City of Hope treated me as a person. I wasn’t just a patient, a chart. I mattered.” Kommah, breast cancer survivor
Breast cancer is a disease in which breast tissue cells start growing abnormally and uncontrollably. In the U.S., breast cancer is the second most common cancer in women after skin cancer. It can occur in both men and women, but it is rare in men.
If you have been recently diagnosed with breast cancer, or you've been told you may be at high risk of developing it, talk to the specialists at City of Hope. Our integrated team of professionals will guide you and your loved ones through each step of the journey, from diagnosis to treatment to recovery and survivorship.
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To make an appointment or to get a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.
City of Hope, located near Los Angeles, California, is a nationally recognized leader in the research and treatment of breast cancer. We have been named a best hospital for cancer by U.S. News & World Report for over a decade and a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education.
As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based breast cancer treatment guidelines for patients throughout the country.
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Breast cancer is a disease in which breast tissue cells start growing abnormally and uncontrollably.
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.
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.
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.
The most common symptoms of breast cancer include:
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
Screening for breast cancer has dramatically increased the number of cancers found before they cause symptoms – catching the disease when it is most treatable and curable. If you notice a change in your breast, such as a lump or clear discharge, check with your doctor immediately.
Factors that can elevate risk breast cancer risk include:
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
A daily dose of aspirin can do more than just help lower the risk of heart disease and stroke. Turns out, the benefits of aspirin can also include cancer prevention.
Researcher James Lacey Jr., Ph.D., wants to pool data from the California Teachers Study and other studies to create a personalized prevention tool.
City of Hope, along with the National Urban league, Anthem and Pfizer, launched Take Action for Health, a free website aimed at reducing the greatest health risks facing the African-American community today: breast cancer, heart disease and emotional well-being.
Young women who eat high amounts of saturated fat or lower amounts of healthy fat have denser breasts 15 years later, according to a new study. The findings were reviewed by breast surgeon, Laura Kruper, M.D., M.S., director of the Women's Center.
October may be National Breast Cancer Awareness Month, but breast cancer awareness should really be top-of-mind throughout the year. Here are the most important symptoms, statistics, risk factors and risk reducers worth remembering all year long.
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.
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:
Many of these tests are conveniently offered at our Women’s Center.
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:
If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:
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.
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.
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.
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.
The current American Cancer Society screening recommendations for women with average breast cancer risk are:
For women with high breast cancer risk, the American Cancer Society recommends:
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.
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:
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
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.
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.
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.
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.
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:
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.
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 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:
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, 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 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:
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.
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.
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.
City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat breast cancer, coupled with our enduring belief in providing unparalleled compassionate care.
Breast Cancer Research
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:
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:
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.
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.
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 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.
Amelia Tena has made it her mission to become an advocate and mentor for people living with cancer.
Don sports his pink City of Hope breast cancer awareness pin wherever he goes – spreading the message of early detection as he enlists new recruits in his personal war on cancer.
“You deserve a doctor you feel confident in and who you believe is invested in your care. That’s why I chose Dr. Somlo and City of Hope.”
For breast cancer survivor Kommah McDowell, a second opinion at City of Hope made all the difference for her and her family…
“City of Hope saved me. They saved my baby. They saved my family portrait.”