Breast Cancers
At West Cancer Center, breast cancer is treated using a team-based approach. Our specialists understand that no two breast cancer cases are alike and work together to develop a personalized treatment plan based on each patient’s unique needs. With more than 2,000 new breast cancer patients seen each year, our physicians bring extensive experience to the care of every patient. Our team is also committed to addressing disparities in breast cancer care and improving outcomes for women of all backgrounds.
Ductal Carcinoma in Situ (DCIS)
Abnormal cells stay inside the milk ducts and do not grow into deeper breast tissue. It is stage 0.
Risk Factors
• Age
• Family history or inherited mutations, such as BRCA1/2
• Prior chest radiation
• Dense breasts
• Certain hormonal or reproductive factors
• DCIS may be detected through screening mammography
Common Symptoms
• Often no symptoms
• Most commonly detected as calcifications on a screening mammogram
• Less commonly detected, a lump or nipple discharge may occur.
Diagnosis
Diagnostic mammogram followed by breast biopsy. Pathology confirms DCIS and evaluates grade and hormone receptor status.
Treatment Options
• Lumpectomy
• Radiation
• Mastectomy (for extensive disease)
• Endocrine Therapy may be offered for hormone receptor-positive DCIS.
Lobular Carcinoma in Situ (LCIS)
Abnormal cell growth happens in the milk-producing lobules. It is a marker for higher general risk.
Risk Factors
• Increasing age
• Family history
• Inherited mutations
• Other breast cancer risk factors
• LCIS is generally a marker of increased future breast cancer risk, rather than an invasive cancer.
Common Symptoms
• Often no symptoms
• Commonly detected incidentally on a biopsy performed for another breast abnormality.
Diagnosis
Breast biopsy with pathology review. Additional imaging and formal breast cancer risk assessment may be recommended.
Treatment Options
• Often surveillance with regular clinical exams and breast imaging
• Risk-reducing endocrine therapy may be considered.
Invasive Ductal Carcinoma (IDC)
Cancer starts in the milk ducts and grows into nearby tissue. It is the most common form.
Risk Factors
• Increasing age
• Family history or inherited mutations
• Dense breasts
• Prior chest radiation
• Certain hormonal or reproductive factors
• Alcohol use
• Excess body weight after menopause
Common Symptoms
• New breast lump or thickening
• Change in breast size or shape
• Skin dimpling
• Nipple changes or discharge
• Enlarged lymph nodes.
• No symptoms
Diagnosis
Diagnostic mammogram and/or ultrasound followed by core needle biopsy. Pathology determines tumor type, grade, hormone receptor and HER2 status. Imaging may assess lymph nodes or spread.
Treatment Options
Treatment depends on stage and tumor biology and may include:
• Surgery
• Radiation
• Endocrine therapy
• Chemotherapy
• HER2-targeted therapy
• Immunotherapy, or other targeted treatments
Invasive Lobular Carcinoma (ILC)
Cancer starts in the milk lobules and spreads into surrounding tissue. It is the second most common form.
Risk Factors
• Increasing age
• Family history
• Inherited mutations
• Prior chest radiation
• Certain hormonal or reproductive factors
Common Symptoms
• Breast thickening or subtle fullness rather than a distinct lump
• Changes in breast size or shape
• Nipple changes
• Abnormal findings on a screening study
Diagnosis
Mammogram and ultrasound, sometimes supplemented by breast MRI, followed by core needle biopsy. Pathology evaluates tumor type and biomarkers including ER, PR, and HER2.
Treatment Options
Treatment is stage- and biomarker-dependent and may include
• Surgery
• Radiation
• Chemotherapy
• Targeted treatment
• Endocrine therapy is important because many ILC tumors are hormone receptor-positive.
Hormone Receptor-Positive (HR+)
Cells use estrogen or progesterone to grow.
Risk Factors
• Risk factors are generally similar to other breast cancers
• HR-positive disease is defined by estrogen and/or progesterone receptor expression
Common Symptoms
• Breast lump
• Breast or nipple changes
• Skin changes
• Enlarged lymph nodes
• Some tumors are found through screening before symptoms develop
Diagnosis
Biopsy with testing for estrogen receptor (ER), progesterone receptor (PR), and HER2. Imaging is used to determine local or distant extent when appropriate.
Treatment Options
Depending on stage and risk, treatments may include:
• Surgery
• Radiation
• Chemotherapy
• Targeted treatment
• Endocrine therapy is a key treatment
HER2-Positive
Cells make too much of the HER2 protein, causing fast growth. Treated with targeted anti-HER2 therapies.
Risk Factors
• Similar with other breast cancers
• HER2-positive disease is defined by increased HER2 protein or gene amplification in the tumor
Common Symptoms
• Breast lump
• Breast swelling
• Breast or nipple changes
• Skin dimpling
• Enlarged lymph nodes
• Some cases are found through screening
Diagnosis
Biopsy with HER2 testing by immunohistochemistry and, when needed, in-situ hybridization. ER and PR are also tested. Imaging helps determine stage when indicated.
Treatment Options
• HER2-targeted therapy, such as trastuzumab
• Often combined with other systemic treatments
• Surgery may be part of treatment depending on stage and response
• Radiation may also be recommended depending on stage and response
Triple-Negative (TNBC)
Cells lack estrogen receptors, progesterone receptors, and extra HER2 protein. It is often more aggressive.
Risk Factors
• Risk factors are similar to other breast cancers
• Inherited BRCA1/2 and other mutations can increase risk
• TNBC lacks ER, PR, and HER2 expression
Common Symptoms
• Breast lump
• Breast swelling
• Breast or nipple changes
• Skin changes
• Enlarged lymph nodes
• Some cancers are detected through screening before symptoms develop
Diagnosis
Core needle biopsy with pathology testing confirming ER, PR, and HER2 status. Imaging assesses tumor size, lymph nodes, and possible spread when appropriate.
Treatment Options
• Chemotherapy
• Surgery
• Radiation
• Immunotherapy for selected patients
• PARP inhibitors or other targeted treatments for selected patients with specific mutations or biomarkers
Inflammatory Breast Cancer (IBC)
A rare and fast-moving cancer that blocks lymph vessels in the skin, making the breast look red and swollen.
Risk Factors
• Increasing age
• Family history
• Inherited mutations
• Other breast cancer risk factors
• IBC is not caused by an infection
Common Symptoms
• Rapid breast swelling
• Redness or discoloration
• Warmth
• Breast heaviness or tenderness
• Peau d’orange (orange-peel skin)
• Breast enlargement
• Nipple changes
• Swollen lymph nodes
• A distinct lump may not be present
Diagnosis
Clinical examination and diagnostic mammography/ultrasound followed by core needle biopsy of the breast and often suspicious lymph nodes. MRI and staging scans are commonly used.
Treatment Options
• Systemic therapy, often including chemotherapy, is typically given first
• HER2-targeted therapy may be added when HER2-positive
• Modified radical mastectomy
• Radiation therapy
• Endocrine, targeted, or immunotherapy may be used based on biomarkers and stage