About Breast Cancer Treatment at Penn Medicine

About Breast Cancer

Making the right diagnosis is a critical component of successful cancer treatment. Penn's cancer specialists have wide-ranging experience treating all forms of breast cancer, including those that occur only rarely. Their expert understanding of the disease allows them to create cancer treatment plans that are customized for every patient.

Breast cancer, the uncontrolled growth of cells in the breast, is the most common type of cancer among women, excluding skin cancer. Breast cancer forms in the tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.


Breast Cancer Risk and Prevention

Penn Medicine recognizes that every case of breast cancer is unique, with different signs and symptoms, risk factors, and prevention strategies. All women are at risk for breast cancer, and that risk increases with age.

Breast Cancer Prevention

While there's no guaranteed way to prevent breast cancer, Penn Medicine encourages women to be screened regularly, increasing the chances that breast cancer will be found early when it's most treatable. All women should know the symptoms and warning signs of breast cancers.

Women should talk with their doctor about specific preventive measures they can take.

As with most cancers, knowing the family history of breast cancer can help patients take action toward prevention.

Women who are or may be at increased risk can take steps to reduce their chances of developing breast cancer. Before deciding, they should speak with their doctor to understand the risk and how much any of these approaches might lower their risk.

The Mariann and Robert MacDonald Womens' Cancer Risk Evaluation Center at the Abramson Cancer Center and the Cancer Risk Evaluation Program at Pennsylvania Hospital's Abramson Cancer Center at Pennsylvania Hospital and Penn Medicine at Radnor are designed for women who want information about their risk for breast and ovarian cancers. These programs offer clinical and research services that can help people with cancer and individuals who may be at an increased risk for cancer.

Breast Cancer Risk Factors

Risk factors affect the chance of getting breast cancer, Having a risk factor, or even several, does not mean that someone will get breast cancer. Most women who have one or more breast cancer risk factors never develop the disease, while many women with breast cancer have no apparent risk factors (other than being a woman and growing older).

There are different kinds of risk factors. Some factors, like age or race, can't be changed. Risk factors for breast cancer that cannot change include:

  • Gender. Being a woman is the leading risk factor for developing breast cancer. The chance of a woman developing invasive breast cancer some time during her life is just under one in eight.
  • Aging. The risk of developing breast cancer increases as women get older.
  • Menstrual periods. Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer.
  • Genetics. Between 5 and 10 percent of breast cancer cases are thought to be hereditary, resulting directly from gene defects (called mutations) inherited from a parent, including BRCA1 and BRCA2.
  • Family history. Breast cancer risk is higher among women whose close blood relatives have the disease.
  • Personal history. Women with cancer in one breast have a three- to four-fold increased risk of developing a new cancer in the other breast or in another part of the same breast.
  • Race and ethnicity. Caucasian women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of breast cancer. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.
  • Dense breast tissue. Women with dense breasts (as seen on a mammogram) have more glandular tissue and less fatty tissue, and are at higher risk of breast cancer. In addition, dense tissue and tumors have similar density so tumors can be harder to detect in women with denser breasts.
  • Benign breast conditions. Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer. Benign conditions include:
    • Non-proliferative (non-spreading) lesions.
    • Proliferative (spreading) lesions without atypia.
    • Proliferative (spreading) lesions with atypia.
  • Lobular carcinoma in situ. Women with lobular carcinoma in situ (LCIS) have a 7- to 11-fold increased risk of developing cancer in either breast.
  • Previous chest radiation. Women who had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma), especially before the age of 30, are at significantly increased risk for breast cancer.
  • Diethylstilbestrol exposure. From the 1940s through the 1960s, some pregnant women were given the drug diethylstilbestrol (DES) because it was thought to lower their chances of miscarriage. These women have a slightly increased risk of developing breast cancer. Women whose mothers took DES during pregnancy may also have a slightly higher risk of breast cancer.

