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.
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.
Following the guidelines for early detection improves the chances that breast cancer can be diagnosed at an early stage and treated successfully. The American Cancer Society recommends:
The goal of breast cancer screenings, such as mammograms, is to find breast cancers before they spread. Breast cancers that can be felt tend to be larger and are more likely to have already spread beyond the breast. Breast cancers found during screening exams are more likely to be small and still confined to the breast. The size of a breast cancer and how far it has spread are important factors in predicting the prognosis for women with breast cancer.
Women at high risk (greater than 20 percent lifetime risk based on family history) should get an MRI and a mammogram every year. Women at moderately increased risk (15 to 20 percent lifetime risk based on family history) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.
MRI screening is done in addition to a screening mammogram. Although an MRI is a more sensitive test, it can return false positive results or miss some cancers that a mammogram does detect.
For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. Because the evidence is limited regarding the best age at which to start screening, this decision should be based on shared decision-making between patients and their health care providers, taking into account personal circumstances and preferences.
If something suspicious is found during a screening exam, one or more breast tools can help doctors find out if breast cancer is present. If cancer is confirmed, the stage of the cancer is then determined. Staging refers to how far the cancer has spread to nearby tissue or organs.
If something suspicious is found during a screening exam, physicians at Penn Medicine will use one or more of the following tests to find out if breast cancer is present. Tests include:
A biopsy is a diagnostic surgical procedure in which a tiny bit of the breast tumor is removed and examined under a microscope.
Penn Medicine surgeons perform several different types of biopsies based the amount of tissue being removed. Some biopsies use a very fine needle, while others use thicker needles or even require a small surgical procedure to remove more tissue. The breast cancer team decides which type of biopsy to use depending on the particular breast mass.
In addition to offering quick results without significant discomfort and scarring, both fine needle aspiration and core needle biopsy give patients the opportunity to discuss treatment options with their doctor before having surgery. In some cases, needle biopsy can be performed right in the doctor's office. However, because needle biopsy takes only a small sample of tissue there is a higher risk of a false negative result, suggesting that cancer is not present when it really is.
Incisional and excisional biopsies are more invasive than needle biopsies. They leave a scar and may require a longer time to recover. As with needle biopsy, there is some possibility that incisional biopsy can return a false negative result. However, the results are available fairly quickly. Excisional biopsy is the surest way to establish a definite diagnosis without getting a false negative result. Having the entire lump removed can also provide some patients with additional some peace of mind.
Unlike mammography, which uses X-rays to examine breast tissue, magnetic resonance imaging (MRI) scans of the breast use radio waves and strong magnets. During the scan, the energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of the breast.
MRI scans present detailed images of the breast and help Penn cancer specialists accurately diagnose and locate breast tumors. Breast MRI has a number of different uses for breast cancer, including:
PET scans can help cancer specialists at Penn precisely find cancer cells in the body. PET scans create computerized images of chemical changes, such as metabolism, that take place in tissue. This helps locate breast cancer cells as they have a higher metabolism than other tissues in the body.
PET scans are not used to screen for breast cancer, but once breast cancer has been diagnosed, PET scans are used to determine:
When appropriate, Penn radiation oncologists use PET for planning radiation therapy. Penn has one of the few radiation oncology departments in the country with a dedicated PET/CT scanner used solely for the purpose of planning radiation treatments The combined matching of a CT scan with PET images improves the ability to discriminate normal from abnormal tissues and helps radiation oncologists check the effectiveness of radiation treatments on the cancer cells.
An important part of diagnosing and treating breast cancer at Penn Medicine is staging. Staging is the process of finding out how much cancer there is and where it is located. This information is used to plan cancer treatment and develop a prognosis.
Staging is a way to make sure patients get the best possible treatment. For most cancers, the stage is based on three main factors:
Once the TNM are determined, a stage is assigned to the breast cancer:
A Penn cancer physician can answer any questions about the stage of cancer and what it might mean regarding prognosis and 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.
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.
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