Breast Cancer Treatment Planning
Following a diagnosis of breast cancer, we work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your needs. We try to maximize treatment success while minimizing the impact that diagnosis and treatment can have on your life.
WHAT TO KNOW ABOUT BREAST CANCER TREATMENT PLANNING
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
Considering Your Options »
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
Assessment
Evaluating Options
Choosing Treatment
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the breast cancer
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of breast cancer you have: invasive or noninvasive
- Markers, such as hormone receptors or growth factors, that provide information about the biological nature of the cancer
- Your age and overall health
- Whether you have had cancer before
- Whether you are still menstruating or have gone through menopause
- There are a number of other considerations which may affect your treatment plan.
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. There are three main types of treatment for breast cancer: surgery, drug therapy, and radiation therapy. A combination of treatment types may be recommended to take place in a specific order to best treat your specific condition.
Learn about treatments for breast cancer »
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of breast cancer, from the least to the most severe.
Choosing your treatment
Your care team will explain the options and the possible treatment sequence. Your providers will help you make an informed decision about which options may be right for you. An oncologist leads your team and remains your main doctor throughout treatment.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for breast cancer have different goals, such as:
- Slowing or stopping the growth of cancer
- Preventing a return of cancer
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing breast cancer treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
- Financial health: How to access resources and manage finances. How to maximize health insurance, disability benefits, and other community resources.
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the breast cancer
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of breast cancer you have: invasive or noninvasive
- Markers, such as hormone receptors or growth factors, that provide information about the biological nature of the cancer
- Your age and overall health
- Whether you have had cancer before
- Whether you are still menstruating or have gone through menopause
- There are a number of other considerations which may affect your treatment plan.
close Assessment
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. There are three main types of treatment for breast cancer: surgery, drug therapy, and radiation therapy. A combination of treatment types may be recommended to take place in a specific order to best treat your specific condition.
Learn about treatments for breast cancer »
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of breast cancer, from the least to the most severe.
close Evaluating Options
Choosing your treatment
Your care team will explain the options and the possible treatment sequence. Your providers will help you make an informed decision about which options may be right for you. An oncologist leads your team and remains your main doctor throughout treatment.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for breast cancer have different goals, such as:
- Slowing or stopping the growth of cancer
- Preventing a return of cancer
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing breast cancer treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
- Financial health: How to access resources and manage finances. How to maximize health insurance, disability benefits, and other community resources.
close Choosing Treatment
Every cancer is different, even in the early stages. The best treatment for one person might not be the best treatment for another. Your doctor will help you make an informed decision about which options may be right for you. Your treatment plan may consist of one or any combination of the following:
Surgery
Your care team may recommend surgery to diagnose, stage, or treat cancer:
- Diagnosis: Your doctor may recommend that you have a biopsy, to obtain tissue samples and determine a more precise diagnosis.
- Staging: Surgery can help determine the stage of breast cancer by identifying the size of the tumor and whether cancer has spread to the lymph nodes.
- Treatment: Surgically removing the tumor may provide the best treatment for you.
Surgery Resources
Should surgery be part of your care plan, we are here to help guide you through the process.
If surgery provides a good treatment option, you will meet with a surgical oncologist to develop a plan. Surgery for breast cancer is different for every patient. Your surgical oncologist (cancer surgeon) will work with you to determine the least invasive and most effective surgery for the type of breast cancer you have.
Combining surgery with other treatments
To achieve the best possible outcome, your care team may recommend combining surgery with other treatments such as radiation therapy or chemotherapy. Treatment can be sequenced 1 of 2 ways:
- Neoadjuvant therapy: This treatment occurs before surgery to make it easier and more effective. Undergoing chemotherapy before surgery, for example, may shrink a tumor and make removal more successful.
- Adjuvant therapy: This treatment occurs after surgery and make include: chemotherapy, hormone therapy, or radiation therapy.
Drug Therapy (Medical Oncology)
Drug therapy, also called systemic or medical therapy, is treatment that works throughout the body to fight breast cancer. These drugs slow the growth of cancer cells or destroy them.
