Breast Cancer Care at Stanford Health Care
As you and your family prepare for your first visit at Stanford, you’ll likely have many questions about your care journey here. This overview explains our diagnosis and treatment planning, to help you understand what to expect as you go through the early steps of your care.
We offer extensive resources to assist you with every facet of your care – physical, emotional, spiritual, and social. We’re here to help you and your family each step of the way.
Where You Are In Your Care
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
Learning that you may have cancer plunges you into uncertainty. The more you understand about your condition, the greater your sense of control. This overview explains diagnosis and treatment planning, to help you understand what to expect as you go through the early steps of your care.
Breast Care at Stanford Health Care
Learn more about how breast cancer is diagnosed and the options for treatment.
Learn more about how lymph nodes are removed and examined to help stage and treat breast cancer.
Learn more about breast cancer may be treated with medications like chemotherapy, targeted therapy, and hormone therapy.
Learn more about what it is like to receive radiation treatments for breast cancer.
Before
During
After
Diagnosing breast cancer
For everyone who comes to us, we start your care by establishing or confirming a diagnosis. Accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options in the correct sequence.
Diagnosis and treatment should be personalized to each patient.
- You may have come to Stanford through a referral from your primary care doctor or another specialist. You may be here because your doctor found a lump, or because your screening mammogram showed an abnormality.
- If you have already received a diagnosis before coming to Stanford, your Stanford team will want to review these test results to confirm or refine your diagnosis.
Wherever you are in the process, your Stanford doctor and care team will work closely with you to determine which tests you need to complete your diagnosis.
Learn more about the diagnostic process »
Developing a treatment plan
Your care team includes cancer experts in several fields. Together, they will recommend treatment options based on your specific diagnosis. We work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your particular needs. We try to maximize treatment success while minimizing the impact that diagnosis and treatment can have on your life.
Learn more about treatment planning »
Different types of treatment for breast cancer have different goals, such as:
- Slowing or stopping the growth of cancer
- Removing or treating cancer cells in the breast
- Treating any cancer cells that may have spread outside the breast
- Working to prevent a recurrence of cancer
- Managing symptoms of incurable cancer
At its broadest level, breast cancer treatment has 2 general categories. As we develop treatment recommendations for you, we consider whether the cancer is confined to your breast or has spread to other parts of your body. Depending on the details of your diagnosis, you may need just one category of treatment, or both:
- Local therapy targets the tumor. Surgery and radiation therapy are local treatments.
- Drug therapy treats the entire body with cancer-fighting medications to destroy cancer cells that have spread from the breast to other parts of the body. Medical oncology is systemic because you take medications in either intravenous (IV) or pill form that circulate throughout the body.
If you have surgery before drug therapy, the drug therapy treatments are called adjuvant therapy. The goal of adjuvant therapy is to treat any microscopic disease that may remain after surgery.
If your doctor recommends drug therapy before surgery, it is called neoadjuvant therapy. The goal of neoadjuvant therapy is to shrink the cancer to make surgery more successful.
We can treat breast cancer with several different methods, often combining them for the best chance at success. Our recommended plan will include the most appropriate treatment types for your unique case. It also will likely recommend that treatments be given in a specific order, to benefit you the most.
Approaches to breast cancer treatment include:
Learn more about breast cancer treatment options, including their uses and side effects »
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 medications and other treatments for safety and effectiveness. Is a trial right for me?
- Surgical oncology: Surgery removes tumors and is used during certain types of biopsies.
- Radiation oncology: High-energy radiation therapy, such as X-rays or gamma rays, shrinks tumors and destroys cancer cells.
- Medical oncology: Medications that shrink tumors and destroy cancer cells include chemotherapy, hormone (endocrine) therapy, and targeted therapy.
