Breast cancer is a type of cancer that starts in the tissues of the breast. Excluding skin cancers, breast cancer is the most frequently diagnosed cancer in women. Regular screening mammograms are routine for women who don't have any breast cancer symptoms. Mammograms can detect early changes in breast tissue and treat breast cancer in its earliest, most treatable stages.
Women should see their doctor when they experience symptoms such as:
- A lump or thickening in or near the breast or in the underarm area
- Changes in the breast size or shape
- A dimple or puckering in the breast skin
Be aware that these symptoms could be due to conditions other than breast cancer, so it’s best to see a doctor right away. A woman must see a doctor immediately if they have any of these symptoms, even if a mammogram is negative.
Breast cancer specialists at North Shore-LIJ Health System offer leading-edge technology and highly experienced radiologists and pathologists to ensure an accurate diagnosis of breast cancer. World-class breast cancer services are available including breast cancer screening and diagnostic imaging as well as breast cancer treatment, follow-up and cancer risk assessment.
North Shore-LIJ Health System takes a comprehensive approach to treating breast cancer at the dedicated Breast Cancer Center, a part of North Shore-LIJ Cancer Institute, which has achieved accreditation by the National Accreditation Program for Breast Centers (NAPBC). The multidisciplinary team of specialists has unparalleled experience diagnosing and treating a high volume of breast cancers at one of the largest cancer programs in the New York metro area that offers specialized therapies available at only a few cancer centers in the nation.
One of the most progressive breast cancer centers in the country, available treatments and services include:
- Complete breast cancer screening, diagnostic imaging, diagnosis, treatment, follow-up and assessment of cancer risks at one convenient location.
- An emerging technology in breast cancer screenings is 3-D mammography (digital breast tomosynthesis), which is used on a case sensitive basis.
- Least-invasive breast cancer procedures, including breast-conservation surgery.
- Intensity-modulated radiation therapy (IMRT) that precisely targets breast tumors while protecting healthy tissue nearby, partial breast radiation therapy and accelerated schedules of radiation therapy.
- Advanced breast reconstruction techniques.
- Dedicated breast care navigator helps patients manage issues resulting from their disease and treatment.
- Support groups.
- Genetic counseling for women at risk of breast cancer or who have had breast cancer, which may have a hereditary basis.
Multidisciplinary Breast Cancer Treatment
Within the first several days of a visit, the multidisciplinary team at the Breast Cancer Center will conduct comprehensive tests and develop a personalized treatment program.
From diagnosis through treatment, you're in the capable hands of experts every step of the way.
There are several types of breast cancer, including:
- The most common type begins in the lining of the ducts and is called ductal carcinoma. Ductal carcinoma in-situ has not spread beyond the milk duct into surrounding tissue. Invasive ductal carcinoma is a cancer that has spread through the wall of the milk duct and has begun to invade the tissues of the breast
- Another common type, called lobular carcinoma, occurs in the lobules (milk-producing glands). Lobular carcinoma in-situ is when the cancer remains inside the lobule and has not spread to surrounding tissues. Invasive lobular carcinoma begins in the milk-carrying ducts and spreads beyond them.
- Paget's disease is a rare form of breast cancer that begins in the glands in or under the skin. It is often characterized by inflamed, red patches on the skin. The patches can occur in sweat glands, in the groin, or near the anus. Because Paget's disease often originates from breast duct cancer, the eczema-like cancer usually appears around the nipple.
- Inflammatory breast cancer is a rare form of invasive breast cancer (a type of cancer that begins in one area and then spreads deeper into the tissues of that area). Usually there is no lump or tumor; rather this cancer makes the skin of the breast look red and feel warm. The breast skin also looks thick and pitted, much like an orange peel.
- Triple negative breast cancers are those that do not have estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on the cancer cell surfaces. These breast cancers tend to occur more often in younger women and in African-American women. They tend to grow and spread faster than most other types of breast cancer.
- Phyllodes tumors are rare breast tumors that contain two types of breast tissue: stromal (connective) tissue and glandular (lobule and duct) tissue.