You can receive drug therapy:
- By mouth (orally) as a pill
- Through the blood vessels (intravenously, or IV) or as an injection or infusion
Chemotherapy: This group of medications stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. While powerful, chemotherapy can cause more side effects than other medication types.
Chemotherapy Resources
Chemotherapy is a treatment option for many people with breast cancers. We are here to help you prepare and guide you through the process.
Hormone (endocrine) therapy
Some cancers grow in response to hormones like estrogen. Hormone therapy (endocrine therapy) lowers the amount of these hormones or blocks their effect, slowing or even stopping the cancer’s growth.
Hormone Therapy Resources
Hormone therapy is a treatment option for some types of breast cancer. We are here to help you prepare and guide you through the process.
Targeted therapy
These medications slow the growth and spread of cancer by targeting proteins on the cancer cells (i.e. Her 2 Neu) or by stimulating the immune system.
For this type of treatment to work, the cancer must have the specific markers a particular medication was designed to target. Some breast cancer cells have certain proteins on the cells that promote growth. These proteins cause cancer to grow quickly and spread. Our pathologists look for the presence of these proteins by examining samples of tissue taken during a biopsy.
Targeted Therapy Resources
Should targeted therapy be part of your care plan, we are here to help you prepare and guide you through the process.
Drug therapy scheduling
If your treatment plan involves drug therapy, you will have routine visits to have lab work, see your provider, receive medication and review side effects. If you need an infusion, you will visit one of Stanford’s infusion treatment centers, where a nurse specializing in chemotherapy will provide your treatment.
Drug therapy side effects
Side effects from drug therapies vary depending on the type of medication you receive. For example, chemotherapy may affect your hair and nails, because it slows their growth as it slows the growth of cancer cells. Fatigue and other side effects are also possible. Ask your care team – we can help you manage or prevent many symptoms and side effects that can affect your everyday life.
Radiation Oncology
Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.
Radiation therapy may provide effective treatment for the type of breast cancer you have. If so, your doctor will speak with you about the best options. The types of radiation therapy we use for breast cancer treatment at Stanford include:
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are found. Some of the types of external radiation we use include:
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer.
Radiation Therapy Resources
Should radiation therapy be part of your care plan, we are here to help you prepare and guide you through the process.
What to expect during external radiation therapy and how to prepare »
- Intensity-modulated radiation therapy (IMRT)
This method is similar to the first method, but the doctor can adjust how much radiation you get from each beam. In certain situations, this enables the doctor to avoid nearby normal cells to reduce the risk for side effects. - Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method works like the first two methods, and the total amount of radiation you get is similar. But with SBRT, the radiation is given in fewer but stronger doses. This is often used for breast cancers or other cancers. - Intraoperative radiation therapy (IORT): This type is delivered right after a surgeon removes a breast tumor. The breast tissue is still exposed as a radiation oncologist delivers a high dose of radiation in the spot where the tumor was removed.
For each treatment, most of your appointment will be spent getting your body positioned correctly. The actual treatment lasts just a few minutes.
Receiving radiation treatments
Radiation therapy itself does not cause pain, so you won’t feel anything during your treatments. Radiation does not make you radioactive, and you can safely be around other people, including children.
The exact number and timing of your radiation treatments depends on the type of breast cancer you have and the type of radiation therapy you need:
- Typically, you will be treated once a day, Monday through Friday, over a few weeks. Your radiation therapy team will recommend the best treatment plan for you.
- Most treatment sessions take 15 to 30 minutes, but some may take up to 1 hour.
- We offer treatment sessions between 8 a.m. and 5 p.m. at our Cancer Centers in Palo Alto, Pleasanton, South Bay, and Turlock.
Radiation therapy side effects
Everyone has a different response to radiation therapy. It may cause short-term side effects during treatment or long-term side effects after treatment ends.
The side effects of treatment depend on the type of radiation you receive, the dose, and your overall health. Common side effects that you may experience after radiation treatment include:
- Fatigue
- Skin color changes, like a tan or sunburn
- Skin irritation
- Coughing
- Trouble swallowing
- Shortness of breath
No matter what you experience, your care team can help ease the side effects of treatment. At least once a week, your radiation oncology team will meet with you to discuss your progress and any side effects that you may have.