Follow-up care
After you complete your breast cancer treatment, your care team works with you to develop an ongoing care plan. Regular follow-up care, also known as surveillance, is important to:
- Monitor your overall health
- Manage any remaining side effects
- Check for possible signs of the cancer coming back (recurring)
Follow-Up Care: Managing Side Effects After Treatment »
Follow-Up Care: What to Expect After Treatment »
We work closely with your primary care doctor throughout your treatment, providing updates on a regular basis. We continue this partnership after you finish treatment, to coordinate your ongoing care for breast cancer and any other health concerns.
Support after treatment
Cancer Care Services is a support services hub for people living with cancer and their loved ones. Our team of doctors, nurses, social workers, spiritual care providers, nutrition experts, financial counselors, and others work with your cancer care team to support your quality of life.
We support you through the challenges of breast cancer and its treatment with counseling, classes, and supportive care to meet your financial, physical, psychosocial, and spiritual needs.
Survivorship care
At Stanford, our support doesn’t end when you complete active treatment (treatment that directly fights cancer). Our Cancer Survivorship Program offers health care and other services to help breast cancer survivors transition to life after cancer and the activities you enjoy.
Palliative care
Our palliative care specialists work closely with your care team to maintain your quality of life and achieve your personal goals during cancer treatment. Our palliative care providers work with your breast cancer care team and provide services including:
- Medical care to relieve cancer symptoms and treatment side effects
- Education about ongoing breast cancer care
- Advance care planning to document your preferences for health care and end-of-life decisions
- Counseling to address issues such as:
- Anxiety and depression
- Body image
- Relationship management
- Return to work
Palliative care does not treat breast cancer. Rather, it helps you and your family cope with the disease in your daily life. You can receive palliative care:
- While you remain under your regular doctor’s care and are still receiving breast cancer treatments
- At any time, starting from diagnosis, throughout treatment, during follow-up, and at the end of life
Find out more about our palliative care and other supportive services for people with cancer in the Cancer Care Services »
Diagnosing breast cancer
For everyone who comes to us, we start your care by establishing or confirming a diagnosis. Accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options in the correct sequence.
Diagnosis and treatment should be personalized to each patient.
- You may have come to Stanford through a referral from your primary care doctor or another specialist. You may be here because your doctor found a lump, or because your screening mammogram showed an abnormality.
- If you have already received a diagnosis before coming to Stanford, your Stanford team will want to review these test results to confirm or refine your diagnosis.
Wherever you are in the process, your Stanford doctor and care team will work closely with you to determine which tests you need to complete your diagnosis.
Learn more about the diagnostic process »
Developing a treatment plan
Your care team includes cancer experts in several fields. Together, they will recommend treatment options based on your specific diagnosis. We work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your particular needs. We try to maximize treatment success while minimizing the impact that diagnosis and treatment can have on your life.
Learn more about treatment planning »
Different types of treatment for breast cancer have different goals, such as:
- Slowing or stopping the growth of cancer
- Removing or treating cancer cells in the breast
- Treating any cancer cells that may have spread outside the breast
- Working to prevent a recurrence of cancer
- Managing symptoms of incurable cancer
close Before
At its broadest level, breast cancer treatment has 2 general categories. As we develop treatment recommendations for you, we consider whether the cancer is confined to your breast or has spread to other parts of your body. Depending on the details of your diagnosis, you may need just one category of treatment, or both:
- Local therapy targets the tumor. Surgery and radiation therapy are local treatments.
- Drug therapy treats the entire body with cancer-fighting medications to destroy cancer cells that have spread from the breast to other parts of the body. Medical oncology is systemic because you take medications in either intravenous (IV) or pill form that circulate throughout the body.
If you have surgery before drug therapy, the drug therapy treatments are called adjuvant therapy. The goal of adjuvant therapy is to treat any microscopic disease that may remain after surgery.
If your doctor recommends drug therapy before surgery, it is called neoadjuvant therapy. The goal of neoadjuvant therapy is to shrink the cancer to make surgery more successful.
We can treat breast cancer with several different methods, often combining them for the best chance at success. Our recommended plan will include the most appropriate treatment types for your unique case. It also will likely recommend that treatments be given in a specific order, to benefit you the most.