When breast cancer metastasizes, or spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body.
Cancer that spreads is the same disease and has the same name as the original, or primary cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ. This may also be called "distant" disease.
The first step in making a diagnosis of breast cancer is usually a physical, during which a doctor exams the breasts and surrounding areas to detect enlarged lumps, nodules, swelling or thickening of breast tissue.
Specialists use a variety of tests, typically outpatient procedures, to deliver an accurate breast cancer diagnosis, including:
- Diagnostic Mammogram - The Breast Cancer Center provides the most advanced diagnostic mammograms for women with current symptoms or previous breast cancer:
- 3-D Mammography (digital breast tomosynthesis) — The Breast Cancer Center uses emerging 3-D technology to detect lesions and reduce false alarms.
- Full Field Digital Mammography — FFDM produces exceptionally sharp digital images with less radiation exposure.
- Ultrasonography - High-frequency sound waves distinguish if a mass is benign or suspicious.
MRI Scan (Magnetic Resonance Imaging) - A powerful magnet, radio waves and computer imaging combine to create highly detailed 3-D breast tissue images.
- CT or CAT Scan (Computerized Axial Tomography) - A combination of X-rays and computer technology produces detailed 3-D images to determine whether the cancer has spread.
- PET Scan (Positron Emission Tomography) - Small amounts of radioactive sugar are injected to highlight cancer and see whether it has spread.
- Bone Scan - An injection of low-level radioactive material helps detect if breast cancer has spread to the bones.
- Biopsy - Choosing from different types of biopsies, a doctor takes a tissue sample for further examination under a microscope by a pathologist to determine the type of cancer.
- Lab Tests - If breast cancer is discovered, additional tests will be given to gather additional information about the cancer:
- Hormone receptor tests measure the amount of estrogen and progesterone receptors are in the cancer tissue. More estrogen and progesterone receptors than normal mean the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
- Genetic tests measure the activity of genes and whether certain proteins are evident in tissue. These tests determine whether the cancer will spread more quickly and narrow down options for treatment.
Once a breast cancer diagnosis has been confirmed, a doctor will conduct one or more of the diagnostic imaging tests listed above to determine the cancer's location and stage, meaning the size of the cancer and how far it has spread.
According to the National Cancer Institute, the stages of breast cancer are:
- Stage 0 — Known as carcinoma in situ, this stage means cancer cells or non-cancerous abnormal cells are not breaking out or invading neighboring normal tissue.
- Stage I — Stage I is subdivided into stages IA and IB:
- Stage IA: The tumor is 2 centimeters (about 3/4 inch) or less across, and cancer is not found in any lymph nodes or distant sites.
- Stage IB: The cancer is 2 centimeters (about 3/4 inch) or less across (or no tumor is found) and very small amounts have spread to the axillary lymph node (lymph nodes under the arm), but not to distant sites. These microscopic metastases, also called micromets, occur where the cancer has implanted and taken hold.
- Stage II — Stage II is subdivided into stages IIA and IIB
- Stage IIA: No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is 2 centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymph nodes.
- Stage IIB: The tumor is larger than 2 centimeters but not larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes; or the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 5 centimeters and has not spread to the lymph nodes.
- Stage III — Stage III is subdivided into stages IIIA, IIIB and IIC:
- Stage IIIA: No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone.
- Stage IIIB: The tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Cancer may have spread to axillary lymph nodes or lymph nodes near the breastbone. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.
- Stage IIIC: No tumor is found in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer has spread to 10 or more axillary lymph nodes; or to lymph nodes above or below the collarbone; or to axillary lymph nodes and lymph nodes near the breastbone. Cancer that spread to the skin of the breast may also be inflammatory breast cancer, a type of breast cancer in which the breast looks red and swollen and feels warm.
- Stage IV — The cancer has spread to other parts of the body, most often the bones, lungs, liver or brain.
Accurate staging is the foundation of the most effective treatment plan.