Clinical Trials
At Stanford, our doctors are always working to improve care for people with breast cancer. As an academic medical center, we conduct clinical trials to evaluate new medical techniques, devices, medications, and other treatments for safety and effectiveness.
For breast cancer, we study new approaches to preventing, screening, detecting, diagnosing, and treating breast cancer. Some clinical trials look at new methods, while others evaluate new combinations of approved, existing approaches.
Depending on your individual circumstances, a clinical trial may provide a treatment option for you. Like any treatment, clinical trials have possible risks and benefits, including:
Possible benefits of joining a clinical trial:
- Access to a new treatment that isn’t widely available
- Expert care from our world-renowned cancer specialists and their teams
- Low- or no-cost treatment
- Participation in research that can save lives in the future
Possible risks of a clinical trial:
- Treatment that may not work for you
- Side effects that may be unexpected or worse than current standard-of-care treatments
- Additional doctor visits, meaning more time and travel
- Additional tests, which may be uncomfortable or time consuming
- Extra expenses if your health insurance does not cover all patient costs for a trial
To learn more about Stanford’s clinical trials for breast cancer, speak with your care team. We can help you decide if a clinical trial may be right for you.
When cancer is found, your doctor will order testing to help assess its stage. Factors that determine the stage include the size of the tumor, whether cancer has spread to other parts of the body, and if so, where.
Staging the cancer helps your doctor tailor a treatment plan. The stages of breast cancer are:
Stage 0-3
Stage 4
These stages are considered curable, and the goal of treatment is to eliminate the cancer and to help prevent recurrence. Our treatment recommendations will provide options given in specific sequences to provide you the best chance of a cure.
Although cancer at this stage is typically incurable (except in rare cases), it is still treatable. We offer the latest therapies to help people with stage IV breast cancer live longer and more comfortably.
These stages are considered curable, and the goal of treatment is to eliminate the cancer and to help prevent recurrence. Our treatment recommendations will provide options given in specific sequences to provide you the best chance of a cure.
close Stage 0-3
Although cancer at this stage is typically incurable (except in rare cases), it is still treatable. We offer the latest therapies to help people with stage IV breast cancer live longer and more comfortably.
close Stage 4
At the Stanford Cancer Center, we offer multidisciplinary care for breast cancer. That means your doctors, nurses and other members of your care team work together to support you before, during and after treatment.
Your Doctors
Oncologist (MD)
This type of doctor specializes in the diagnosis and treatment of cancer. Oncologists in Stanford’s Breast Cancer Program have years of training and experience in breast cancer care. The treatments we offer include:
- Surgery
- Radiation therapy
- Medical therapy such as chemotherapy, targeted therapy, and other systemic therapies (medications that travel through the bloodstream to treat cancer anywhere in the body)
You will have a care team for each type of treatment you receive. The type of oncologist on your care team will depend on the type of breast cancer and treatment you have. The types of oncologists include:
Surgical Oncologist
These surgeons specialize in treating cancer through traditional (open) and minimally invasive surgery. Surgical oncologists perform biopsies (taking tiny tissue samples) to test for cancer. They also surgically remove tumors, some surrounding breast tissue, and lymph nodes to evaluate them for the presence of cancer.
View All {0} Surgical OncologistsMedical Oncologist
These cancer doctors have specialized training in diagnosing breast cancer. They also treat it using medications, including chemotherapy, hormone therapy and biologic therapy (targeted therapy and immunotherapy). Medical oncologists often serve as your main health care provider, coordinating your treatment among several specialists.
View All {0} Medical OncologistsRadiation Oncologist
These cancer specialists have subspecialty training in high-energy X-rays and other radiation therapy. Radiation can destroy or prevent the spread of breast cancer. Using advanced technologies, radiation oncologists can precisely target cancer cells to avoid damaging nearby healthy tissue.
View All {0} Radiation OncologistsBreast Reconstructive Surgeon
If you have breast cancer surgery and choose to have your breast restored, a reconstruction surgeon will work on its size, shape, and appearance. Our breast reconstruction surgeons are plastic surgeons with specialty training in reconstructing (rebuilding and reshaping) breasts. If you choose breast reconstruction, you will meet with your reconstruction surgeon soon after you meet with your breast cancer surgeon.
