Breast Cancer

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Our patients with breast cancer are treated at the Moores Breast Cancer Unit. See the Breast Cancer Unit for more information.

You can also review the tabs at top of this page for information on breast cancer symptoms and risks, diagnosis, and treatment.

Symptoms

• Breast lump, thickening, swelling, distortion, or tenderness
• Skin irritation or dimpling
• Nipple pain, scaliness, or retraction

Note: Breast pain is very commonly due to benign conditions and is not usually the first symptom of breast cancer. The earliest sign of breast cancer is usually an abnormality on a mammogram.

Risks

• Age (risk increases with age)
• Personal or family history of breast cancer
• Biopsy-confirmed atypical hyperplasia
• Long menstrual history (menstrual periods that started early and ended late in life)
• Recent use of oral contraceptives or postmenopausal estrogens among women who have never had children or had their first child after age 30
• Treatment with radiation therapy to the breast or chest
• Breast tissue that is dense on a mammogram
• Consumption of two or more alcoholic drinks daily
• Higher education and socioeconomic status

• Variations in diet, especially fat intake
• Pesticide and other chemical exposures
• Weight gain
• Induced abortion
• Physical inactivity
• Selective estrogen-receptor modulators (SERMS) such as tamoxifen and raloxifene

Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease.

Mammography is especially valuable as an early diagnostic tool because it can identify breast abnormalities that may be cancer at an early stage before physical symptoms develop. Numerous studies have shown that early detection increases survival and treatment options. The large declines in breast cancer mortality have been attributed, in part, to the use of regular screening mammography.

The American Cancer Society recommends that yearly mammograms start at age 40 and continue for as long as a woman is in good health. A clinical breast exam (CBE) by a health care professional is recommended about every 3 years for women in their 20s and 30s, and these women should also perform a monthly breast self-examination.

Most breast lumps are not cancer, but only a physician can make a diagnosis. When a woman has a suspicious lump or when a suspicious area is identified on a mammogram, diagnostic mammography can help determine whether additional tests are needed and if there are other lesions that are too small to be felt in the same or the opposite breast. All suspicious lumps should be biopsied for a definitive diagnosis.

Nonsurgical Treatments

Many patients may not require surgical intervention and will be given recommendations for radiation therapy, chemotherapy, hormone therapy, immunotherapy, biological therapy or a combination of several of these modalities.

What Happens After Surgery

Your medical oncologist will meet with you shortly after your surgery, usually within a week and often on the same day as your post-operative appointment with your surgeon. At this time, we will have more definitive pathology results and a better profile of your cancer. Your case likely will have been discussed at the Weekly Breast Conference.

At this appointment, you’ll have as long as you need to discuss the findings and your options. Your doctor will review with you:

• Definitive surgical results
• Amount of cancer found during surgery
• Extent of involvement, if any, of lymph nodes or other organs
• In-depth findings of the pathology (cancer cells)
• Composition and type of cancer
• Stage of the cancer
• Probability of living free of disease through surgery alone
• Options for hormonal therapy or chemotherapy
• Options for radiation therapy
• Additional imaging studies indicated, if any
• Impacts of standard therapies as well as new therapies
• Risks of recurrence
• Novel therapies or clinical trials for which you qualify
• Impacts of treatment on fertility and premature menopause
• Lifestyle changes and recommendations
• Strategies and resources for dealing with pain, depression, side effects
• Your questions and concerns
• This visit is an opportunity for you to learn as much as you need and want to know about your disease and the options for your treatment.

Therapy Begins: Let Your Nurse Case Manager Help See You Through

Once your course to recovery is charted, you’ll be assigned a nurse case manager who will help coordinate your care, answer your questions and hook you up to the resources you’ll need. Our Breast Cancer Unit nursing team members have specialized training and certification in oncology nursing, so they are attuned to the special needs of breast cancer patients.

“We can usually answer the question before it’s asked,” said Deborah Noell, R.N., BSN, OCN, who has worked with breast cancer patients for 17 years. “We triage with patients on a daily basis. We have the ability and the knowledge base to know what needs to be taken care of and expedited. We can allay anxiety and counsel patients, intervene early on with psychosocial issues and coordinate support groups and social services.”

Allow our nursing team to tackle your issues and concerns. Let them help you navigate our system so you can make the most of the many resources available to you. They will accompany you throughout the course of your treatment and follow-up care, which often continues for several years, so “you’ve got a friend” to walk you through it.

Radiation Oncology

If your treatment plan includes radiation therapy, UCSD’s advanced technologies include state-of-the-art linear accelerators. These image-guided radiation therapy systems offer virtually unmatched precision, power and speed in pinpointing and destroying tumors. With this high degree of selectivity in targeting cancer cells, you’ll benefit from less damage to healthy cells, fewer complications and faster treatments.

Infusion Therapy

Today’s chemotherapy drugs are often medicines you can take at home. If you need infusion therapy, which is a course of drugs delivered intravenously, you’ll come to our Infusion Center. You’ll see windows overlooking a garden and comfortable chairs that let you put up your feet as you read a book, chat with a family member or talk to other patients. You can pull a privacy curtain if you prefer or you can stroll outside and sit in the garden during your therapy. The center provides snacks or you can bring your own luncheon with you or purchase something from the coffee cart.

Infusion Center nurses can equip you with a central catheter line for your safety and convenience. If you’re having regular treatment or need frequent blood draws, this option may be more comfortable and efficient for you.

Clinical Trials

In addition to standard approaches to treating your breast cancer, you may qualify for a clinical trial, which is a final stage of research that involves patient participation in the most promising therapies and advanced technologies. Your physician will advise you if you quality for one or more of the studies currently being conducted.

For information about the kinds of things we’re discovering at Moores UCSD Cancer Center in the area of breast cancer research, visit Clinical Trials.