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In normal breast tissue, cells are continually dividing and dying as part of the natural process of tissue renewal. When the DNA of some cells is damaged, those cells may begin to divide uncontrollably, creating a lump in the breast.
Some of these lumps, or tumors, are benign (non-cancerous) and do not damage surrounding tissue. Benign lumps can be cysts or formed from fibrous tissue, which cause no threat to the breast and typically require no intervention beyond the diagnostic biopsy.
Tumors that grow uncontrollably and invade the healthy tissue around them are malignant (cancerous). A malignant tumor is what is known as breast cancer. The two most common forms of breast cancer are lobular and ductal. These cancers usually begin in the milk lobules (tiny sacks that produce milk) or in the ducts that transport milk to the nipple. If not removed, malignant tumors can spread through the breast into the lymph nodes under the arm and into other organs.
Lymph nodes are part of the lymphatic system, which runs throughout the body and normally helps the body fight disease. When cancer invades these nodes, however, the lymphatic system can spread the cancer cells to other parts of the body. Cancers can also spread directly through the blood vessels. The process of spreading cancer to other organs is called metastasis.
In the United States, breast cancer is the most common cancer in women and is the second leading cause of cancer-related deaths. Nearly 40,000 women will die of breast cancer each year. At Indiana University Health Melvin & Bren Simon Cancer Center, prevention and early detection of breast cancer is our focus.
There are a variety of means for detecting breast cancer. Our advanced detection technologies include:
- Digital mammography. A more accurate form of mammography.
- Tomosynthesis. A new form of three-dimensional imaging that increases the accuracy of diagnosis, especially for dense breast tissue.
- Breast magnetic resonance imaging (MRI). A proven form of three-dimensional imaging that is the most sensitive for detecting breast cancer.
- Breast ultrasound. Imaging that allows real-time viewing of tissue within the breast.
We are focused on personalized comprehensive cancer care. The breast cancer center at IU Health Melvin & Bren Simon Cancer Center has a highly specialized, multidisciplinary team of doctors that includes:
- Breast surgeons
- Medical oncologists
- Radiation oncologists
- Plastic surgeons
- Medical geneticists
Our team of experts evaluates the unique genetic features of each breast cancer for the most effective personalized treatment plan.
Our breast surgeons are experts in preserving the natural appearance of the breast, utilizing advanced techniques such as lumpectomies, through very small incisions. If a mastectomy is necessary, the nipple can be spared and a new breast reconstructed. Because we specialize in breast cancer, we have the expertise to treat cancers that are rare and aggressive. Our surgical expertise offers treatment for tumors that are sometimes considered too difficult to treat.
There are three general levels of cancer treatment:
- High risk. At this stage, you do not have breast cancer, but for various reasons, are at a high risk to develop it. You will be watched closely with clinical breast exams, annual mammograms and possibly breast MRI to detect breast cancer at its earliest development. Genetic testing may be needed to check for mutations that cause breast cancer. Lifestyle modification counseling, risk factor assessment, and preventive medicine and surgery are offered through our prevention program.
- Early stage. At this stage, the cancer is small and treatment is highly successful. You and your doctor have time to consider all treatment options.
- Late stage. With late stage cancer or recurring cancer, treatment begins with an honest conversation about realistic options. Even at this stage, our intense, multidisciplinary approach to treatment yields many good outcomes and improved quality of life. Clinical trials that are not available elsewhere may be an option for new therapies and advanced breast cancer treatment.
Treatment for breast cancer is personalized for the most effective therapy. Treatment techniques used at the IU Health Simon Cancer Center focus on surgical and nonsurgical procedures that maximize the aesthetic and natural appearance of the breast. These techniques include:
- Lumpectomy. Lumpectomy removes the cancer through a very small incision and conserves the appearance of the breast. If a large amount of breast tissue requires removal, the breast can be reshaped through plastic surgery techniques to retain a natural appearance.
- Mastectomy. Mastectomy removes the breast, with or without preservation of the skin and nipple. Advanced forms of mastectomy allow creation of a natural appearance with reconstruction surgery.
- Sentinel node biopsy. This form of biopsy removes only the lymph nodes under the arm, which are more likely to harbor cancer. This focused surgery provides information to personalize cancer treatment and reduces the complications of nerve damage or arm swelling (lymphedema).
- Reconstruction surgery. Reconstruction reshapes the breast following mastectomy. Advanced reconstruction techniques include one-step implant placement and tissue flaps from your own body. A new breast can be recreated at the time of mastectomy or delayed after a mastectomy. There are many options for reconstruction. An implant can be placed as a one-step procedure at the time of mastectomy or as a staged procedure after a temporary expander. Tissue from the back, gluteus or abdomen can also be used to recreate a breast. Our plastic reconstructive surgeons can discuss which reconstruction option would be best for you, based on your body shape, current medical condition, type of breast cancer surgery and personal preference. The opposite breast can also be contoured for a balanced appearance.
- Chemotherapy. Chemotherapy destroys cancer cells with special medicine.
- Radiotherapy. Radiation is included as part of breast cancer treatment to reduce the risk of tumor recurrence within the breast. Several forms of radiation are available and consultation with a radiation oncologist can help determine the best option for you.
- External beam breast radiation. This type of radiation treats the entire breast once daily for about 15 minutes over a course of five to six weeks. This can begin within three weeks of surgery or completion of chemotherapy.
- Accelerated partial breast irradiation. A focused form of radiation that targets the lumpectomy site and reduces damage to the surrounding healthy breast tissue. A special catheter is placed in the lumpectomy site about one to three weeks after surgery. This highly focused radiation can shorten the course of treatment to five days.
- Hypofractionated radiotherapy. A newer type of treatment that delivers a lower total dose of radiation with fewer, larger fractions of radiation over a shorter time of three weeks.
- Hyperfractionated radiation therapy. Involves lower doses of radiation given more frequently to reduce the side effects of treatment.
- Hormonal therapy. Hormonal therapy uses drugs to block the body’s hormone effect on tumor growth.
One focus of research at the IU Health Simon Cancer Center is innovative, minimally invasive treatments for early breast cancer. One potential form of treatment is cryoablation or destruction of the tumor by freezing. Continued research of this therapy may help identify breast cancers that can be treated without surgery. More information about breast cancer research can be found on the Indiana University School of Medicine website.
The Catherine Peachey Breast Cancer Prevention Clinic is the first line of defense against breast cancer. The breast cancer prevention program treats women that are at a high risk of developing breast cancer. It provides education and genetic counseling to identify women with cancer-causing mutations in their genes. A personalized program is available to prevent breast cancer and detect it at its earliest stage.
Because the breast cancer team at IU Health Simon Cancer Center is so specialized, we are involved in groundbreaking research at the national and international level. If you qualify, you may be able to join leading edge clinical trials for care options not yet available elsewhere.