Lifestyle risk factors can be changed, potentially lowering the risk of breast cancer. Lifestyle-related factors that increase the breast cancer risk include:

  • Not having children, or having them later in life.
  • Taking post-menopausal combination hormone replacement therapy such as estrogen and progesterone. Estrogen-alone therapy is not believed to increase the risk of breast cancer.
  • Alcohol use. The risk for developing breast cancer increases with the amount of alcohol consumed.
  • Being overweight or obese.
  • Lack of physical activity.

Risk Factors for Men

Men have different kinds of breast cancer risk factors. Some, like age or race, can't be changed. Risk factors for breast cancer that cannot change include:

  • Aging. The risk of developing breast cancer increases as men get older. Men with breast cancer are, on average, about 67 years old when they are diagnosed.
  • Genetics. Male breast cancer can be hereditary, resulting directly from gene defects (called mutations) inherited from a parent, including BRCA1 and BRCA2.
  • Family history. About one out of five men with breast cancer have close male or female relatives with the disease.
  • Personal history. Men with cancer in one breast have an increased risk of developing a new cancer in the other breast or in another part of the same breast.
  • Klinefelter syndrome. This congenital condition (present at birth) affects about one in 1,000 men. Normally the cells in men's bodies have a single X chromosome along with a Y chromosome, while women's cells have two X chromosomes. Men with this condition have cells with more than one X chromosome (sometimes as many as four).
  • Radiation exposure. A man whose chest area has been treated with radiation (usually for treatment of a cancer inside the chest, such as lymphoma) has an increased risk of developing breast cancer.
  • Drinking. Heavy drinking of alcoholic beverages increases the risk of breast cancer in men.
  • Liver disease. Men with severe liver disease, such as cirrhosis, have relatively low levels of androgens and higher estrogen levels. Therefore, they may have an increased risk of developing breast cancer.
  • Estrogen treatment. Estrogen-related drugs are sometimes used in hormonal therapy for men with prostate cancer. This treatment may slightly increase their breast cancer risk. However, this risk is small compared with the benefits of this treatment in slowing the growth of prostate cancer.
  • Conditions affecting the testicles. Some studies have suggested that certain conditions that affect the testicles, such as having an undescended testicle, having mumps as an adult, or having one or both testicles surgically removed (orchiectomy) may increase breast cancer risk.
  • Certain occupations. Some reports have suggested an increased risk in men who work in hot environments such as steel mills. This could be because long-term exposure to higher temperature can affect the testicles, which in turn affects hormone levels. Men heavily exposed to gasoline fumes may also have a higher risk.

Breast Cancer Risk Assessment

The Cancer Risk Evaluation Program (CREP) at Penn offers knowledge about the presence of genetic risk for cancer and provides patients with important, sometimes life-saving options.
All women, regardless of racial or ethnic background, who have a BRCA1 or BRCA2 gene mutation are at increased risk for developing breast and/or ovarian cancer. Women at risk can discuss monitoring and preventive options to reduce their chances of developing breast and/or ovarian cancer with a Penn Medicine physician at the Abramson Cancer Center, Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital or Penn Medicine at Radnor.
As leading experts in the diagnosis and management of genetic risk for breast cancer, Penn Medicine's multidisciplinary team can coordinate care for those with known or suspected genetic risk.

After providing detailed information about their family history of cancer and medical history, participants in the program are scheduled for two appointments:

  • One with a genetic counselor to assess risk and arrange genetic testing if indicated.
  • A second appointment with a medical oncologist for results, an examination and medical recommendations.

Penn's Cancer Risk Evaluation Program also provides second opinions and long-term follow-up care.

Following the evaluation, a detailed report outlining the risk assessment, genetic testing results and medical recommendations is provided to participants. Assistance in arranging follow-up care is also available.