Approaches to breast cancer treatment include:
Learn more about breast cancer treatment options, including their uses and side effects »
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 medications and other treatments for safety and effectiveness. Is a trial right for me?
- Surgical oncology: Surgery removes tumors and is used during certain types of biopsies.
- Radiation oncology: High-energy radiation therapy, such as X-rays or gamma rays, shrinks tumors and destroys cancer cells.
- Medical oncology: Medications that shrink tumors and destroy cancer cells include chemotherapy, hormone (endocrine) therapy, and targeted therapy.
close During
Follow-up care
After you complete your breast cancer treatment, your care team works with you to develop an ongoing care plan. Regular follow-up care, also known as surveillance, is important to:
- Monitor your overall health
- Manage any remaining side effects
- Check for possible signs of the cancer coming back (recurring)
Follow-Up Care: Managing Side Effects After Treatment »
Follow-Up Care: What to Expect After Treatment »
We work closely with your primary care doctor throughout your treatment, providing updates on a regular basis. We continue this partnership after you finish treatment, to coordinate your ongoing care for breast cancer and any other health concerns.
Support after treatment
Cancer Care Services is a support services hub for people living with cancer and their loved ones. Our team of doctors, nurses, social workers, spiritual care providers, nutrition experts, financial counselors, and others work with your cancer care team to support your quality of life.
We support you through the challenges of breast cancer and its treatment with counseling, classes, and supportive care to meet your financial, physical, psychosocial, and spiritual needs.
Survivorship care
At Stanford, our support doesn’t end when you complete active treatment (treatment that directly fights cancer). Our Cancer Survivorship Program offers health care and other services to help breast cancer survivors transition to life after cancer and the activities you enjoy.
Palliative care
Our palliative care specialists work closely with your care team to maintain your quality of life and achieve your personal goals during cancer treatment. Our palliative care providers work with your breast cancer care team and provide services including:
- Medical care to relieve cancer symptoms and treatment side effects
- Education about ongoing breast cancer care
- Advance care planning to document your preferences for health care and end-of-life decisions
- Counseling to address issues such as:
- Anxiety and depression
- Body image
- Relationship management
- Return to work
Palliative care does not treat breast cancer. Rather, it helps you and your family cope with the disease in your daily life. You can receive palliative care:
- While you remain under your regular doctor’s care and are still receiving breast cancer treatments
- At any time, starting from diagnosis, throughout treatment, during follow-up, and at the end of life
Find out more about our palliative care and other supportive services for people with cancer in the Cancer Care Services »
close After
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.
Medical 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.
Radiation 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.
Breast 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.
Other doctors on your care team
In Stanford’s team-based approach to breast cancer care, your oncologist works with other doctors throughout your course of treatment.
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.
Attending physician
This doctor supervises doctors in training or in medical school. Your attending physician may be your surgeon, medical oncologist, or radiation oncologist.
Radiologist
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.
Pathologist
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.
Fellow
This type of doctor is doing postgraduate studies specializing in the care of patients with breast cancer.
Resident
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.
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.
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 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.
Call Cancer Care Services at 650-498-6000 to speak with us about how we can support you and your family members. Cancer Care Services is Stanford’s system of services that support physical, mental, and emotional healing and well-being.
We can help you identify professional therapists, services, and resources that are personalized to the needs of you and your family. Many of these services are free for Stanford patients and families.
Yes, always feel free to bring someone with you to your appointments. A family member or friend can help ask questions, write down and remember information your care team gives you, and provide support.
Yes. Just let your care team know that you would like to record your conversation. Another good way to keep track of your care team discussion is to keep notes (bring a pencil or pen and your Patient & Family Resource Guide, which has a notes section). A family member or friend can attend your appointments to take notes for you.
The decision about whether and how much to share with your children is personal. Call Cancer Care Services at 650-498-6000 to learn about the support available for your family members.
