YOUR CANCER TREATMENT SHOULD BE, TOO.
One in eight U.S. women will be diagnosed with breast cancer at some point during her lifetime. That’s one woman diagnosed every 2 minutes.
Breast Cancer Survivor
Breast cancer is the second most diagnosed cancer in women behind skin cancer. More than 230,000 women in the U.S. are diagnosed every year, but, when it’s detected early, more than 90 percent of women will still be alive for the 5-year survival benchmark.
Seventy-five percent of breast cancer diagnoses are in women aged 50 years and older, but younger women are also affected. And, although quite rare, men may also develop breast cancer.
Inherited gene mutations cause about 10 percent of all breast cancers. However, those who have inherited these mutations have a much higher risk for developing aggressive breast and ovarian cancers at an earlier age than women who do not have the mutations. If you have a family history of breast or ovarian cancer, you may wish to undergo genetic testing to identify whether or not you have inherited one of these aggressive, cancer-causing genetic mutations.
There is no single, cookie-cutter method of preventing, detecting, treating or curing breast cancer. The variety of breast cancer types, stages of cancer, plus your own genetic characteristics and family history require varying approaches to treatment.
Sylvester physician-experts and cancer researchers work together to discover, develop and deliver some of the world’s most advanced and targeted treatments for your unique breast cancer.
Breast cancer begins with a growth or tumor, created by abnormal cells dividing uncontrollably that may invade and damage nearby tissues and organs. Most often, tumors are classified as invasive or non-invasive. Some cancers may be recurrent (came back after treatment) or metastatic (spread outside the breast).
The majority of breast cancers are invasive. If you have invasive breast cancer, it means the cancer has moved beyond the cells where it began, either deeper into the breast tissue or into another organ. Noninvasive tumors, known as carcinoma in situ, grow and remain in the cells where they began, usually confined to the milk ducts (ductal carcinoma in situ, or DCIS), or in the lobules, the milk-producing glands of the breast (lobular carcinoma in situ, or LCIS).
Additional cancer types include:
• Paget’s disease of the nipple
Triple negative breast cancer is a subset of invasive ductal cancer and is characterized by having no estrogen receptors or progesterone receptors, and no excess of the HER2 protein on the cancer cell surfaces. This type of breast cancer has been hard to treat in the past, but a novel clinical trial at Sylvester is changing that by targeting vitamin D and androgen receptors. Used in conjunction with chemotherapy, this treatment is showing great promise.
Men who are diagnosed with breast cancer typically detect a hard lump under the nipple and areola. The most common type seen in men is ductal carcinoma in situ or invasive, but there have been diagnoses of Paget’s disease of the nipple and inflammatory breast cancer.
The right diagnosis and the right, targeted treatment delivered at the right time lead to better outcomes, faster responses and fewer side effects.
When you come to Sylvester, your team is composed of world-renowned experts who treat only breast cancer, and sometimes only a specific type of breast cancer. That depth of expertise helps ensure that you receive an accurate and complete diagnosis the first time, the most targeted treatments, and results that are among the best in the nation.
The Role of Clinical Trials in
Breast Cancer Treatment
Sylvester offers a wide range of options to treat your unique breast cancer, including surgery, radiation therapy, chemotherapy, hormone therapy, and immune and targeted therapies, all of which may be used individually or in combination. Your dedicated team of experts will advise you on your options for genetic testing, clinical trials, breast reconstruction and fertility preservation, all designed to be specific to you, right down to the molecular level.
That’s why it’s important that you take the time to fully understand the treatment that is being proposed and why. Write down your questions before you visit your doctor – and make sure you get the answers you need.
In addition to the highest standards of breast cancer diagnosis and care, we offer the following advanced treatment options and services:
- Multidisciplinary team approach to care
- Clinical trials offering the newest drugs and treatment
- Genomic tumor profiling
- Genetic counseling and testing for cancer-causing mutations
- Microsurgical venous lymph node transfer and lymphatic grafting
- Cold cap therapy to prevent hair loss
- Fertility preservation
- Palliative care
Multidisciplinary team approach to care:
When you come to Sylvester for breast cancer care, your individual case will be reviewed by the entire care team during tumor board – a meeting where the care team collaboratively develops a treatment plan personalized to the unique characteristics of your cancer.
