Breast Cancer


Breast cancer is the most commonly diagnosed cancer in women in the United States. The incidence of breast cancer in the US has been decreasing since 2000, after increasing over the previous two decades. Ninety-nine percent of breast cancers occur in women, although men can also be at risk for breast cancer.

Mammography is the most effective tool used for breast cancer screening today.  In the past, yearly mammograms were recommended in all women after the age of 40.  However, several major health organizations have recently come out with new recommendations that tailor a woman’s screening schedule to her age and overall risk of breast cancer. For higher risk patients, breast MRI may also be recommended in addition to mammography.

The majority of women diagnosed with breast cancer on a mammogram will not have any clinical symptoms.  In those patients who do present with symptoms, the most common symptom is a palpable lump. Other signs can include swelling of the breast, redness of the nipple or skin, skin dimpling, nipple discharge, or nipple inversion.

Risk factors for breast cancer include age, family history, and exposure to estrogen, such as long-term use of hormone replacement therapy after menopause or oral contraceptives.  There is also increasing evidence that lifestyle plays a role in breast cancer risk, with obesity, poor diet, lack of exercise, and alcohol use placing women at increased risk.  Most women diagnosed with a new breast cancer do not have a family history of breast cancers. However, patients with an extensive family history of breast and ovarian cancer may require genetic testing to rule out syndromes that may place them at increased risk for these cancers.

A breast cancer diagnosis is usually made with a biopsy. This is commonly performed under ultrasound, mammographic, or MRI guidance. Once the diagnosis is made, further staging studies such as CT scan, PET scan, or bone scan may be recommended.

Women with early stage tumors usually have the option of pursuing breast conservation surgery (lumpectomy) or mastectomy (removal of the entire breast). In most patients undergoing lumpectomy, radiation therapy will be recommended to the remaining breast to reduce the risk of local recurrence.  In patients who undergo mastectomy, radiation therapy is recommended in high risk cases, such as those with large tumor size or multiple positive lymph nodes.

In the event that chemotherapy is recommended, the radiation is usually deferred until after the chemotherapy is complete. Your medical oncologist will review the risks, benefits, and side effects of a course of chemotherapy with you if it is recommended. 

External beam radiation is typically delivered to the remaining breast or chest wall over a 5 to 7 week course of treatment, Monday through Friday. Each treatment lasts 5 to 10 minutes.  Breast radiation is usually very well tolerated, but may include fatigue, skin burning, skin peeling or blistering, and shooting pains within the breast tissue. Your radiation oncologist will monitor your symptoms closely during treatment and recommend medications as needed.

In select cases, a shorter course of partial breast treatment may be recommended to the tumor bed in lieu of a 5 to7 week course of radiation.  Partial breast treatments are typically delivered over a 5 day course with two treatments each day for a total of 10 treatments. Your radiation oncologist will evaluate your situation to determine whether this is an appropriate treatment option for you. Mammosite is one example of a brachytherapy treatment and is offered at several of our treatment centers. For more information, you can visit the link below.

For patients with left-sided breast cancer, a special device may be used to help a woman hold her breath during radiation treatments.  This helps to increase the distance between the heart and the breast, which in turn decreases the dose of radiation to the heart.  This device has the potential to decrease long-term effects of radiation on the heart.  The ABC, or Active Breathing Coordinator, is a type of device used for this purpose and is offered at our Sharp Memorial treatment center.  For more information on the device, please visit the link below.

Following radiation for breast cancer, the treated breast may have a slightly different appearance and texture. In many cases, patients will be recommended to take a 5 year course of hormone suppression therapy to reduce the chance of tumor recurrence or the development of a new breast cancer. Your medical oncologist will discuss the risks of this therapy with you.  You will be followed with regular breast exams and annual imaging.

For more information about MammoSite, please visit their web site.

* MammoSite Targeted Radiation Therapy        

* Active Breathing Coordinator