box-decodingMore breast cancer treatment options are available today than ever before:

  • Surgery can be less invasive in most cases.
  • Not every woman with breast cancer will need chemotherapy.
  • Long-term therapy with drugs targeting markers specific to your tumor can reduce the risk of recurrence and improve outcomes.

If you have been diagnosed with breast cancer, www.MyBreastCancerCoach.org is a new resource presented by BreastCancer.org featuring videos of nurse Lillie Shockney of Johns Hopkins University and Dr. Marisa Weiss of BreastCancer.org answering key questions. The sight has important lists of questions to ask your doctor.

Once you have been diagnosed with breast cancer, you should learn about the details of your type of breast cancer and different treatment options. Treatment options vary depending on a number of variables:

  • The location and size of your tumor.
  • The specific markers your tumor may or may not express (like the estrogen receptor or the HER2 protein).
  • How fast your tumor cells are growing.
  • The activity of specific sets of additional markers in your tumor.

If you have invasive (infiltrating) breast cancer, your pathology report will include the results of a hormone receptor assay and your HER2 status. Pathology reports can be confusing because they are written by the pathologist and intended for your doctor.

Breastcancer.org has a simple Pathology Report Checklist that will help you to understand your report and a guide to reading and understanding the contents of your report.


Hormone receptors:
Your pathology report will have the results of a hormone receptor assay, a test that tells you whether or not the breast cancer cells have receptors for the hormones estrogen and progesterone. Hormone receptors are proteins – found in and on breast cells – that pick up hormone signals telling cells to grow.

  • A cancer is called estrogen-receptor-positive (or ER+) if it has receptors for estrogen. Drugs targeting (blocking) the estrogen receptor or estrogen production will be recommended. These drugs are referred to as hormonal therapy. This is considered a favorable prognostic factor.
  • The cancer is progesterone-receptor-positive (PR+) if it has progesterone receptors. This too is considered a favorable prognostic factor.
  • Roughly two out of every three breast cancers test positive for hormone receptors.

HER2 Status: HER2 is one gene that can play a role in the development of breast cancer and overproduces a certain protein called HER2. Your pathology report should include information about HER2 status (human epidermal growth factor receptor 2). Today there are special drugs designed to prevent breast cancer cells from overproducing this specific HER2 protein.

Grade: The grade of the cells will also be determined. Grade 1 means slow-growing cells; grade 2 are average-growing cells; and, grade 3 are fast-growing cells.

Additional markers: In addition to testing your tumor for markers including ER-status, PR-status and HER2 status, several newer tests are now available to analyze additional sets of markers expressed in your tumor; which can help guide treatment decision-making. You should learn about the OncoTypeDx, MammaPrint and Mammostrat test options.

Learn More: www.breastcancer.org

Different types of breast cancer

box-diseaseBreast cancer is not just one disease. There are different kinds. The type of breast cancer depends on which cells in the breast turn into cancer. Breast cancer can begin in different parts of the breast, like the ducts or the lobes.

Common kinds of breast cancer are:

  • Ductal carcinoma in situ (also called DCIS): Abnormal cells are only in the lining of the breast ducts and have not spread to other tissues in the breast. DCIS usually does not advance to invasive breast cancer.
  • Invasive ductal carcinoma (also called ‘invasive breast cancer’):
    The cancer cells that started in the ducts break through the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. This is the most common kind of breast cancer.
  • Invasive lobular carcinoma (also called ‘invasive breast cancer’): Cancer cells that started in the lobes spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

There are also several other less common kinds of breast cancer, including Paget’s disease and inflammatory breast cancer.

Different kinds of breast cancer treatment

Breast cancer is treated in several ways, depending on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.


Surgery
is an operation where doctors cut out cancer tissue along with a healthy margin of tissue around the tumor.

  • Surgery could be a lumpectomy, mastectomy or mastectomy with reconstruction.
  • For invasive tumors, a sentinel node biopsy is done to determine if the cancer has traveled into the lymphatic system.
  • An axillary node dissection is done when cancer cells are already confirmed to be in the lymph nodes underneath the arms.
  • Learn more about surgery options at: www.breastcancer.org

Radiation therapy uses high-energy rays (similar to X-rays) to kill cancer cells locally. It’s typically used to eliminate any cancer cells that might be left behind in the rest of the breast after lumpectomy surgery, in the chest wall after mastectomy, or under the arm in certain patients.

Chemotherapy uses special medicines to shrink or kill the cancer. The drugs can be pills you take orally or medicines given in your veins, or both.

Hormonal therapy blocks cancer cells from getting the hormones they need to grow.

Biological therapy works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.

Different kinds of doctors and nurses from different specialties often work together in “multidisciplinary” teams to diagnose and treat breast cancer. Radiologists interpret breast imaging such as mammography, ultrasound, MRI and they can perform core biopsies. Surgeons or surgical oncologists are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicines like chemotherapy and hormonal therapy. Radiation oncologists are doctors who treat cancer with radiation.

Patient Navigators are specialized staff, often nurses or trained breast cancer survivors, who can help you ‘navigate’ the multiple doctor appointments, treatment options, and other life barriers like securing transportation to your appointments. You should ask your treating hospital, or doctor’s office, if a patient navigator is available to help you. Although breast cancer is a disease that in most cases requires treatment, many women and men who are diagnosed with breast cancer are leading full and active lives.



Sources & Resources

  1. Society, A.C., Breast Cancer Facts & Figures 2013-2014. 2013.
  2. Hunt, B.R., S. Whitman, and M.S. Hurlbert, Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiol, 2014. 38(2): p. 118-23.
  3. Wild, B.W.S.a.C.P., World Cancer Report 2014 2014.
  4. Ross, A.C., et al., The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab, 2011. 96(1): p. 53-8.
  5. Silverstein, M.J., et al., Special report: Consensus conference III. Image-detected breast cancer: state-of-the-art diagnosis and treatment. J Am Coll Surg, 2009. 209(4): p. 504-20.

Disclaimer
This website was created for educational purposes only and should not be interpreted as medical advice. Be sure to partner with your medical provider to develop the best personal care plan for you. Adapted from the American Cancer Society, 2013-2014 Breast Cancer Facts & Figures.