The Importance of a Multidisciplinary
Team of Breast Cancer Experts
The multidisciplinary team includes everyone involved in your care – medical oncologists, surgical oncologists, pathologists, radiation oncologists, obstetrician/gynecologists, radiologists, nurse practitioners, research coordinators, nurse coordinators, patient care coordinators and other essential health care professionals such as social workers, pharmacists, nutritionists and allied staff. You can think of it as having a whole team of doctors focused on you rather than just one!
Newest drugs and treatments via clinical trials: As a breast cancer patient at Sylvester, you’ll have access to more innovative and advanced treatments than at any other hospital in South Florida. Clinical trials provide patients with new treatments before they become available in standard clinical practice. This can include new targeted and immune-based therapies, new approaches to surgery or radiation therapy, new combinations of drugs or treatments, or new methods such as gene therapy. Ask your doctor if a clinical trial may be a good option for you.
The Role of Immunotherapies
for the Treatment of Breast Cancer
Genomic tumor profiling: Also called somatic DNA testing, this breakthrough test is the driver for precision medicine. It looks at your tumor’s molecular signature to identify characteristics indicating how aggressive it is and what types of treatment will work best. Through this genomic profiling, your pathologist can identify groups of mutations in your tumor tissue sample and create a tumor profile for your specific cancer. The genomic profile can be used to select a targeted therapy specific to your cancer’s molecular characteristics. In addition, genomic profiling is useful in determining if you would benefit from chemotherapy before surgery, what other types of treatment would be the most effective and how long you should have treatments like chemotherapy or hormone suppression. Genomic profiling also helps your team of experts predict whether your cancer is aggressive and likely to spread to other parts of the body or recur, and guide your treatment accordingly.
New Technology Allowing Doctors to Treat Shifting Tumors
Genetic counseling and testing: If you have a family history of certain cancers, counseling can help identify potential health problems and develop a screening and management plan. If you have a family history that includes multiple generations of cancer diagnoses on the same side of your family, diagnosis of breast cancer before age 50, cancer in both breasts, a male with a cancer diagnosis, personal and family history of ovarian cancer, or having one of several certain ethnic backgrounds, it could signal that you are at greater risk. Ask your doctor about a referral to Sylvester’s cancer genetics clinic, or call 305-243-6006 to ask for an appointment.
Vascularized lymph node transfer and lymphatic grafting: Sylvester’s surgeons can provide relief from the debilitating condition of lymphedema. About 14 percent of women who have lymph nodes under the arm removed during mastectomy will develop lymphedema – 80 percent of these women within three years after mastectomy. This is because removal of cancerous lymph nodes in the armpit disrupts the normal flow of lymphatic fluid out of the arm. With nowhere to go, the fluid backs up in the tissues of the limb, causing painful and disfiguring swelling.
Living Beyond Lymphedema
Sylvester’s microsurgeons are among a handful nationwide who have the expertise to prevent lymphedema and provide relief to women who already have lymphedema. Our surgeons pioneered a technique called axillary reverse mapping during mastectomy that identifies and preserves lymphatic channels during surgery and reconstructs those that cannot be avoided. This approach protects the flow of lymphatic fluid, and is proven to dramatically reduce the chance that patients will develop lymphedema following breast cancer surgery.
Another technique, called vascularized lymph node transfer (VLNT), is a good option for women who have previously had surgery and already have lymphedema. VLNT involves taking three or four healthy lymph nodes and surrounding tissue from another place on the body, like the groin, and grafting them into the affected limb to restore lymphatic flow. Women suffering from lymphedema experience significant relief soon after VLNT surgery.