View All {0} Breast Reconstructive SurgeonsOther doctors on your care team
Anesthesiologist
An anesthesiologist is a doctor who specializes in using medications to block pain, help you relax, or make you unconscious for surgery. Anesthesiologists also maintain your vital functions such as breathing, blood pressure, and heart rate during surgery. Depending on the type of surgery you have, you may need local (small area), regional (larger area), or general (overall) anesthesia.
View All {0} AnesthesiologistsRadiologist
A radiologist is a doctor who specializes in using imaging techniques including X-ray, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Our radiologists have additional training and experience in breast cancer care. These doctors interpret imaging results and take biopsies (when needed) to help confirm a diagnosis. You may not meet your radiologist, since these doctors usually work behind the scenes to determine your diagnosis.
View All {0} RadiologistsPathologist
Your pathologist performs and reads laboratory tests to determine the type and stage of breast cancer present. These doctors have special training to detect and diagnose cancer. They use a microscope to examine tissue samples taken during a biopsy. As with radiologists, you may not meet your pathologist.
View All {0} Pathologists
Extended Care Team
This health care provider works in collaboration with your medical oncologist to help care for you during your treatment and follow up. An APP can be a physician’s assistant (PA) or nurse practitioner (NP). A nurse practitioner is an advance practice nurse who has completed graduate education and is trained to do physical exams, diagnose, prescribe, and treat medical conditions. Our APPs can help manage your side effects and help carry out your treatment plan safely. You may alternate visits between your APP and oncologist.
These specialized registered nurses provide one-on-one support to guide you through your breast cancer journey. MCCs serve as your point of contact to help manage your care, from your first appointment through follow-up visits. They assess your needs, answer your questions, make referrals, coordinate appointments, and provide patient education.
This team member helps with nonmedical issues such as scheduling your appointments, managing your paperwork, and requesting your medical records and disability paperwork.
This team member greets you at the front desk and registers you for your appointments.
If you are prescribed to have any injections, blood infusions, or chemotherapy, your infusion treatment area (ITA) scheduler will schedule these appointments.
This staff member supports you and your care team by recording details of your clinic visits, which may include your current medical condition, your past medical history and clinical care, pertinent details of your habits and lifestyle, and details of your imaging and lab work.
This doctor supervises doctors in training or in medical school. An attending physician may be your surgeon, medical oncologist, or radiation oncologist.
This type of doctor is doing postgraduate studies specializing in the care of patients with breast cancer.
This doctor has graduated from medical school and is in training (also called residency) at Stanford. Residents in their first year are also called interns.
This health care provider is a student enrolled in Stanford’s medical school who is studying to become a doctor.
Support Services
Care team and supportive services
Depending on your treatment, additional health professionals may be on your care team. You may meet or hear about these team members during your visits.
Clinical nurse
A registered nurse will take care of you if you are hospitalized after surgery or need chemotherapy.
Genetic counselor
These health professionals have specialized experience in cancer genetics, the study of genes and gene mutations and how they affect a person’s risk of cancer. Not everyone may benefit from genetic testing. It is designed for people whose medical history shows the possibility of an inherited gene mutation. Genetic counselors advise you and your family on identifying and managing any risk of inherited breast cancer. They work with you and your doctors to perform and review any genetic testing and help you understand the results.
Health librarian
If you are interested in learning more about breast cancer, our professional medical librarians can help. We offer free, science-based information on breast cancer and other health topics at the Stanford Health Library.
ITA scheduler
If you have apheresis (a specific type of blood transfusion) or chemotherapy, your infusion treatment area (ITA) scheduler will schedule your appointments.
Medical assistant (MA)
This team member helps you during your doctor visits by:
- Bringing you to your exam room after you check in for an appointment
- Providing you with a hospital gown or other clothing for your physical exam
- Taking your vital signs before your doctor sees you
New patient coordinator (NPC)
A staff member calls you before your first appointment to:
- Provide information that you need to know to prepare
- Provides a list of what you need to bring
- Helps gather your medical records
Occupational therapist (OT)
These skilled practitioners provide rehabilitation care to help you regain strength and functional ability during and after treatment for breast cancer. We help you with activities of daily living such as:
- Bathing or showering
- Dressing and grooming
- Using the restroom
- Feeding yourself
- Managing your medications
- Driving
Patient access representative (PAS)
This team member greets you at the front desk and registers you for your appointments.