The Mariann and Robert MacDonald Womens' Cancer Risk Evaluation Center at the Abramson Cancer Center and the Cancer Risk Evaluation Program at the Abramson Cancer Center at Pennsylvania Hospital are designed for women who want information about their risk for breast and ovarian cancers. These programs offer clinical and research services that can help people with cancer and individuals who may be at an increased risk for cancer.

Types of Breast Cancer

There are many types of breast cancer and sometimes a breast tumor can be a mix of these types. Every cancer and every person is different. Penn's breast cancer teams work with patients to choose the treatment approach and option that are best. The following information includes some of the options by cancer type and stage the team may recommend.

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in-situ is breast cancer that starts in and is contained within the milk ducts, but has not spread through the wall of the duct. It does not have the potential to spread and has an excellent prognosis.

DCIS generally has no signs or symptoms and is most commonly picked up by a finding on screening mammogram. Less commonly, it can present with a lump or mass, or nipple discharge.

DCIS is considered stage 0. Treatment options include lumpectomy and radiation or mastectomy. In selected cases, tumor removal alone can be offered. No chemotherapy is needed. Medications like tamoxifen can be offered in hormone receptor positive cases to reduce the risk of recurrence.

Invasive (infiltrating) ductal carcinoma (IDC)

Invasive (infiltrating) ductal carcinoma (IDC), starts in a milk duct, breaks through the wall of the duct, and invades the tissue of the breast. IDC is the most commonly diagnosed breast cancer. Invasive ductal carcinoma accounts for about 8 out of 10 of all cases of invasive breast cancers.

IDC may feel like a hard, bumpy, irregularly shaped lump in the breast. The most common symptoms of IDC are a change in the look or feel of the breast or the nipple, a breast mass or a suspicious finding on a mammogram. Less common signs of IDC may include nipple discharge.

Treatments for stage I, II, III and operable stage III may include:

  • Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
  • Modified radical mastectomy with or without breast reconstruction surgery.
  • Sentinel lymph node biopsy followed by surgery.
  • Adjuvant therapy (treatment given after surgery to increase the chances of a cure) that may include:
    • Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
    • Systemic chemotherapy with or without hormone therapy.
    • Hormone therapy.
  • Clinical trials.

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include:

  • Systemic chemotherapy.
  • Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.
  • Additional systemic therapy (chemotherapy, hormone therapy, or both).
  • Clinical trials.

Treatment of stage IV or metastatic breast cancer may include the following:

  • Hormone therapy and/or systemic chemotherapy.
  • Radiation therapy and/or surgery for relief of pain and other symptoms.
  • Clinical trials.

Invasive (infiltrating) lobular carcinoma (ILC)

Invasive lobular carcinoma (ILC) is lobular carcinoma that has spread, or invaded, the nearby tissue outside of the lobes. ILC has the potential to spread, or metastasize, to other parts of the body.

ILC does not always feel like a breast lump. ILC cells may leave the lobes through one opening, staying together in a line. They can proceed to infiltrate fatty tissue, creating a web-like mass. This web of cancer cells may feel like a thickened area of breast tissue, and at first may not cause concern or pain. Unfortunately, if left undetected, ILC can develop into a large mass before causing more noticeable symptoms.

Treatments for stage I, II, III and operable stage III may include:

  • Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
  • Modified radical mastectomy with or without breast reconstruction surgery.
  • Sentinel lymph node biopsy followed by surgery.
  • Adjuvant therapy (treatment given after surgery to increase the chances of a cure) that may include:
    • Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
    • Systemic chemotherapy with or without hormone therapy.
    • Hormone therapy.
  • Clinical trials.

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include:

  • Systemic chemotherapy.
  • Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.
  • Additional systemic therapy (chemotherapy, hormone therapy, or both).
  • Clinical trials.

Treatment of stage IV or metastatic breast cancer may include the following:

  • Hormone therapy and/or systemic chemotherapy.
  • Radiation therapy and/or surgery for relief of pain and other symptoms.
  • Clinical trials.

