In the U.S., one in eight women will get breast cancer, which is the most common cancer among Black women and the second most common cancer among white women (after skin cancer) and has slightly lower rates among Hispanic and Asian women.
“There isn’t just one type of breast cancer, and each woman’s situation, goals and concerns are different, so not every woman should receive the same type of treatment,” says Dr. Heather Thieme, a WellSpan breast cancer surgeon and medical director of the breast cancer program. “That’s why WellSpan offers a variety of treatments, from surgery to immunotherapy, to meet every woman’s unique need.”
When breast tissue cells begin to grow abnormally, they can turn into different types of breast cancer.
Possible signs of breast cancer include new lumps in the breasts or armpits, any thickening or swelling in the breasts, any irritation or dimpling of breast skin or redness/flaky skim in the nipple area, pulling in of the nipple or any discharge, or other noticeable changes in the breasts.
WellSpan physicians have a variety of screening tools to detect cancer. Mammograms, or a screening of the breast, are the best tool, and detect up to 87 percent of all cancer. Ultrasounds can be used to evaluate women’s symptoms, particularly masses, or as a follow-up to a specific mammogram finding. Breast MRIs have the highest sensitivity of any test but are used only in select patients who need this type of screening.
While imaging and an exam can show a possible problem, only biopsy can prove it, Thieme says.
“It is best to get the diagnosis from a needle biopsy, when a surgeon uses a long, hollow tube to take a small sample of tissue from the breast,” Thieme says.
Typing and staging
With the information gathered from the biopsy, physicians can plan a treatment, based on the type of cancer and the stage of cancer.
The two most common types of breast cancer are ductal (which starts in the milk ducts) and lobular (which starts in the glands that produce milk.)
“It is vital that physicians diagnose both the type of cancer that a woman has and the stage of that cancer, or how much it has grown and spread,” Thieme says.
Staging looks at the size of the cancer, whether it has spread into nearby tissue (the lymph nodes), and whether it has spread to other parts of the body.
If surgery is warranted, surgeons have a variety of options, depending on the type and stage of cancer. They can opt for breast-conserving surgery, which includes a lumpectomy or a partial mastectomy. Or, if it is warranted, they can do a full mastectomy, which removes all of the breast tissue as well as targets the area where cancer was detected.
“Surgery is often the first line of treatment,” Thieme says, noting that afterward women can choose to have reconstructive surgery, which is covered by insurance, and often can choose the level of surgery they want as well.
“For most breast cancers,” she says, “it is the patient’s choice to keep or remove the whole breast, based on their level of comfort.”
After surgery, possible additional treatments include radiation, which uses high-energy rays (similar to X-rays) to kill the cancer cells. Radiation targets the area where cancer was detected, such as the breast and armpit, or even other areas of the body, such as the spine.
There also are systemic treatments, which treat the entire body. Hormone therapy is done through pills that block cancer cells from getting the hormones they need to grow. Chemotherapy targets the growth of cancer cells. Immunotherapy uses the body's own immune system to identify and fight the cancer.
“Not everyone needs every treatment,” Thieme says. “Your physician will help find the plan that is right for your stage and type of cancer.”
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