Physical therapist (PT)
Breast cancer treatment can affect your strength and mobility, especially in the shoulder and arm. Physical therapists work with you and your family to recover your physical function after treatment, such as improving your:
- Strength, especially in the upper body
- Sensation, to relieve numbness in treated areas
- Range of motion, to reduce stiffness and pain
- Movement control, to improve endurance and reduce fatigue
Registered dietitian (RD)
Team members with specialized training and experience in food and nutrition work with you to understand your preferences and needs. RDs provide education about healthy eating and create a personalized diet to keep you healthy before, during, and after treatment.
Social worker (SW)
This health professional works with you and your family to provide emotional support, counseling, and resources such as financial assistance, spiritual counseling, and transportation. A social worker can also connect you with community services and, if you’re coming from out of town, help you find a place to stay.
Surgery scheduler
If you are meeting with a surgical oncologist or reconstruction surgeon or having surgery, a surgery scheduler will call you to arrange the details.
If you or your doctor found a lump in your breast, or a mammogram shows a suspicious area, you will need further testing to confirm a diagnosis. Our diagnostic evaluation includes imaging and a biopsy.
If you have a confirmed diagnosis of inflammatory breast cancer, it’s urgent that you begin treatment right away. We schedule an appointment with a medical oncologist for drug therapy and a surgeon for breast cancer surgery.
Depending on specific details about the type of breast cancer you have, you may need appointments with more than one type of cancer specialist:
- Most people will meet with a surgeon for breast cancer surgery, a medical oncologist for drug therapy, and a radiation oncologist for radiation therapy.
Metastatic breast cancer means that cancer cells have spread to nearby lymph nodes to other parts of the body. Your care will likely be managed primarily by a medical oncologist. You will see a surgeon and radiation oncologist, if needed.
Your appointment timing depends on your treatment goals:
- If you need treatment for a diagnosis of newly recurrent or metastatic breast cancer, you will see a medical oncologist for drug therapy. Newly recurrent describes breast cancer that has come back or spread to another part of the body.
- If you are interested in clinical trials for metastatic disease, you will see a medical oncologist for drug therapy.
- If you need a second opinion of a diagnosis, you will see a medical oncologist.
If you already have a diagnosis of Breast cancer and want a second opinion about treatment options, we can usually schedule you within 14 days. Your reason for seeking a second opinion will help us determine which specialist(s) you should see:
If you are still deciding where you will receive treatment, you may see a medical oncologist and a surgeon.
If you need a second opinion about drug therapy, you will see a medical oncologist.
If you need a second opinion about surgery, you will see a breast surgeon.
Cancer Care Services
Connect you and your loved ones to personalized, supportive services before, during and after your treatment
Learn More About Breast Cancer
What We Offer
Our providers use leading edge techniques to diagnose and treat breast cancer.
About this Condition
Learn about the symptoms, risk factors, types, diagnosis, stages and prevention of breast cancer.
Patient Care Resources
Learn what to expect as you go through the early steps of your care.
At Stanford Health Care, we offer you the most advanced diagnosis and treatment techniques for breast cancer, no matter how common or complex the type. Our center is a major referral center for women and men across the country with breast cancer.
Overview
What is breast cancer?
The breast is made up of a system of lobes (separate parts) and branching tubes that exit at the nipple. Breast cancer develops in the tissues that make up this system. It has many different forms, each with different behavior and treatments.
In general, cancer develops after the genetic material in cells changes and the cells grow out of control. When there are enough of these abnormal cells, they form a tumor that is visible on a mammogram or felt as a lump during a breast exam.
Not all tumors in the breast are cancerous. A biopsy can help your doctor evaluate a tumor that looks suspicious.
How does breast cancer develop?
Many patients wonder why they developed breast cancer or if they are at a high risk for the disease.