Discussing Unique Breast Reconstruction Options
Breast Reconstruction after Surgery: If you want reconstruction after mastectomy, talk to your surgeon about your options. For many patients, reconstruction can be done during the same procedure as the breast cancer surgery, by your specially trained surgical oncologist or with your surgeon and the reconstructive surgeon working as a team. Sylvester surgeons offer the full range of reconstructive techniques using your own natural tissues and implants.
Cold cap therapy to minimize hair loss: In addition to all the normal questions and fears a woman may face when she receives a breast cancer diagnosis, the prospect of losing one’s hair during chemotherapy is perhaps one of the most personal. With this in mind, Sylvester offers FDA-cleared cold cap therapy to minimize hair loss during chemotherapy.
One Woman’s Experience with Cold Cap Therapy
Chemotherapy is effective in treating cancer because it attacks fast growing cancer cells. Unfortunately, other fast growing, non-cancerous cells, like those in skin, finger nails and hair follicles, are also affected. Cold cap therapy works by cooling the scalp during treatment – dramatically slowing metabolism in the hair follicles and limiting the amount of chemotherapy follicle cells can absorb. This enables the follicles to survive chemotherapy and significantly reduces hair loss.
Fertility Preservation: Being diagnosed with cancer is difficult enough, but certain life-saving treatments could affect your ability to conceive a child. Making informed decisions regarding your fertility between the time you are diagnosed and the beginning of treatment will give you greater control over your reproductive future. Specialists at the Department of Obstetrics and Gynecology at the University of Miami offer fertility counseling for male and female cancer patients to help you explore your options and make decisions regarding fertility preservation before you undergo treatments such as chemotherapy or radiation.
The UHealth Fertility Center offers a variety of treatment options to preserve fertility, including freezing sperm for males, and for female patients, freezing eggs and embryos, and suppressing ovarian function, a medical treatment which prevents ovulation and preserves your ovarian reserve.
In data published by the Society for Assisted Reproductive Technology in 2007, approximately 61 percent of our patients under age 35 receiving treatment went on to have a live birth, compared to a nationwide rate of 37 percent.
Palliative care: To maximize your quality of life during treatment and recovery, Sylvester offers palliative care, a specialized approach to medical care for people with serious illnesses. Palliative care begins at diagnosis to offer relief from symptoms of both your illness and your treatment, and it can ease the challenges of your treatment for your whole family. A specially trained team of doctors, nurse practitioners, and social workers work with your treatment team to provide palliative care as an extra layer of support. Started early in the treatment process, palliative care can increase your tolerance to treatment and its side effects, thereby improving treatment effectiveness.
There is no set formula for preventing, detecting, treating or curing cancer. However, there are many things you can do to prevent or lower your chance of developing breast cancer, like making positive lifestyle changes.
You Have the Power Over:
Your Weight: Being overweight can increase your risk for many cancers, including breast cancer, especially after menopause.
The Role of Obesity in Breast Cancer
Your Diet: A diet rich in plant-based foods like fruits, vegetables, nuts and whole grains can reduce risk.
Your Physical Activity: Do something active you enjoy for at least 30 minutes a day to lower your risk of breast cancer. Activity also helps keep your weight down, a double plus.
Your Alcohol Intake: If you drink alcoholic beverages, keep it below one drink a day. Even moderate amounts increase the risk of breast cancer.
Breast Feeding: Studies have shown that if you breast feed your children for a minimum of six months, if possible, there are health benefits for your children and breast cancer risk reduction benefits for you.
Birth Control Pills: Try to avoid birth control pills, especially after age 35 or if you smoke.
Hormone Replacement Therapy: Limit the amount of time that you take post-menopausal hormones, because both estrogen-only and estrogen-progestin hormone replacements increase your risk of breast cancer.
Healthy behaviors should be started early in life. Your youth and young adult years are critical for preventing up to 50 percent or more of breast cancers later in life.
Some cancer risks, on the other hand, can’t be avoided. That’s where the experts at Sylvester come in.
