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Your Health

Breast cancer: Finding the right treatment for patients

In the Bay Area, one out of eight women will receive a diagnosis of breast cancer. I meet people affected by this disease wherever I go – in the clinic and hospital where I work, at the non-profit Breast Cancer Connections where I volunteer, at PTA meetings and in the grocery store.

When a patient is diagnosed with breast cancer, she’s often scared and worried, and she usually feels overwhelmed and confused about her next steps. Part of my job is to provide support and counsel regarding treatment options. There’s no one right answer or treatment, but I can help a patient navigate through all the information and settle on a decision that’s right for her.

Breast cancer generally forms in the ducts that carry milk to the nipple, or in the glands that make milk. Risk factors include age, race (Caucasians are at the highest risk), having a personal or family history of breast cancer, receiving radiation therapy to the chest area, having dense breast tissue, taking hormone replacement therapy and drinking alcoholic beverages. Other quantifiable risk factors include menstruating at an early age, giving birth at a late age or not giving birth at all.

 

Symptoms

Many women with early breast cancer show no symptoms. But as the cancer grows, the breast’s appearance may change. This may include:

• A lump or thickening of tissue either in or near the breast or under the arm.

• Changes in breast shape or size.

• A dimpled or puckered appearance on the breast.

• An inverted nipple.

• Clear or bloody discharge from the nipple.

• Scaly, red or swollen skin on the breast or nipple.

These symptoms could be caused by other health conditions and don’t always lead to a cancer diagnosis, but it’s better to be safe than sorry. A woman with any of these symptoms should see a doctor right away.

Because early breast cancer often has no symptoms, regular screening is very important. This includes performing breast self-exams, undergoing annual manual breast examinations by your doctor and having routine mammograms as recommended by your doctor.

Breast cancer stages range from 0 to IV. Breast cancer composed of cancer cells that have stayed within the ducts and have not gone into other breast tissue is called noninvasive breast cancer and is considered stage 0.

Cancer that has begun to spread from the ducts or lobules where it developed to other parts of the breast tissue is called invasive breast cancer. Invasive cancer is staged from I to IV; staging depends on tumor size, spread to lymph nodes and spread to other parts of the body.

When breast cancer is diagnosed, the patient is referred to specialists who will discuss treatment options. Treatment is based on many factors, including cancer type and stage. Common options include local treatments (such as surgical removal of the cancerous tissue, lymph-node procedures and radiation therapy) and systemic therapy (such as chemotherapy, hormone therapy and targeted therapies such as Herceptin).

Given the complexity of treatment, women need to see various specialists, such as a surgeon, radiation oncologist or medical oncologist. Coordinated care among these specialists is called “multidisciplinary care.” Physicians regularly gather in meetings dubbed “tumor boards” to discuss treatment recommendations for cancer. When various specialists see a woman in one place at one visit, it is called a “multidisciplinary clinic.” A treatment team usually includes a nurse educator or navigator and may also include a nutritionist, social worker, physiotherapist and others who work to help the patient maintain a sense of well-being.

 

Removal and reconstruction

Surgical removal falls into two categories. The first is breast-conservation surgery (also known as lumpectomy, partial mastectomy or segmental mastectomy). This is removal of the cancer with a rim of normal tissue around it. The second is mastectomy, which is removal of the entire breast. Women who have a mastectomy often undergo reconstruction at the same time. Reconstruction falls into two categories: implant-type reconstruction and tissue-transfer reconstruction.

After treatment, it’s very important that women continue to have regular care to check for the return or spread of breast cancer. It’s also important for women to receive the necessary support to return to a healthy, active lifestyle and regain emotional strength.

Receiving a diagnosis of breast cancer can be scary for women and their families, but the good news is that there are many treatments available to fight the various types and stages of this disease. I feel very fortunate to serve the women of this community by helping them make educated decisions about their treatment.

Dr. Runi Chattopadhyay is a breast surgical oncologist at the Palo Alto Medical Foundation.

The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

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