Breast Cancer Treatment

Breast cancer is the most common cancer diagnosed in women in the United States after non melanoma skin cancer. Approximately 1 in 8 women will receive a breast cancer diagnosis in their lifetime. Rarely, breast cancer can affect men. When caught at an early stage, most breast cancers can be cured, even those that exhibit aggressive features. The doctors at North Cascade Cancer Center have extensive experience treating all stages of breast cancer and offer the most up to date, evidence based treatment regimens. Most patients who undergo modern radiation therapy for breast cancer have limited and manageable short term and long term side effects.

We usually see patients with breast cancer referred by their breast surgeons, primary care physicians, and medical oncologists, or as self referrals. Most patients begin their journey with breast imaging (mammogram and/or ultrasound) and a breast biopsy performed by a breast radiologist. Many patients newly diagnosed with breast cancer are recommended imaging with a breast MRI to evaluate the extent of cancer in the breast and nearby lymph nodes. Some breast cancer patients may be recommended additional imaging with a CT scan of the chest, abdomen and pelvis, a bone scan, and/or a PET scan, all of which are available in Bellingham. Molecular tests called biomarkers (including estrogen receptor, progesterone receptor, and Her2) are done on initial cancer biopsy samples to determine the best type and sequence of treatment for each patient.

Breast cancers that have not spread beyond the breast and nearby lymph nodes are typically treated with surgery to remove the known tumor, and in many cases to sample or remove nearby lymph nodes in the armpit. Depending on the type and extent of cancer, drug treatment with chemotherapy, immunotherapy, and/or hormone therapy may be recommended before and/or after surgery. Radiation treatment is recommended for many patients with localized or lymph node positive breast cancer, and is usually given following surgery. Radiation treatment is offered to most patients who undergo a lumpectomy or breast conserving surgery, and to some patients who undergo a mastectomy or removal of the breast. We are ready to meet with you at any point during your breast cancer journey to help you navigate these options and decisions. Some patients find that a radiation oncology consultation before breast cancer surgery helps them feel more confident in selecting their preferred type of surgical approach in collaboration with their surgeon.

During your initial visit, one of our doctors will review your breast cancer history as well as your other medical problems. A breast exam is typically performed at this time. We will work with you to formulate a personalized treatment plan following the latest in research and national guidelines, as well as your own goals, wishes and preferences. We will then work closely with other doctors involved in your care to put the plan into action.

For most breast cancers that have not spread outside of the breast and nearby lymph nodes, radiation therapy is given with the goal of a long term cure. For patients with early stage, localized breast cancer, whole breast or partial breast treatment is typically done over 1-4 weeks of daily 15 minute external beam radiation treatments Monday-Friday. For patients with breast cancers that involve nearby lymph nodes, treatment is usually given over 3-6 weeks. We offer both 3D conformal and intensity modulated radiation therapy treatments. We offer treatment with deep inspiration breath hold gating for patients with left sided breast cancers to minimize side effect risks to the heart. Your radiation oncologist will help you decide which of these options and treatment techniques best fits your goals and needs.

Once you are ready to proceed with radiation, the next step is called a simulation, or a mapping appointment. This typically involves stickers and marks being placed on the breast or chest wall, followed by a CT scan in the treatment position. Daily treatments typically start 1-2 weeks later. You will meet with one of our doctors on a weekly basis to make sure that treatments are going as planned, to answer questions and to address any side effects. We will then see you in follow up to ensure that you have healed well from the treatment and develop a personalized follow up plan together with other members of your treatment team.

Some patients with widespread (metastatic) breast cancer may also be recommended radiation therapy. This may involve lower dose treatment of areas of spread to improve pain, and to prevent complications such as fracture. These treatments are usually given over 1-2 weeks with limited side effects.

No matter where you are in your breast cancer journey, we look forward to meeting with you to discuss your options and formulate your personalized breast cancer treatment plan. Please contact us through the web site portal or request a referral from one of your care team members to schedule an appointment.

Consult our Breast Cancer Specialists

North Cascade Cancer Center is one of the premier facilities in Washington with the most advanced technology and unsurpassed expertise to manage and treat all types of breast cancer. 

Breast cancer can begin in different areas of the breast — the ducts, the lobules, or in some cases, the tissue in between. In this section, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

Types of Breast Cancer

The most common types of invasive breast cancer are:

  • Invasive Ductal Carcinoma (IDC) – The most common type of cancer encompassing 80% of diagnosed breast cancers. This cancer starts in the inner lining of milk ducts. Breast cancer is more common in women 55 years or older.
  • Invasive Lobular Carcinoma (ILC) – The second most common type of breast cancer starts in lobules where breast milk is produced.
  • Rare breast cancers – There are several subtypes of rare IDC cancers including tubular, medullary, mucinous, papillary, and cribriform carcinomas.