Inflammatory breast cancer (IBC)

Inflammatory breast cancer (IBC) is a rare but aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red. Penn Medicine estimates 1 to 4 percent of breast cancer cases are IBC.

IBC affects the lymphatic system of the skin of the breast, so it does not present as a traditional lump. It tends to be diagnosed in younger women and it occurs more frequently and at a younger age in African Americans. Like other types of breast cancer, IBC can occur in men, but usually at an older age than in women.

Making the right diagnosis is a critical component of successful IBC treatment. Penn's cancer specialists have extensive experience in understanding the results and creating cancer treatment plans that are customized for every patient.

IBC is usually classified as stage III breast cancer. The treatment involves neoadjuvant chemotherapy, possibly followed by surgery, radiation, hormone therapy, biologic therapy or a combination of such treatments.

Male breast cancer

Men are not exempt from breast cancer. Male breast cancer makes up less than one percent of all breast cancer cases, but men at any age may develop breast cancer. The following types of breast cancer are found in men:

  • Invasive ductal carcinoma. Cancer that has spread beyond the cells lining the ducts in the breast. Most men with breast cancer have this type of cancer.
  • Ductal carcinoma in situ. Abnormal cells that are found in the lining of a duct.
  • Inflammatory breast cancer. A type of cancer in which the breast looks red and swollen and feels warm.
  • Paget disease of the nipple. A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

Treatment options for stage 0 male breast cancer include lumpectomy and radiation or mastectomy. In selected cases, tumor removal alone can be offered. No chemotherapy is needed.

Treatments for stage I, II, III and operable stage III may include:

  • Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
  • Modified radical mastectomy with or without breast reconstruction surgery.
  • Sentinel lymph node biopsy followed by surgery.
  • Adjuvant therapy (treatment given after surgery to increase the chances of a cure) that may include:
    • Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
    • Systemic chemotherapy with or without hormone therapy.
    • Hormone therapy.
  • Clinical trials.

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include:

  • Systemic chemotherapy.
  • Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.
  • Additional systemic therapy (chemotherapy, hormone therapy, or both).
  • Clinical trials.

Treatment of stage IV or metastatic breast cancer may include the following:

  • Hormone therapy and/or systemic chemotherapy.
  • Radiation therapy and/or surgery for relief of pain and other symptoms.
  • Clinical trials.

Other types of breast cancers

  • Triple-negative breast cancer. Usually IDCs, whose cells lack certain receptors and tend to grow and spread more quickly than other types of breast cancer. Breast cancers with these characteristics tend to occur more often in younger women and in African-American women.
  • Mixed tumors. Contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer.
  • Medullary carcinoma. This infiltrating breast cancer has a rather well-defined boundary between tumor tissue and normal tissue.
  • Metaplastic carcinoma. Also known as carcinoma with metaplasia, is a very rare type of invasive ductal cancer that includes cells that are normally not found in the breast, such as cells that look like skin cells or cells that make bone.
  • Mucinous carcinoma. Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells.
  • Paget disease. This breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. Paget disease is almost always associated with either DCIS or IDC.

Breast Cancer Symptoms

Not all breast cancer is found through mammography. The most common symptoms of breast cancer are:

  • A change in the look or feel of the breast
  • A change in the look or feel of the nipple

Other breast cancer symptoms may include:

  • Lump, hard knot or thickening
  • Swelling, warmth, redness or darkening
  • New pain in one spot that doesn't go away
  • Spontaneous nipple discharge

Inflammatory breast cancer symptoms

Symptoms of inflammatory breast cancer (IBC) may seem like an infection — redness, swelling and warmth — without a distinct lump in the breast. Other symptoms of IBD can include:

  • Red, pink, reddish purple or bruised look to the skin
  • Skin that appears pitted or to have ridges
  • Breast heaviness
  • Burning
  • Aching
  • Increase in breast size
  • Tenderness
  • Inverted nipple
  • Swollen lymph nodes

Symptoms of IBC usually develop quickly — over a period of weeks or months. Cancer cells blocking the lymph vessels in the skin cause the redness and warmth. Changes in the skin's appearance signal a buildup of fluid.