We can help you decide on an approach for involving your family that is right for you. In addition to our services at Stanford, some of our patients and families have recommended other websites for children and teens with parents who have cancer:
An advance health care directive is a legal document you can complete. It specifies the kind of care and treatments you want (or don’t want) if you become seriously ill and can’t make such decisions yourself.
In California, an advance health care directive allows you to designate an agent, or someone you trust to make health care decisions on your behalf. You can also list your health care instructions. You can ask your doctor, nurse, social worker, or other health care provider for more information.
At Stanford, advance health care directive forms are available in the hospital units and at the clinics. You can also call our Spiritual Care Service at 650-723-5101 to get a form or discuss a directive with one of our spiritual care counselors.
Our Cancer Survivorship Program will help you adjust and cope with your new lifestyle after treatment for cancer. You’ll speak with Advance Practice Providers (APPs), survivorship experts who specialize in working with people with cancer and their families.
We help you and your family transition from diagnosis to wellness through a variety of psychosocial services, in addition to medical care. Call 650-498-6000 or visit https://stanfordhealthcare.org/medical-clinics/cancer-survivorship-program.html.
Our social workers can help you plan ways to manage your job during cancer care. Call Cancer Care Services at 650-498-6000 to speak with us about your work-related concerns. We can help you with completing disability paperwork, finding financial assistance, and taking a leave of absence from your job during treatment.
You can provide support to a loved one receiving care in many ways. You can help with day-to-day activities such as accompanying them on doctor visits or preparing food, for example. You can also coordinate care and services by phone or email.
For coping, often the best support you can provide is helping your loved one work through feelings. Talk with your loved one, listen, or just be present. Although you may naturally feel inclined to put your own feelings and needs aside, it’s important to take care of yourself as well. Call Cancer Care Services at 650-498-6000 to speak with someone about seeking support for your loved one and yourself.
Finding a balance between your loved one’s needs and your own can feel challenging. As much as possible, continue the activities that you did before diagnosis. Ask family members, friends, neighbors, and community members to help. They can provide support when you need a break.
Remember that you are not alone – you can find support among other caregivers. We offer workshops, support groups, and other programs for people who have cancer and their caregivers. Talk with your care team or call Cancer Care Services at 650-498-6000 for more details about our cancer supportive care programs at Palo Alto and South Bay.
Only you and your loved one can decide the right time and the right words to tell family and friends about the cancer diagnosis. Family and friends may have a wide range of reactions, from wanting to know more details to giving advice to not knowing how to react at all. Talking with family and friends about the cancer diagnosis can help them provide support.
Some of our patients recommend websites where you can create personal, privacy-protected pages for your loved one’s health journey:
- CaringBridge allows people to share updates, photos, videos, and words of encouragement. You can also schedule help with everyday tasks such as meals, carpools, errands, and appointments: http://www.caringbridge.org.
- MyLifeLine offers the same services as CaringBridge but is designed specifically for people affected by cancer. In addition to the personal page for your family member, you can also find educational and supportive resources for cancer: http://www.mylifeline.org.
Common side effects include fatigue, constipation, loss of appetite, and nausea. Specific side effects depend on the type of treatment and medications the patient is receiving.
Your loved one’s care team can prepare you, so you can watch for side effects and help manage them. Ask team members:
- Which side effects should be reported right away, and how should I report them?
- Which side effects require a visit to the emergency room?
Keep track of:
- Date and time that the symptom or side effect started and how long it lasted
- Description of the side effect or symptom
- Which symptoms or side effects worsen or become difficult to manage
Your social worker can provide you the most current information on housing and hotels near Stanford’s clinics and hospitals. Call Cancer Care Services at 650-498-6000 or visit “Where to Stay”.
Find answers to your questions about cancer at the Stanford Health Library, with help from professional medical librarians and trained volunteers. We offer free science-based information to help answer your medical questions.
You can access journal articles, books, e-books, databases, and videos to learn more about medical conditions and treatment options at the library. We also provide information on related issues such as coping, caregiving, pain management, and eating. Request a comprehensive literature search on the latest research to answer your specific questions. Stop in, call, or email your questions.
