About Breast Cancer

When it comes to breast cancer, there is good news and there is bad news...

The good news is, the number of deaths from breast cancer continues to decline as we detect the disease at earlier, more easily treatable stages.

The bad news is, the incidence of breast cancer has been rising steadily since the 1960’s for reasons that are poorly understood. The United States currently boasts the highest rates in the world. In this country, one in eight women will develop breast cancer in her lifetime and about 44,000 women die of the disease annually. These seem like harsh statistics, but thanks to advances in medical science, we have some very effective ammunition against them.

Dr. Grange Staff

Annual Clinical Breast Exams aid in Early Detection.


Types of Breast Cancer

Infiltrating Ductal Carcinoma

The most common type of breast cancer is called infiltrating ductal carcinoma. This type of cancer starts in the milk duct, then invades the local breast tissue. The body often responds to this type of cancer by producing a “scar” around it which makes the tumor feels firm on exam, and it will be visible as a white spot on your mammogram.

Infiltrating Lobular Carcinoma

The second most common type of breast cancer is called infiltrating lobular carcinoma. It starts in the breast lobules and grows in an insidious, infiltrating pattern that may be difficult to feel on exam or see on the mammogram. Once diagnosed, it is treated the same as ductal carcinoma, but because of its poorly localized growth pattern, it may require additional imaging such as breast MRI to define the extent of the disease in the breast.

Ductal Carcinoma In-situ (DCIS)

Ductal carcinoma in-situ (DCIS) is the earliest stage of ductal cancer. When we look at this cancer under the microscope, we see cancer cells trapped within the duct but they are not invading into the surrounding tissue. When found at this stage, appropriate treatment results in a 99% survival. We never have to use chemotherapy for this type of cancer so there is a huge incentive to find disease at this stage. Fortunately, DCIS often develops calcium deposits early in its development and this process shows up as "suspicious microcalcifications" on a screening mammogram. A stereotactic needle biopsy of these microcalcifications is then performed to make the diagnosis.

 

New Ways of Thinking about Breast Cancer Types

While it has been traditional to classify breast cancer types by what they look like under the microscope, it is more useful to think of breast cancer types by the things that they use to grow. If we can understand what makes a cancer grow, we can make it stop growing, which is the goal of all cancer therapies. We can tell what a cancer cell is using to grow by what "receptors" it has on its cell surface.

Hormone Receptor Positive

When a cancer cell has estrogen or progesterone receptors on its surface, it is using a woman's own natural estrogen to grow. In that setting, blocking the estrogen receptor, or making estrogen unavailable to the cancer cell is effective therapy to stop cancer growth. In many cases, these "hormone receptor positive" cancers (also known as "ER/PR" positive) are so responsive to hormone blocking strategies that we don't have to use chemotherapy to control their growth.

On the other hand, if the cancer cell does not have these hormone receptors on its surface, it is called "hormone receptor negative" or "estrogen receptor (ER) negative." These cancers will not respond to hormone blocking strategies and we generally must use chemotherapy to control their growth.

Her-2-neu Positive

The "Her-2-neu" receptor is another receptor that is important to a cancer cells growth. Only about 20% of all breast cancers have this receptor and when it is present, the cancer is able to grow more rapidly. Fortunately, we have a drug called Herceptin that is specifically designed to block this receptor and is very effective in controlling the growth of these "Her-2 positive" breast cancers. Because of its aggressive nature, this type of cancer is always treated with chemotherapy along with Herceptin.

Triple Negative Breast Cancer

When a cancer cell has neither the hormone receptors nor the Her-2-neu receptor, it is called "ER/PR/Her-2 negative" or "triple negative" breast cancer. We don't really understand how these cancers grow but they will not respond to either hormone blocking drugs nor to Herceptin. They are always treated with chemotherapy and they are a bit more difficult to control so we tend to be fairly aggressive with them. Learn More »

The Value of Working with a Breast Specialist

My professional focus on breast disease has allowed me to develop some specialized services that streamline the process of evaluating a breast complaint and facilitate the best possible management plant. I perform breast ultrasound as part of my initial evaluation. This allows me to do an image-guided needle biopsy if necessary so that a definitive diagnosis can be made and treatment options offered without delay. I also make full use of more advanced breast imaging such as breast MRI and Breast Specific Gamma Imaging if need be to make the right diagnosis.

If a diagnosis of cancer is made, I present each of my patients to a weekly breast cancer treatment planning conference attended by some of the region’s most experienced medical and radiation oncologists, along with expert pathologists and radiologists. Drawing upon the shared expertise of these colleagues, I am able to design a comprehensive treatment plan that represents the stat of the art for an individual patient and her disease. This type of specialized multidisciplinary breast cancer management has been shown in clinical studies to result in the best outcomes for women battling this disease.

What I consider one of my most important missions as a breast specialist is to provide education about breast health issues, and help women to become advocates in their own health. I not only want to provide women complete information about my practice, but also important facts about breast cancer, including strategies for early detection, news about clinical treatments, information on risk factors, recommended resources and much more. 

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