest seeing a physical or occupational therapist, or a cancer exercise specialist. In addition to improving range of motion and flexibility, exercise can also decrease pain, improve immune function, decrease depression, stress and anxiety, and boost body image and confidence.

After surgery, patients and medical professionals need to stay alert for possible signs of lymphedema — retention of lymph fluid and swelling that can occur after surgery and radiation. Lymphedema usually occurs in the arm and hand, but sometimes in the breast, underarm, chest, trunk and/or back. A variety of treatments and lifestyle changes can be used to improve the flow of fluid. Early diagnosis and treatment of the condition is essential to preventing tissue damage and other long-term side effects.

Radiation therapy as a breast cancer treatment

Radiation therapy uses high-energy rays (such as X-rays) or particles that destroy cancer cells. Some women with breast cancer will need radiation in addition to other treatments, including surgery. The need depends on the type of surgery performed, whether cancer has spread to the lymph nodes or somewhere else in the body, and in some cases, age. Patients may have just one type of radiation or a combination of types.

Situations in which radiation is commonly used:

• After breast-conserving surgery, to help lower the chance that the cancer will come back in the breast or nearby lymph nodes
• After a mastectomy, especially if the cancer was larger than two inches, or if cancer is found in the lymph nodes
• If cancer has spread to other parts of the body, such as the bones or brain.

City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

In addition to standard radiation therapy, which takes place daily over six or seven weeks, patients may also be eligible for hypofractionated radiotherapy — which delivers a higher dose of radiation in a shorter amount of time (four weeks), allowing patients to make fewer visits for treatment and recover faster.

Select breast cancer patients may also be eligible for intraoperative radiation therapy (IORT), which delivers high dose radiation treatment at the time of their breast cancer surgery. This procedure allows patients to skip the usual six-week cycle of radiation following lumpectomy, and may reduce radiation exposure to normal breast tissue.

Drug therapy

Drug therapy may be given to patients to fight breast cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

• Chemotherapy, which targets all rapidly-dividing cells, including breast cancer cells. Chemotherapy treatment consists of cancer-killing drugs that may be injected into a vein or taken by mouth. They travel through the bloodstream to reach cancer cells in most parts of the body. Chemotherapy is often recommended to treat breast cancer in situations that include:
  • After surgery (called adjuvant chemotherapy), to try to kill any cancer cells that may have been left behind or spread but can't be seen
  • Before surgery (called neoadjuvant chemotherapy), when it is often used to treat cancers that are too big to be removed at the time of diagnosis
  • For advanced breast cancer
• Targeted therapy, which selectively attacks cancer cells based on specific characteristics
• Immunotherapy, which stimulates the patient’s own immune system to attack the cancer cells

Drugs may also be prescribed to treat conditions related to breast cancer, such as minimizing bone loss and fracture risk if the cancer has spread to the bones.

The drug or drug combination used depends on the type and stage of breast cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight breast cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.
 

Endocrine (hormone) therapy

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

In addition to standard endocrine therapy treatments, City of Hope patients have access to promising endocrine therapies through our clinical trials program. These innovative therapies may be better at treating endocrine-sensitive breast cancer and/or reduce side effects associated with endocrine therapy.

LEARN MORE
 

For Many Breast Cancer Patients, IORT Is an Attractive Alternative to Traditional Radiation

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Breast cancer 2016: Dramatic advances create revolution in treatment

The evolution of breast cancer treatment has become a revolution thanks to precision medicine, improved screening, and a move to more refined surgical techniques. This momentum will continue in 2016 as advances such as immunotherapy, nipple-sparing surgery, and gene therapy continue to transform the field.

 

Breast cancer research and clinical trials

At City of Hope, breast cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

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 breast cancer fighting compounds in natural products — such as mushrooms, pomegranates and blueberries
• 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 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, such as diet and exercise, and their link to breast cancer risk
• Improving genetic counseling and other support services for women with a high breast cancer risk, so they can be better informed and equipped to make decisions about prevention procedures, such as taking hormone blockers or undergoing risk-reducing surgeries
• Studying survivorship with a focus on quality-of-life issues, prevention of cancer recurrence and, for premenopausal survivors, fertility concerns
• Investigating breast cancer incidence and outcomes disparities among different populations and ways to reduce that disparity through outreach, education and screening efforts in underserved groups

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Breast Cancer Studies Garner $500,000 in Research Grants

Two City of Hope physicians have received yearlong grants from the Breast Cancer Research Foundation, an organization that works to prevent and cure breast cancer by advancing the world's most promising research.

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For breast cancer patients with BRCA gene mutations, compounds called poly ADP ribose (or PAR) can help determine treatment response and clinical outcomes.

Hormonal drugs show promise in preventing early breast cancer’s return

Hormonal drugs can prevent the return of a non-invasive cancer found in cells around the milk ducts. That’s the takeaway message for Joanne Mortimer, M.D., on two studies reported in HealthDay.

 

Living with breast cancer

City of Hope saved me. They saved my baby. They saved my family portrait.”  Stephanie, breast cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your breast cancer treatment.

We can help with all of the following concerns, and more:

• Managing symptoms and side effects, such as pain, lymphedema, nausea and fatigue
• Handling emotional, social and spiritual issues
• Coping with stress
• Navigating the health care system
• Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
• Addressing fertility and intimacy concerns
• Building caregiver skills
• Improving communication with family, partners and loved ones
• Restoring normalcy in your family, job or school routine
• Healing arts workshops to restore the body and mind
• Learning cosmetic techniques for cancer- or treatment-related appearance issues
• Returning to wellness after active treatment

Visit our Living with Cancer or Supportive Care Medicine sites for more information. For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE) or the Women’s Center at 800-934-5555.

LEARN MORE

• Making life easier: 10 tips for breast cancer patients in treatment
• Couples cope best with breast cancer when they cope together
• Breast cancer: The return to wellness begins when treatment ends
• Cancer doctor/patient on life after breast cancer: You must flourish

Follow-up care

Many women are relieved or excited to be finished with breast cancer treatment. However, some worry that their cancer could come back, or feel lost without the same level of care from their cancer-care providers. It’s very important to go to all follow-up appointments, when doctors will ask patients about any problems, and may conduct exams, lab tests or imaging tests to look for signs of cancer or treatment side effects.

Return to Wellness Program

Already  a leader in supportive care of cancer patients, City of Hope has a new program called “Return to Wellness,” designed to tackle that big “What now?” question, one topic at a time.

City of Hope experts lead workshops in nutrition, health monitoring, long-term side effect management, body image, sexuality and intimacy, lymphedema prevention, meditation, spirituality and more. Survivors also participate in weekly strength training, restorative yoga and support group sessions.

“Return to Wellness” is a collaboration with the Cancer Support Community of Pasadena.  The program is open to women who have completed treatment for breast cancer. Survivors need not be City of Hope patients to participate. 

Please call 626-218-CARE (2273) for more information.

Hopeful.org

Hopeful.org is an online community, a space for everyone who has been touched by cancer to make connections, share their stories, offer support and seek advice.

It features new stories weekly on everything from recipes to news about immunotherapy and other groundbreaking treatments. No one should have to go through cancer alone, and Hopeful ensures that every person will have a supportive community to lean on.

To connect with fellow breast cancer fighters, caregivers and supporters alike, join our Community of the Hopeful today.