- Cancer Center, Palo Alto: First floor near the café, 650-736-1960
- Cancer Center, South Bay: Third floor lobby, 408-353-0197
- Email us your questions: healthlibrary@stanfordhealthcare.org
Meet with one of our financial counselors to determine the best approach to paying for your health care. Call 844-498-2900, Monday through Friday from 8 a.m. to 5 p.m.
Our financial counselors will work with you to:
- Understand your health insurance coverage and benefits
- Estimate your out-of-pocket costs for your care at Stanford
- Connect you with as many resources as possible to help pay for your care
- Answer your questions about billing and financial assistance, including helping you complete financial applications
- Find places to stay near Stanford
Stanford Health Care offers a variety of financial assistance options for uninsured or underinsured patients. Some options require an application, while others do not:
No application is necessary for:
- Discounts for people who are uninsured (some services may be excluded)
- No-interest payment plans (balances typically to be paid within 6 months)
You must submit a completed financial assistance application and proof of income for:
- Financial need discounts at a rate comparable to our government payers (some services may be excluded)
- Full financial assistance for 100 percent of the patient portion of treatment costs (some services may be excluded)
- Extended no-interest payment plans for patients who qualify for financial need discounts
You can obtain a financial assistance application form:
- Downloading and printing the form online
- In the Patient & Family Resource Guide
- By asking your care team or a financial counselor for the form
For confidential help with your health care questions, contact the Stanford Health Library. Professional medical librarians and trained volunteers can help you access journals, books, e-books, databases, and videos to learn more about medical conditions, treatment options, and related issues.
- 875 Blake Wilbur, Palo Alto: 1st floor near the cafe, 650-736-1960
- South Bay Cancer Center: 3rd floor lobby, 408-353-0197
- Email us your questions: healthlibrary@stanfordhealthcare.org
Your oncologist is a physician, or doctor, focused on cancer. Your oncologist works with other types of doctors and cancer care professionals throughout the process of diagnosing and treating you for cancer.
This type of doctor specializes in the diagnosis and treatment of cancer. Oncologists in Stanford’s Cancer Program have years of training and experience in cancer care. The treatments we offer include:
- Surgery to remove all or part of cancer tumors, or all or part of the affected body areas
- Radiation therapy using high-energy radiation to destroy or prevent the spread of cancer cells
- Drug therapy such as chemotherapy, targeted therapy, and other medical therapies (medications that travel through the bloodstream to treat cancer anywhere in the body)
At Stanford, our team members hold subspecialty training in the latest tools and techniques for cancer diagnosis and treatment. This additional, highly specific training within cancer education means that your care team has broad and deep experience in cancer care.
Stanford is an academic medical center, a type of hospital setting in which doctors teach medical students, residents, and fellows as they complete their schooling and training. Because Stanford is a teaching hospital, you may meet many doctors and doctors in training affiliated with the Stanford University School of Medicine.
Throughout your care in the Stanford Cancer Program, you will have a board-certified doctor as your attending physician. This fully credentialed doctor has complete responsibility for your care and works with you to make all of your care decisions.
Our medical students accompany attending physicians as part of their training. This team approach provides contact with patients to prepare them as medical professionals.
Stanford Health Care has earned magnet status from the American Nurses Credentialing Center. This organization awards magnet recognition for excellence and innovation in nursing practice and quality patient care. Learn more about magnet recognition at www.nursecredentialing.org.
The Stanford Cancer Center is designated as a Comprehensive Cancer Center by the National Cancer Institute. The cancer teams at these centers use the knowledge they gain from research to treat cancer more effectively. The National Cancer Institute is part of the National Institutes of Health (NIH). Learn more at www.cancer.gov.
At your first appointment, you will meet the team who will take care of you throughout your treatment. During this visit, your doctor will discuss your medical history with you in detail, perform a physical examination, and discuss possible treatment options. During your first visit, we will share some important information about breast cancer and your treatment options.
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.
Connect to Care
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.