Breast cancer

Breast cancer is the second most common form of cancer in women. Getting a breast cancer diagnosis can feel overwhelming – but when detected early, breast cancer can often be treated successfully.

The team at Aurora Breast Centers, part of Aurora Cancer Care, is there for you every step of the way. We offer the latest radiologic and cancer care technology, from genetic counseling to better determine your risk, to a range of diagnostic tools, to cancer research that may give you access to the latest treatments.

Aurora Breast Centers are accredited by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. NAPBC accreditation requires that a center has successfully completed a rigorous application process and survey, and it meets the criteria for 27 standards in such categories as leadership, clinical management, research, community outreach, professional education and quality improvement.

Breast cancer types

Breast cancer types can be described in many ways, including by where they occur and whether they are invasive. Most breast cancers start in the milk lobules (glands in the breast that make milk) or in the milk ducts (tubes that carry milk from the lobules to the nipple). Cancers are considered invasive when they grow beyond where they started into other parts of the breast tissue.

The four main types of breast cancer are ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), lobular carcinoma in situ (LCIS) and invasive lobular carcinoma (ILC). The most common breast cancer types in women and men are invasive ductal carcinomas and invasive lobular carcinomas. These types of breast cancer are possible in women and men. Learn about breast cancer in men.

Symptoms of breast cancer

The most common early symptoms of breast cancer are new lumps or masses in your breast. Other symptoms of breast cancer may include:

• A change in how the breast or nipple feels, including tenderness, a lump in the breast or in the armpit or a change in skin texture
• A change in breast or nipple appearance, including size, dimpling, swelling, shrinking, asymmetry or inverted nipples
• Spontaneous or bloody nipple discharge
• Pain in the breast or nipple
• Swollen lymph nodes under the arm or near the collar bone

Sometimes there are no early symptoms of breast cancer.

Risk factors for breast cancer

Lifestyle and biological factors that increase the risk of breast cancer include:

• Alcohol consumption
• Dense breast tissue
• History of breast cancer or benign breast disease
• History of hormone replacement therapy
• Life events that raised levels of estrogen
  • No births
  • Older age at first birth
  • Older age at start of menopause
  • Younger age of first menstruation
• Obesity
• Older age
• Past radiation therapy to the breast or chest

Find more in-depth, evidence-based lifestyle recommendations that can help reduce your risk of developing breast cancer in our breast cancer risk reduction booklet [PDF].

Is breast cancer genetic?

Breast cancer may have genetic causes including some that are inherited. According to the CDC, 5% to 10% of breast cancers are hereditary.

Screening for signs of breast cancer

Screening mammograms

Mammograms are the most commonly used screening for signs of breast cancer.

When you’re 25, we recommend that you talk to your doctor about your family history of breast cancer. Your doctor will assess if you’re average, intermediate or high risk for breast cancer and may give you a referral to a high-risk breast clinic or a genetics counselor if it’s appropriate.

At age 40, talk with your primary care doctor about establishing a screening mammogram plan. Together, you and your provider can develop a plan based on your individual risk factors, personal preferences, and your provider’s recommendation.

Other imaging tools for breast cancer

Additional imaging tools used to detect signs of breast cancer and figure out its type and extent include:

• Tomosynthesis: A three-dimensional mammogram.
• Breast ultrasound: An ultrasound is often used to precisely position biopsy needles and to determine if abnormalities found on a mammogram solid or fluid filled.
• MRI (magnetic resonance imaging): An MRI may be used with mammography for improved breast cancer detection, to determine the extent of the disease and to monitor breast cancer therapy.
• PET/CT: This technology is helpful in defining areas where breast cancers have metastasized (spread to other areas).
• Ductoscopy: This procedure involves inserting a very small video scope into a milk duct so doctors can examine the affected duct and find areas to biopsy. It’s used to evaluate women with abnormal nipple discharge.

