Breast Cancer

Awareness of breast cancer and of the importance of getting screened has never been higher. Still, breast cancer remains the second most common cancer in women after skin cancer.

If you notice a lump in your breast or a change in the appearance of your breast, it’s very important to get it checked out quickly by a healthcare professional.

The American Cancer Society estimates that about 297,790 new cases of invasive breast cancer and about 55,720 new cases of ductal carcinoma in situ, also called stage 0 (zero) breast cancer, will be diagnosed in 2023. The average risk of a woman in the U.S. developing breast cancer sometime in her life is about 13%, or a 1 in 8 chance.

Our physicians are well versed in the treatment of breast cancer, and our support staff will make your treatment journey as easy as possible. We have offices in Louisville and just across the river in Jeffersonville for your convenience. Learn more about our physicians.

Mammograms

The mammogram, basically an x-ray of the breasts, is a screening tool that has saved countless lives. It has detected numerous breast cancers while they were still small enough to get conservative treatment. At its simplest, a mammogram is an x-ray of your breasts. The U.S. Preventive Services Task Force recommends that women ages 50 to 74 get a screening mammogram every other year. Talk to your doctor about your individual breast cancer risk to find out when and how often you should be screened.

Mammograms can also be diagnostic. The difference between a screening vs diagnostic mammogram is that a screening mammogram is done even if there are no concerning symptoms. A diagnostic mammogram is used after suspicious results from a screening mammogram or your doctor detects other signs of breast cancer. Diagnostic mammograms are often done for women with breast implants, too. Diagnostic mammograms take longer than screening mammograms and the total dose of radiation is higher because of the need for more x-ray images from different angles of the breast

Types of breast cancer

A breast cancer’s type is determined by the specific cells in the breast that become cancer. Most breast cancers are carcinomas, which are tumors that start in the cells that line the organs and tissues throughout the body. When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the milk ducts or the lobules, the glands in the breast that make milk.

IN SITU VS. INVASIVE BREAST CANCERS
Breast cancers are classified as in situ or invasive. An in situ tumor is a pre-cancer that starts in a milk duct and has not spread to the rest of the breast tissue. Invasive, or infiltrating, breast cancer is used to describe any type of breast cancer that has spread into surrounding breast tissue.

SPECIAL TYPES OF INVASIVE BREAST CANCERS
Some invasive breast cancers have special features or develop in different ways that influence their treatment and outlook. These cancers are less common but can be more serious than other types of breast cancer.

• Triple-negative breast cancer is an aggressive type of invasive breast cancer in which the cancer cells don’t have estrogen or progesterone receptors and also don’t make any, or make too much, of the protein called HER2. It accounts for about 15 percent of breast cancers.
• Inflammatory breast cancer is an aggressive type of invasive breast cancer in which cancer cells block lymph vessels in the skin, causing the breast to look inflamed. This cancer is rare and accounts for about 1 to 5 percent of all breast cancers.

Breast cancer risk factors

There are several known risk factors for breast cancer, some preventable and others not. While knowing risk factors can be helpful, it’s also important to understand that the presence of risk factors is not a guarantee that breast cancer will occur; likewise, the absence of risk factors does not guarantee a woman will not develop breast cancer. With that in mind, here are some of the top risk factors for breast cancer.

Risk factors you cannot control include age, genetics (such as having the BRCA1 or BRCA2 genes), reproductive history (starting menstruation before age 12 or going through menopause after 55 increases the lifetime amount of hormone exposure), having dense breasts, personal or family history of breast or ovarian cancer or certain breast diseases, previous radiation therapy treatment on the chest, or exposure to diethylstilbestrol (DES).

Exposure to DES

Risk factors you can impact include not being physically active, being overweight or obese after menopause, hormone replacement therapy (progesterone + estrogen), certain oral birth control pills, reproductive history (first pregnancy after 30, not breastfeeding, or never carrying full-term), and drinking alcohol.

Drinking Alcohol

Radiation therapy for breast cancer

Radiation therapy can be used after breast-conserving surgery (BCS) to help lower the chance that the cancer will return in the same area; after a mastectomy, especially if the tumor was large, if cancer is found in many lymph nodes, or if the surgical “margins” had cancer cells; or if the breast cancer has spread to other parts of the body like the bones, spinal cord, or brain.

There are two types of radiation therapy used for breast cancer. External beam radiation therapy uses a machine outside the body to send radiation toward the area of the body with the cancer. Internal radiation therapy, known as brachytherapy, uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Whole breast radiation is used after BCS. If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where you had drains after your surgery. Accelerated partial breast irradiation gives larger doses of radiation at specific places near where the tumor was located, but more research is needed to determine if this method of treatment will have the same long-term results as standard radiation therapy.

Brachytherapy, or internal radiation, delivers radiation through a device containing radioactive seeds or pellets into the breast tissue in the area where the cancer was removed, also called the tumor bed. Tumor size, location, and other factors may limit your ability to access brachytherapy.

Radiation vs. hormone therapy for breast cancer

Both radiation therapy and hormone therapy are effective options for treating breast cancer. Like radiation therapy, hormone therapy is used after surgery to reduce the risk that the cancer will return. Hormone therapy and HER2 targeted therapy can be given at the same time as radiation. Typically, patients will either receive radiation therapy and hormone therapy or hormone therapy with or without radiation therapy.

For patients receiving both hormone therapy and radiation therapy, the standard schedule for getting whole breast radiation is five days a week (Monday-Friday) for 6 to 7 weeks. In hypofractionated radiation therapy, the radiation is given to the whole breast but in larger daily doses for a shorter time period. Hormone therapy on its own can last up to 11 years depending on the protocol your doctor uses.

When it comes to the choice of using hormone therapy and radiation vs. hormone therapy alone, talk to your treatment team about the benefits and pitfalls of each regimen and understand how these options could change the trajectory of your cancer treatment.

Information on this page is sourced from the American Cancer Society and the National Cancer Institute.

Cancers We Treat

Our physicians treat a wide variety of cancers. You can view the full list here, or you can click below to learn about the cancers we most commonly treat.