Breast Cancer Statistics and Information - 8 Steps . . .

Breast cancer is being diagnosed at earlier stages and the treatment is easier than just 10 years ago.  The symptoms of breast cancer are usually nothing in most cases.  Sometimes a mass is felt, but more often it is diagnosed on mammogram.  If faced with a cancer diagnosis, the first person one usually sees is the breast surgeon.  A medical oncologist and radiation oncologist will see you for breast cancer treatment after surgery.  Information about the tumor, such as size or lymph node status is needed from surgery before the oncologist can determine treatment.  In some cases chemotherapy is given before surgery.  Others only the pill form of chemotherapy is needed.  There are also many surgical options. 

Inflammatory breast cancer (IBC) is very rare (approximately 1% of breast cancers diagnosed).  It is characterized by a red, swollen breast with skin dimpling.  Sometimes antibiotics are given as this can mimic a breast infection.  IBC usually covers the entire breast whereas, infection is usually more localized.  Even though rare, one should see their physician if this is expected.

In an attempt to make the journey easier, here are the usual 8 steps through the Breast Cancer maze.
Mammogram	Surgical Visit	Results
Surgery	Onocologist	Breast Cancer Treatment
Reconstruction	Follow-Up Process Begins

STEP 1: Mammogram, sonogram and needle biopsy for diagnosis.

STEP 2: Visit to the surgeon for discussion of surgical options. 
A breast exam will be performed and mammogram films reviewed.  A breast MRI will be scheduled on most women with a new cancer diagnosis. Sometimes a CT, bone, or PET scan will be ordered. Genetic testing is discussed and blood drawn if indicated by your family history.  Lumpectomy and radiation can be used in some cancers.  If radiation was not performed, the cancer would come back in the same location in up to 35-40% of women.  Radiation lowers this percentage to 10-15%.  The reoccurrence of breast cancer after mastectomy is 2-3%.  The important message is that survival is the same with lumpectomy and radiation when compared to mastectomy.  Referral to a plastic surgeon will be made if desired in the case of mastectomy.

STEP 3: Discussion of the results. 
A separate meeting can be scheduled to discuss any unexpected test results.  Sometimes the breast MRI uncovers an area that needs core needle biopsy.  Mastectomy is necessary if two cancers are found in the same breast or if a person has the breast cancer gene. 

STEP 4: Surgery. 
The reconstruction process will begin at the same time as the mastectomy.  Usually the discomfort is not as bad as expected.  I use an injection of long acting pain medicine during surgery.  Occasionally a pain reducing pump will be used.  A stretchy support garment is provided that helps decrease pain by lessening swelling and bruising.  A post op visit usually takes place one week later.  The pathology results take one to three days and will determine the stages of breast cancer.  I will call you with these results as soon as I receive them. 

STEP 5: Oncologist.
A visit will be scheduled to a Medical Oncologist who will discuss any further treatment such as chemotherapy or anti-estrogen pills.  I refer all cancer patients to an oncologist for this important visit.  A Radiation Oncologist gives radiation treatment if a lumpectomy was performed or in certain cases after mastectomy. These treatments usually begin 3 weeks after surgery.  If you have a preference for a physician or location closer to home or work, this can be arranged.  Second opinions can also be arranged.

STEP 6: Breast cancer treatment begins.
Chemotherapy can last anywhere from 3 to 18 months.  Some women need a drug called Herceptin that is given once a month for one year.  Radiation begins 3 weeks after surgery or at the completion of chemotherapy.  Traditional whole breast radiation is given Monday through Friday and lasts 20 minutes from entering the office to leaving.  Whole breast radiation lasts 6 ½ weeks with minimal side effects.  Mammosite or partial breast radiation is radiation through a balloon inserted in the breast.  It is given twice a day for 5 days.  The type of radiation treatment is determined by the size and location of your tumor, your age and your comfort levels with the risks and benefits of each treatment.  Anti-estrogen pills are given after chemo and radiation if indicated. View a demonstration of the Mammosite procedure (link opens in a new browser window).

STEP 7: Reconstruction.
If chemotherapy was needed, reconstructive breast surgery is completed after chemo.  The tissue expander is exchanged for the permanent implant.  The nipple reconstruction will be completed.  Sometimes the opposite side needs a lift or reduction.

STEP 8: Follow-up process begins.
The oncologist will begin follow-up every 3 to 6 months.  The radiation oncologist might see you one or two times after radiation is completed.  I will see you every six months for a few years then yearly for ever.  With a lumpectomy, a mammogram is obtained every 6 months on the cancer side (and yearly for both) for a total of five years.  Mammography then becomes yearly.  No mammograms are needed on the mastectomy side.  Physical exam is most important in this case.  The opposite breast still needs yearly mammograms.  In some instances an MRI will be used with mammograms or sonograms. 

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