After a biopsy or the removal of a lump, the tissue that was removed may be tested for:

• Hormone receptors: A hormone receptor is a cell protein that binds to a hormone. The hormones estrogen and progesterone may help some cancer cells grow. If your breast cancer cells have too many hormone receptors for estrogen or progesterone, we can treat those cells with medicine that reduces or blocks estrogen in your body.
• HER-2 status (sometimes referred to as ErbB2): HER-2 is a gene that helps control how cells grow, divide and repair themselves. About one in four breast cancers have too many copies of the HER-2 gene. These cancers tend to grow quickly. Anti-HER-2 antibody therapy is often very effective against them.

High-risk breast clinics

To help you understand your risk of developing breast cancer, your doctor may calculate your Tyrer-Cuzik score. The Tyrer-Cuzik model takes your age, breast health history, family healthy history and other factors into consideration to help determine your likelihood of developing breast cancer within the next 10 years. The model also estimates your lifetime risk of breast cancer. If your score is great than 20%, you’re typically considered high risk.

Aurora’s high-risk breast clinics offer education and resources to help you monitor your breast health and cancer risk, including:

• Additional screening recommendations such as MRIs and ultrasounds
• Further evaluation of genetic risk due to family history of breast cancer, genetic mutations, and breast conditions such as atypical ductal hyperplasia, atypical lobular hyperplasia, ductal carcinoma in situ and lobular carcinoma in situ
• Preventive measures such as lifestyle modifications (e.g., smoking cessation and dietary changes)
• Preventive treatment options such as chemoprevention

Our clinics’ interdisciplinary teams combine the expertise of breast surgeons and breast surgery advanced practice clinicians, oncology advanced practice clinicians, genetic counselors, dieticians and local weight management resources.

If you have a high risk of breast cancer, ask your doctor about a referral to a high-risk breast clinic.

Services for breast cancer

If tests indicate breast cancer in addition to symptoms of breast cancer, your doctor will discuss breast cancer treatment options with you.

Surgical treatment options include:

• Breast conservation: A surgeon removes the breast cancer, a little normal breast tissue around the lump and usually some lymph nodes under the arm.
• Total mastectomy: Removal of breast tissue. A total mastectomy is needed when cancer is found in more than one area of your breast, if your breast is too small or shaped in such a way that removing the cancer will leave little breast tissue or deformed breast, or if you can’t have radiation therapy. Skin-sparing and nipple-sparing mastectomies may be offered, depending on the proximity of the tumor to those structures.
• Modified radical mastectomy: Removal of as much breast tissue as possible, the nipple, some of the overlying skin and lymph nodes in the armpit.
• Intraoperative radiation therapy (IORT): Delivers radiation into an open incision after surgery has finished. After the radiation treatment is done, the surgeon closes the incision.

Additional options, which may be paired with surgery, include:

• Radiation therapy: Breast conservation surgery is usually followed by radiation therapy. Radiation therapy can be given either to the whole breast or a focused area, called brachytherapy. Intraoperative radiation therapy (IORT) is offered in some locations. Check with your provider.
• Chemotherapy: Chemotherapy can prevent cancer from coming back in women who are newly diagnosed, control the disease when found in other places in the body and control the disease in women whose cancer has come back after previous treatment.
• Hormone therapy: If tests determine the cancer is sensitive to estrogen or progesterone you may be given medication that prevents your body’s natural hormones from reaching the cancer.

Reconstructive cosmetic surgery

If you choose to have reconstructive cosmetic surgery after breast cancer treatments, we offer:

• Anaplastic surgery: Breast-conserving surgery in combination with plastic surgery techniques, such as reduction mammoplasty, which may give a more natural appearance.
• Breast reconstruction: This surgery uses silicone or saline implants to reconstruct a breast. Or the surgeon may use muscle, fat and skin from other parts of your body. Though you won’t get a breast with all the natural feelings, this kind of surgery can give you a result that looks like a breast.
• Fitting services for breast forms: Breast forms come in a variety of shapes and sizes and fit into specially designed lingerie. They help you maintain your balance and avoid upper back and neck pain. Breast forms may help you feel more self-confident.

Life beyond breast cancer

At Aurora, we offer support systems to help you live well beyond your breast cancer treatment. From guidance and education on breast cancer symptoms and treatment, to helping you take a proactive role in your own health care – our support systems are here to help you with your ongoing journey beyond cancer.