Most breast cancers result from the accumulation of random mutations, or mistakes, in genes. Because these mutations increase over time, your risk of developing cancer also increases as you get older.
Only about 5% to 10% of breast cancers are linked to inherited genetic mutations such as BRCA1 and BRCA2. These mutations make it difficult for cells to fix the random mutations that occur over time. Patients who have an inherited mutation are at a much higher risk of developing breast cancer, often at a younger age than the average woman.
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Let us help find personalized care options for you and your family.
Understanding Breast Cancer
Symptoms of Breast Cancer
While screening mammograms detect most breast cancers, self-detection plays an important role in recognizing breast cancer early. Signs and symptoms of breast cancer you can watch out for include:
- A lump or irregular area of firmness
- A lump under the arm, along or above the collarbone, or at your neck
- Changes such as retraction or dimpling in the breast skin, nipple, or areola
- Nipple discharge or bleeding
- Nipple inversion, where the nipple flattens or points inward instead of outward
- Skin inflammation or redness that does not go away
Breast Cancer Risk Factors
Some risk factors for breast cancer fall within your control, while others do not. Having one or more of these factors does not necessarily mean that you will develop breast cancer. Most people who develop the disease have minimal risk factors.
Breast cancer risk factors include:
- Age: Breast cancer risk increases with age, especially in women over 50.
- Gender: Women are much more likely to develop breast cancer than men.
- Breast density: Dense breast tissue makes it harder to detect cancer on mammograms.
- Ethnicity: Women of Ashkenazi Jewish heritage are more likely to have an inherited BRCA gene mutation.
- Exposure to radiation: Radiation exposure to the chest from childhood through early adulthood increases breast cancer risk.
- Family history: Breast cancer risk increases if you have a close relative who had breast cancer.
- History of breast or ovarian cancer: Having cancer in one breast slightly increases the risk of developing a second separate breast cancer. Women with ovarian cancer associated with BRCA1 or BRCA2 genetic mutation have an increased risk of breast cancer.
- Hormone replacement therapy: Taking hormone replacement therapy after menopause increases the risk of developing breast cancer.
- Inherited genetic predisposition: Having specific hereditary genetic mutations, such as a BRCA1 or BRCA2 mutation, increases your risk.
- Lifestyle factors: Factors such as lack of physical activity and overconsumption of alcohol can increase the risk of breast cancer.
- Menstrual history: Women whose periods began before age 12 or who experienced menopause after age 55 are at a higher risk for breast cancer.
- Reproductive history: Women who gave birth to their first child after 30 or have never been pregnant have an increased risk of breast cancer.
Types of Breast Cancer
Breast cancer types are often named for where they start in the breast. Several types of breast cancer exist, including:
- Invasive ductal carcinoma makes up about 80% of all breast cancers. It invades the breast ducts and may spread nearby or to distant parts of the body.
- Invasive lobular carcinoma invades throughout the lobule system of the breast and has the potential to spread nearby or to other parts of the body.
- Invasive inflammatory breast cancer spreads in the breast and skin lymph vessels, causing blockage that leads to fluid buildup. As a result, the skin appears red, dimpled, and swollen
- Invasive metastatic breast cancer means the cancer has spread to other parts of the body. This advanced form of breast cancer is treatable but most often not curable.
- Noninvasive ductal carcinoma (also known as ductal carcinoma in situ) develops only within the milk ducts. If left untreated, it likely evolves into invasive ductal cancer.
- Noninvasive lobular carcinoma (also known as lobular carcinoma in situ) begins in the lobes and increases the risk of developing other breast cancers.
Biological Factors
Invasive breast cancer is characterized based on additional pathology findings. Some of these pathology findings include:
- Cell type (histologic type): This feature is based on the growth pattern of the cancer under the microscope. The vast majority (approximately 80%) of breast cancers are a ductal histologic subtype. About 5-10% of breast cancers are lobular. Lobular cancers are less likely to form a distinct mass and their extent may be harder to identify on mammography. There are other less common special histologic types, like mucinous and tubular carcinomas, that have a particularly slow growth and good prognosis.