Risks You Can’t Control:
Your Age: Risk for breast cancer goes up as we age, especially after age 60.
Your Sex: Most breast cancer patients are women, but men can get it too, especially in families with a breast cancer history.
Your Family History: If your family has a history of cancer, especially first or second degree relatives – such as parents, siblings, children, aunts and uncles – it may change your doctor’s recommendations for screening and preventive measures.
There are a few “red flags” for possible hereditary cancers. These include:
- Multiple generations diagnosed on one side of your family,
- A diagnosis before age 50
- A diagnosis of cancer in both breasts
- A male was diagnosed
- A personal or family history of ovarian or pancreatic cancer
Certain ethnic backgrounds, such as Ashkenazi Jewish, Eastern European descent, French-Canadian or Bahamian, have a history of higher breast cancer risk. Genetic counselors can help create and refine your risk profile by taking into account your family history, hormonal and medical history details.
Surgical History: If you have a history of biopsies for certain high-risk, non-cancer breast diseases, you may be at a higher risk.
In addition, statistically, there is a greater risk if:
- Your first menstrual period was before age 12.
- Menopause occurred later than 55.
- Your first childbirth was after age 35.
- You didn’t have children.
- You have dense breasts, or a history of benign breast disease, such as atypical hyperplasia.
Be aware of changes in your body. Trust your screenings to the experts, but conduct monthly breast self-exams, too.
You should be familiar with how your breasts normally look and feel, and report any changes to your health care provider right away.
If you notice any of the following symptoms or changes in your breast, promptly report it to your doctor:
- A breast lump or thickening that is different from surrounding tissue
- A change in the size, shape or heaviness of one breast
- A rapid change in the look of one breast, over the course of days or weeks
- Redness or changes in the skin on the breast resembling an orange peel
- A change in the color of the breast to red, purple, pink or a bruised appearance
- Unusual warmth of one breast
- Bloody discharge from the nipple
- Peeling or flaking of the nipple skin
- Itching, tenderness, pain or aching
- Enlarged lymph nodes under the arm, above or below the collarbone
A screening mammogram is the most effective tool in detecting breast cancer. Trust the mammography experts at Sylvester Comprehensive Cancer Center – these physicians specialize in reading breast images and are solely focused on ensuring the accuracy your mammogram reading to avoid false-positives and missed diagnoses.
Sylvester breast radiologists use digital tomosynthesis, or 3-D mammography, to capture images of the breast from multiple angles so they get a comprehensive view the first time. The imaging center is also designated as a Breast Imaging Center of Excellence by the American College of Radiology for both mammography and breast ultrasound.
Women with very dense breasts may need additional screening. For more information on dense breasts and screening, watch the following video before your mammogram:
Understanding Your Mammogram
An initial abnormal finding on a screening mammogram may need to be followed up by a diagnostic mammogram or ultrasound study.
Who Should Get a Mammogram?
- Women ages 40 to 44: You may choose to start annual breast cancer screening with mammograms, considering the risks of screening as well as the potential benefits.
- Women age 45 to 54: You should get mammograms every year.
- Women age 55 and older: With your doctor’s consent, you may switch to mammograms every two years or continue yearly screening as long as you are in good health.
If you have a significant family history of breast cancer:
If you have a mother or sister who has breast cancer, it is recommended that you:
- Begin yearly mammograms and clinical breast exams five to 10 years before the age cancer was diagnosed in your family member.
- Take part in genetic counseling for a strong family history or a known inherited breast cancer gene.
- Ask your doctor about breast MRI in addition to your mammograms.
Breast disease may appear in many forms: it could be benign or non-cancerous and may or may not need treatment. The breast care experts at Sylvester Comprehensive Cancer Center work together in multidisciplinary teams to analyze the genetic make-up of your unique tumor and determine the best course of action to give you the best cancer treatment outcome.