The same symptoms may also be signs of other conditions such as infection, injury, or other types of cancer. It is important for women experiencing any of these symptoms to see their doctor.

Male breast cancer symptoms

In men, the most common symptoms of breast cancer are a change in the look or feel of the breast, a change in the look or feel of the nipple and nipple discharge. Possible signs of breast cancer to watch for in men include:

  • A lump or swelling, which is usually (but not always) painless
  • Skin dimpling or puckering
  • Nipple retraction (turning inward)
  • Redness or scaling of the nipple or breast skin
  • Discharge from the nipple

These changes aren't always caused by cancer. For example, most breast lumps in men are due to gynecomastia (a harmless enlargement of breast tissue). Any breast changes are a reason to speak to Penn Medicine cancer specialist.

Staging Breast Cancer

Staging systems provide doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. By understanding the stage of their cancer, patients can make informed decisions about their treatment.

There are five stages of breast cancer:

  • Stage 0. This is the earliest stage of non-invasive breast cancer.
  • Stage I. The cancer is relatively small and contained where it started.
  • Stage II. The cancer is localized, but the tumor is larger than in stage I and lymph nodes close to the original site may contain cancer cells.
  • Stage III. The cancer is larger and there are cancer cells in the lymph nodes in the area.
  • Stage IV. The cancer has spread (metastasized) from where it started to other organs, such as the liver, bones or lungs.

Breast Cancer Treatment at Penn

At Penn Medicine, breast cancer is treated at the Abramson Cancer Center, home of the Rena Rowan Breast Cancer Center, and at the Abramson Cancer Center at Pennsylvania Hospital, home of the Integrated Breast Center at Pennsylvania Hospital. Researchers at Penn continue to identify new detection methods, develop new therapies and improve the quality of life for women with breast cancer. Both centers have been granted full, three-year accreditation by the National Accreditation for Breast Centers. The accreditation recognizes the centers' commitment to offering patients every advantage in their breast disease care.

The Abramson Cancer Center's NCI-approved breast cancer research program is a leader in new detection techniques and clinical trials for breast cancer.

Penn brings together investigators from diverse disciplines and focuses their collective energies on understanding, preventing and treating breast cancer. This combined effort has enabled research advances to be used more quickly benefit patients and has made Penn a leader in breast cancer research.

Breast Cancer Diagnosis

Doctors at Penn Medicine believe that early detection tests for breast cancer save many thousands of lives each year, and that many more lives could be saved if even more women took advantage of these tests.

Read more Breast Cancer Diagnosis

Breast Cancer Treatment

Breast Cancer Surgery options include breast-conserving surgery such as lumpectomy and partial mastectomy; total mastectomy; modified radical mastectomy; and radical mastectomy.

Two types of breast reconstructive surgery are offered at Penn: natural tissue reconstruction and breast implant reconstruction.

Radiation therapy options include accelerated partial breast irradiation (APBI), which includes breast brachytherapy and external beam partial breast irradiation; 3-D conformal radiation therapy; image-guided radiation therapy (IGRT); intensity-modulated radiation therapy (IMRT); targeted radiation therapy treatment called MammoSite®; internal mammary node irradiation; and prone breast radiotherapy.

Chemotherapy and biologic therapies for breast cancer include chemotherapy, hormone therapy, immunotherapy, and vaccine therapy.

Breast cancer clinical trials are also available at Penn.

Read more Breast Cancer Treatment

Breast Cancer Survivorship

There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete. Survivorship programs at Penn Medicine are a distinct phase of breast cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

Read more Breast Cancer Survivorship


Donna Lee Lista

Donna Lee Lista shares her story.

Clinical Trials

Breast Cancer Trials

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