The only method for improving cure rates for breast cancer is through early detection.  Every woman should perform breast self examination every month and have a mammogram every year.  Look  for changes in the skin color or texture.  Feel for the presence of lumps or thickening.  Consult your doctor about any discharge or bleeding from the nipple.  Breast nodules should be removed—even if the mammogram is  normal.  Remember, there is no perfect medical test.

Mammograms are most useful for women older than 40.  In younger women, dense glandular tissue can obscure small tumors.  When doctors read a mammogram, they look for tell tale signs such as the cluster of calcium in the picture above.  The quality of the mammogram is also affected by the skill of the person taking the picture. All facilities that do mammograms must meet professional standards set by the FDA.  Subtle changes in your mammogram from one year to the next may be the tip off that something is brewing.  If possible, try to go to the same mammography center every year.

Nowadays, women are aware of the need for screening and self examination and most breast cancer is detected early--when it is usually possible to save the breast.  Large randomized clinical trials in the United States and Europe have conclusively shown that, for most women, mastectomy is not necessary.  However, simply removing the lump is not enough.  Cure requires treatment of the entire breast to eliminate microscopic cancer cells that remain behind.

Good treatment begins with good surgery.  Usually, just a small piece is removed to establish the diagnosis.  If cancer is confirmed, a second operation is done to remove a margin of normal breast around the original mass.  This is called a lumpectomy.  It must be done carefully to avoid unnecessarily deforming the breast.  In addition, a second part of the procedure checks to see if the cancer has spread to the lymph nodes under the arm.

Our surgeons are skilled in the techniques of breast cancer surgery including the use of Sentinel Node Mapping.  This involves injecting a radioactive material and blue dye around the tumor before surgery.  After the breast lump is removed, the dye can be followed to the first lymph nodes under the arm.  These first nodes are removed, and, if they are normal, no further surgery is needed.  This spares the patients unnecessary surgery.  If the first nodes contain cancer, the surgeon will remove all the nodes under the arm to prevent relapse of the cancer in this area.  Occasionally women have tumors which are too large to perform a lumpectomy without deforming the breast.  In this case, a mastectomy is done.  This is an operation which removes the entire breast.  Even in this case, the breast can often be reconstructed by a skilled plastic surgeon using either a breast implant, or by moving some of the patient’s own tissue around.

For some women, chemotherapy is needed.  This includes most women with positive nodes.  But also, some groups of women with negative nodes do benefit from the use of chemotherapy or hormone therapy after surgery.  The decision to recommend this type of treatment depends upon some chemical features of the tumor that are determined in the lab.   Breast cancer chemotherapy is very effective and a large number of drugs are available for your doctor to choose from.  Each combination of medications has its own panel of side effects.  It is important to visit with a Medical Oncologist after  breast cancer diagnosis to see what types of systemic treatments might be needed.

Once a woman has recovered from her operation sufficiently to raise her arm over her head, and after chemotherapy if it was needed, radiation  usually begins.  Radiation is a painless treatment requiring only a few minutes per day over a six week period.   Radiation beams are strong x-rays which can destroy cancer cells remaining in the breast. Side effects are usually minimal and limited to tiredness and skin irritation much like a sunburn.  After treatment, the breast will heal and usually returns to normal after a month or so.  Long term the breast is usually somewhat stiffer than the other side, but it should still be warm, soft, and sensate.  Cure rates are excellent and most women feel the appearance of their breast is good to excellent.

Breast cancer is the most common cancer in western women.  Fortunately, it is also the one for which the most treatment options exist.  But, cure depends upon early detection and aggressive treatment.  Emotional support is available through the American Cancer Society’s  "Reach to Recovery" program.  See this and other information on our "Links" page.