- Grade: This feature describes how like or unlike normal tissue the cancer is. A higher grade means it is more aggressive and fast growing, with features that are less like normal breast tissue. A lower grade is usually associated with slower growth. One method of determining grade is the Nottingham system, with a range of grades from 1 (low), to 2 (intermediate) to 3 (high).
- Hormone receptor status: Breast cancers that produce estrogen receptors (ER) and/or progesterone receptors (PR) are considered hormone receptor positive. Approximately 80% of breast cancers are hormone receptor positive. These cancers may require estrogen and/or progesterone to grow so anti-hormone treatments can be very effective treatments for these cancers.
- HER2 status (human epidermal growth factor 2): Between 10-20% of breast cancers have too many copies of the HER2 gene, which results in increased production of the HER2 protein on the cancer cell. This high level of HER2, which is a growth factor receptor, allows the cancer cells to grow very quickly. There are special antibody treatments targeted to the HER2 protein that can be given with chemotherapy to treat this particularly aggressive form of breast cancer.
- Oncotype DX: Special genetic testing performed on early-stage tumors, which predicts a breast cancer recurrence score. This helps your provider to evaluate whether chemotherapy may benefit you.
Breast Cancer Stages
When your care team determines your diagnosis, they also assess what stage of breast cancer you have. Staging helps you and your doctor make decisions about your treatment plan. This information also helps in determining your prognosis, or probable outcome, after treatment based on the experience of others.
The specific stages of breast cancer tumors are:
- TX: A primary tumor cannot be assessed.
- T0: No evidence of a primary tumor.
- Tis: Ductal carcinoma in situ.
- T1a, b, c: The tumor is smaller than 2 centimeters across.
- T2: The tumor is between 2 centimeters and 5 centimeters across.
- T3: The tumor is more than 5 centimeters across.
- T4(metastatic): The tumor of any size has grown beyond the breast to the chest wall or skin. Inflammatory breast cancers are stage T4.
- Recurrent: Breast cancer that has come back after treatment.
Breast Cancer Prevention
While some breast cancer risk factors are out of your control, you can take many other precautions to protect yourself from breast cancer. Take care to:
- Avoid smoking.
- Breastfeed your child if you are able.
- Drink less than one alcoholic drink per day.
- Eat a diet that can help reduce your risk of breast cancer, such as a plant-based diet (learn more about nutrition and breast cancer).
- Limit your radiation exposure, including X-ray imaging and sun exposure.
- Maintain a healthy weight, especially after menopause.
- Stay physically active and exercise regularly.
Diagnosis
Wherever you are in the process, your Stanford Health Care doctor and care team will work closely with you to determine which tests you need to complete your diagnosis. Tests may include:
If your mammogram or other screening tests show an abnormality, you may need a breast biopsy. This procedure takes a tiny sample of cells the abnormal breast tissue.
To obtain the most precise understanding of your cancer, your doctor may schedule different types of breast imaging to diagnose breast cancer. If you have been screened elsewhere and received abnormal results, we may perform additional imaging if needed. If there is a risk the cancer has spread, you may require body-wide imaging to look for distant disease.
Before and during treatment, your doctor may ask you to have your blood drawn and tested at a lab. Blood tests can provide a variety of information to help establish your diagnosis and plan your course of breast cancer treatment.
Genetic testing identifies mutations, or changes, in genes or chromosomes that increase your risk of developing cancer. For breast cancer, genetic testing can show whether you have inherited mutations in genes related to the disease, like BRCA1 or BRCA2.
Complex Cases
Stanford Health Care breast cancer experts from several specialties meet as a team in weekly reviews to discuss cases that require more complex recommendations. Based on your diagnosis, we determine our recommendations for the type and sequence of treatment.
If a doctor or facility outside Stanford Health Care has already given you a diagnosis, our medical team will review your test results. We will then discuss your diagnosis and treatment options with you.
Genetic Counseling for Breast Cancer
Our comprehensive risk assessment can help when breast cancer appears to run in your family. Given that 5-10% of breast cancers likely have hereditary causes, we offer additional steps to protect your health or adjust your treatment. Learn more about our Cancer Genetics Program and cancer risk assessment.