There are two types of breast tumors that are non-invasive, meaning they have not invaded through the wall of mammary gland duct or lobule. These types of cancer are almost 100% curable when properly treated. They are precursors to their invasive counterparts:

  • Ductal Carcinoma In Situ (DCIS) — This type of cancer is found when abnormal cells appear in the lining of breast ducts. If untreated, DCIS can transition to invasive ductal carcinoma (IDC).
  • Lobular Carcinoma In Situ (LCIS) — This abnormal grouping of abnormal cells is found in the breast lobules. LCIS was recently downgraded to a non-cancerous disease. LCIS does increase the risk of developing breast cancer, however.
Male Breast Cancer

Breast cancer in men is very rare, but approximately 2,600 men are expected to be diagnosed this year. A number of factors can increase the risk of breast cancer in men, including:

  • Older Age – Like women, older men are more at risk for breast cancer than their younger counterparts.
  • High Estrogen Levels – Men can have high estrogen levels from taking hormone medicines, being overweight (which produces estrogen), being exposed to estrogens in the environment, being heavy alcohol users, or having liver disease.
  • Klinefelter Syndrome – Klinefelter syndrome is a condition that occurs in 1 in 1000 men as a result of being born with an extra X chromosome. Men with this syndrome may develop breast tissue as a result of having higher amounts of estrogen.
  • Family History – Men with a strong family history of breast cancer, especially of men with breast cancer, are more likely to develop breast cancer themselves.
  • Radiation Exposure – Being exposed to radiation before age 30 increases your risk of having breast cancer.
Stages of Breast Cancer

The most common classification for staging breast cancer is the American Joint Committee on Cancer (AJCC) 8th edition TNM classification system. There are many sub-types of categories It features:

  1. Tumor – T=tumor to designate the size or extent of the primary breast cancer.
  2. Node – N=node status to designate whether or not the primary breast cancer has spread to nearby, or regional lymph nodes. 
  3. Metastasis – M=metastasis to designate whether the primary breast cancer has spread beyond the breast and/or regional lymph nodes.

TNM status are grouped to create an overall stage. There are many sub-categories of overall stage. It essentially can be summarized by 5 groups:

  • Stage 0 – Non-invasive cancer or DCIS.
  • Stage I – Early invasive breast cancer.
  • Stage II – Slightly larger primary breast cancer and/or early spread to regional lymph nodes.
  • Stage III – Breast cancer confined to the breast and regional lymph nodes that is more advanced.
  • Stage IV –  Breast cancer that has spread beyond the breast and regional lymphatics.
Diagnosing Breast Cancer

When breast cancer is found early, the success rate is nearly 100%. The American Cancer Society recommends breast screenings annually for women over 45 and continuing as long as you are in good health. Other organizations, including the Mayo Clinic and your radiology oncologists at North Cascade Cancer Center, suggest you begin annual screenings at age 40.  In women with a strong family history of breast cancer breast screening should begin by age 35 or younger.

The staff of caring and qualified radiologists can determine the best type of imaging for your needs including:

  • 2-D Mammography – This is the most common form of screening for breast cancer. It captures an x-ray of the breast from two angles and makes it possible to detect tumors that cannot be felt.
  • 3-D Mammography –  Also called breast tomosynthesis, this is the most advanced breast cancer detection technology available. Similar to 2-D mammography, it requires breast compression. It allows radiologists to examine breast tissue layer by layer for a more detailed view. The screening accuracy results in fewer unnecessary biopsies, tests, and false-positives.
  • Automated Breast Ultrasound (ABUS) – This procedure is a second step screening tool that allows radiation oncologists to view breast tissue using sound waves. It is recommended for women with documented dense breast tissue. It can also be used with a mammogram to further characterize tissue in a suspicious area. ABUS usually requires a radiation oncologist’s referral.
  • Breast MRI – This tool is a non-invasive test that uses a powerful magnetic field, radiofrequency waves, and a computer to produce clearer, more detailed pictures of your breast. It is a diagnostic tool that helps radiologists determine if a biopsy is necessary and can also determine the extent of cancer after a new diagnosis.
  • Stereotactic Breast Biopsy – When radiation oncologists identify a mass or suspicious breast tissue, a tissue sample is sometimes necessary to find out whether or not cancer is present. Today’s biopsy technologies can avoid incisions and instead use stereotactic, ultrasound, or MRI equipment to guide radiation oncologists to the specific location of the tissue and extract a sample through a hollow needle.
Types of Radiation Therapy for Breast Cancer

The majority of breast cancers are managed with surgery. Most women, 80-90%, have the option of having the breast removed or just the cancer itself. For women who choose to keep their breast, radiation therapy is recommended to minimize the risk of cancer returning in the breast or surrounding tissue. The cure rates for total breast removal, known as a mastectomy, and partial breast removal (aka lumpectomy) followed by radiation therapy are equal. While surgery and radiation therapy are local treatments, systemic therapy is often recommended. Systemic therapy can involve chemotherapy, immunotherapy, or anti-estrogen therapy. Your medical oncologist will assist in making an informed decision regarding systemic therapy. When it comes to treating your breast cancer with radiation therapy, North Cascade Cancer Center is your radiation oncologists choice.