Here’s how we do it:
• The Sylvester breast cancer radiologists read mammograms exclusively, giving them a superior level of expertise not found elsewhere. Their trained eyes mean the difference between a breast cancer that is discovered and one that isn’t.
• Our team of diagnostic experts goes beyond location and stage of a cancer to provide you with a full and accurate diagnosis. They determine the molecular, genetic and biologic drivers of your unique cancer.
• Once your breast cancer is fully and correctly diagnosed, your multidisciplinary team of experts works in concert to provide you with a targeted therapy to stop the growth and give you the best possible outcome.
Sylvester Comprehensive Cancer Center includes a radiology/breast imaging department that is designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR) for both mammography and breast ultrasound. That means you and your doctors have access to imaging experts to ensure you have the most accurate technology for detecting and diagnosing breast cancer.
While not comfortable, mammograms are lifesavers – the best, quickest and most effective method of detecting an abnormal growth in your breast. Tomosynthesis, or 3-D mammography, allows radiology technologists to obtain breast images from multiple angles, enhancing the accuracy of a reading and reducing the need for repeat scans.
The Role of 3-D Mammography
in the Detection of Breast Cancer
A breast ultrasound is a non-invasive method that your doctor may request if you have dense breasts and are at a higher risk of breast cancer. Many physicians prefer a breast MRI in addition to your mammogram, especially for patients with a 20 to 25 percent, or higher, lifetime risk for breast cancer.
If your imaging exam reveals a mass or growth, your doctor will usually want to perform a biopsy. During this procedure, a small sample of the suspicious area of the breast is removed and tested to see if it is cancerous and to identify the characteristics of the tumor.
Biopsies can be performed in several ways, depending on the circumstances:
Fine needle aspiration: This is the least invasive biopsy. The surgeon or radiologist uses a thin needle with a hollow center to remove a sample of cells from the suspicious area. If your lump cannot be felt during a physical exam, the radiologist may perform a stereotactic (two-angle) breast biopsy, which uses digital mammography to guide the needle precisely to the right location.
Image-guided core needle biopsy: Because fine-needle biopsy produces less material for testing, core needle biopsy is more often used. The surgeon or radiologist uses a larger hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area, again, guided by imaging. Typically, three to six samples are obtained during the procedure.
Cyst aspiration: Your imaging exam may reveal fluid-filled sacs or cysts within your breast. The good news is that these are usually not cancer. The cysts may feel very fluid or solid. If the cysts are painful, your surgeon or radiologist can insert a needle and drain them. The fluid is then sent for analysis.
Ductoscopy: More than 80 percent of cancer arises in milk ducts. If your symptoms include a watery blood-tinged discharge from the nipple, ductoscopy helps the surgeon find the lesion, sample or remove it and save normal breast tissue. It uses a fiber-optic scope less than a millimeter thick inserted into the milk duct at the nipple and threaded deep into the breast through the duct, sending images to a computer monitor.
Surgical biopsy: Sometimes an incision, or a small cut, is required. During this procedure, the surgeon may be able to remove the entire mass (excisional biopsy) or a sample to test (incisional biopsy).
When the surgeon has the needed tissue, the team will run additional tests on the biopsied tissue to determine:
- If the growth is cancerous
- How quickly the cancer may grow
- How likely it is to spread through the body
- How well certain treatments might work
- If the mass is likely to recur
Tests include the following:
Genomic tumor profiling: Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of mutations in your tumor tissue sample and create a tumor profile for you. That profile can be used to determine if you would benefit from chemotherapy before surgery, what type of treatment would be the most effective and how long you should have treatments like chemotherapy or hormone suppression. Your profile may also help predict whether cancer is likely to spread to other parts of the body or recur and guide treatment accordingly.
Estrogen and progesterone receptor test: This test measures the amount of estrogen and progesterone (hormone) receptors in your cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
Human epidermal growth factor type 2 (HER2/neu) receptor test: This laboratory test measures how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow more quickly and is more likely to spread to other parts of the body. There are specific drugs that target this protein.