  • Image-Guided Radiation Therapy (IGRT) – North Cascade Cancer Center houses the most advanced radiation therapy delivery system, TrueBeam. TrueBeam’s onboard imaging technology allows your radiation oncology team to image the area targeted prior to each treatment session. This is known as Image-Guided Radiation Therapy, or IGRT. TrueBeam is also capable of tracking movement during treatment sessions. This allows for tighter treatment margins and sparing of normal, healthy surrounding tissue.
  • Intensity-Modulated Radiation Therapy (IMRT) – IMRT involved fixed beams of radiation therapy creating a ‘cloud’ of radiation conforming to the size and shape of the target (areas at risk for harboring cancer cells) while protecting surrounding normal, healthy tissue.
  • Volumetric Modulated Arc Therapy (VMAT) – VMAT is essentially IMRT through moving arcs of radiation therapy. Treatment times are considerablywith VMAT, typically 1-2 minutes.
  • Stereotactic Ablative Radiotherapy (SABR)/Stereotactic Body Radiotherapy (SBRT) – SABR and SBRT are synonymous terms, involving 3-5 treatments of higher doses of radiation therapy to small areas. VMAT is utilized. North Cascade Cancer Center’s TrueBeam model, the most advanced in the TrueBeam lineup and available in the world, has a special beam, called 10FFF, that delivers radiation therapy 4 times faster than most units in the market. Typical SABR/SBRT treatment times are 30-90 seconds.

FAQ

Cancer is never something you want to hear about or deal with. It is sometimes too scary to even say out loud sometimes. Let North Cascade Cancer Center help alleviate some of your concerns by answering the most frequently asked questions about breast cancer for you.

The professional advice for this question has changed in recent years. The American Cancer Society recommends annual mammography screenings for all women when they turn 45 years old. Other prominent organizations, including the Mayo Clinic and our Mat-Su Valley Cancer Center specialists, suggest you begin annual screenings at age 40. Women at higher risk should begin screening no later than age 35.

If your radiologist finds something suspicious in your mammogram scan, he or she will order additional screenings to confirm whether you have an abnormal group of cells that has formed a tumor. Once that is confirmed, they may take a biopsy of the tissue to test whether it is cancerous (malignant) or benign. North Cascade Cancer Center will work with your primary care physician to confirm the diagnosis and develop an individualized cancer treatment plan for you.

When detected early, cancer survival rates are excellent. Many factors influence an individuals likelihood of success.

Women who do regular monthly exams as recommended may notice a change in the shape or size of lump in their breast. Others have no symptoms and find out during their annual mammogram when a radiologist spots a clump of abnormal cells. Check out our Breast Cancer – Detection & Treatment Options page for more information.

There are many risk factors connected with the development of breast cancer. However, the links between these factors and women who develop breast cancer is still unclear. Besides being a woman and getting older, hormone levels seem to play a major part in the development of breast cancer, but it is not clear to what extent.

Cells become cancerous in a woman’s breast when her DNA is changed or mutated. DNA is complex molecule that carries the information that makes a living organism function. It is the chemical in our body that makes up our genes, which can tell our cells when to grow, divide or die. Sometimes these mutations are inherited. But oftentimes, your DNA is changed throughout your life, possibly through prior exposure to radiation therapy or cancer-causing chemicals.

While you cannot control your family history, other lifestyle choices you can control are shown to increase your risk of breast cancer, including:

  • Drinking an average of two to five alcoholic beverages daily
  • Being overweight or obese
  • Lack of physical activity
  • Using oral contraceptives (this risk goes away over time after you stop using them)
  • Not having children or having first child after 30
  • Hormone therapy

Fortunately, few women diagnosed with breast cancer require mastectomy, or removal of the breast. Almost all women diagnosed with breast cancer, however, have the option of mastectomy with or without immediate reconstruction. Many women who have a non-invasive tumor select the option of a lumpectomy to remove the tumor, followed by radiation therapy to help prevent recurrence of any cancer. 

Because there are so many stages and types of breast cancer, the treatment options also vary. North Cascade Cancer Center offers the most comprehensive array of radiation therapy. Check out the detailed treatment options available to you.

High doses of radiation therapy are used to kill cancer cells during cancer treatment. This radiation therapy can also affect surrounding tissue and organs. Because of the advanced technology at North Cascade Cancer Center, the damage to surrounding tissue is greatly minimized with fewer side effects. However, general side effects from radiation therapy include fatigue and skin irritations (itching, peeling, dryness, redness) at the site of the radiation therapy. 

Contact North Cascade Cancer Center Today

If you are ready to start the fight against cancer, we are here to help and support you. Give us a call at (360) 370-2873 with any questions or reach out to us at our contact page. We look forward to hearing from you and helping you overcome cancer on your way to a healthier, happier life.