Breast

Virginia Cancer Specialists offers cutting-edge research into Breast Cancer related knowledge.

Disease Information

Use the sections below to review diagnosis, staging, and treatment information for each condition in one place.

Breast Cancer

What You Need to Know About Breast Cancer

Breast cancer is the most common type of cancer among women in the United States (other than skin cancer). Each year in the United States, more than 192,000 women are diagnosed with breast cancer. Review this important information about diagnosis, staging, treatment, and reconstruction and ask your cancer care team about your individual situation

What are the risk factors for breast cancer?

Gender: Women are about 100 times more likely than men to get breast cancer.
Age: Most breast cancers develop in adults over the age of 55.
Genetics: Women who have a close blood relative with breast cancer have a higher risk, as do women with inherited gene mutations such as BRCA1 and BRCA2.
Reproductive history: Women who began menstruating before 12 or experienced menopause after 55 may have an increased risk. Having a child before age 30 and/or breastfeeding can reduce the risk.
Alcohol: Consumption of alcohol can increase the risk.
Weight: Being overweight after menopause is linked to a higher risk.
Being sedentary: Those who have sedentary lifestyles may be at a higher risk.

What are the signs and symptoms of breast cancer?

Patients experiencing any of these symptoms should consult a physician:

A new lump or mass (most common sign)
Swelling of part or all of the breast
Skin irritation or dimpling
Nipple pain, nipple turning inward and/or abnormal discharge
Redness or scaliness of the nipple or breast skin

Screening for Breast Cancer

Always discuss the best screening guidelines with your doctor. The American Cancer Society recommends the following guidelines for the screening and early detection of breast cancer:

Women between the ages of 40 and 74 start mammogram screenings annually.
Women 75 and over should continue with mammograms as long as their overall health is good, and they have a life expectancy of 10 or more years.
Women at a higher than average risk for breast cancer should get an MRI and mammogram every year starting at age 30.

How is breast cancer prevented?

Check out these prevention activities to lower your risk of breast cancer.

Avoid alcohol. Women who don’t drink have a slightly lower risk than those who have one drink every day.
Stay fit. Maintaining a physically active lifestyle and staying at a healthy weight can reduce your risk.
Talk to your doctor about birth control. The hormones in birth control may slightly increase your risk.
If it’s in your life plan, have children. Studies have shown that women who bear children before 30 have a lower risk.

How is breast cancer diagnosed?

Your doctor can check for breast cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam and your doctor may order one or more imaging tests, such as a mammogram.

Doctors recommend that women have regular clinical breast exams and mammograms to find breast cancer early. Treatment is more likely to work well when breast cancer is detected early.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

If you have a lump, your health care provider will feel its size, shape, and texture. Your health care provider will also check to see if the lump moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests are needed to diagnose the problem.

Mammogram

A mammogram is an x-ray picture of tissues inside the breast. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If the mammogram shows an abnormal area of the breast, your doctor may order clearer, more detailed images of that area. Doctors use diagnostic mammograms to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Other Imaging Tests

If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other imaging tests:

Ultrasound: A woman with a lump or other breast change may have an ultrasound test. An ultrasound device sends out sound waves that people can’t hear. The sound waves bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer, but a solid lump may be cancer.
MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.

Biopsy

A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to tell for sure if cancer is present.

You may need to have a biopsy if an abnormal area is found. An abnormal area may be felt during a clinical breast exam but not seen on a mammogram. Or an abnormal area could be seen on a mammogram but not be felt during a clinical breast exam. In this case, doctors can use imaging procedures (such as a mammogram, an ultrasound, or MRI) to help see the area and remove tissue.

Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. The surgeon or doctor will remove fluid or tissue from your breast in one of several ways:

Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump.
Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue.
Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin.
Surgical biopsy: Your surgeon removes a sample of tissue.
An incisional biopsy takes a part of the lump or abnormal area.
An excisional biopsy takes the entire lump or abnormal area.

A pathologist will check the tissue or fluid removed from your breast for cancer cells. If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. It begins in the cells that line the breast ducts. Lobular carcinoma is another type. It begins in the lobules of the breast.

Lab Tests with Breast Tissue

If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed:

Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option. See the Hormone Therapy section.
HER2/neu test: HER2/neu protein is found on some types of cancer cells. This test shows whether the tissue either has too much HER2/neu protein or too many copies of its gene. If the breast tumor has too much HER2/neu, then targeted therapy may be a treatment option. See the Targeted Therapy section.

It may take several weeks to get the results of these tests. The test results help your doctor decide which cancer treatments may be options for you.

How is breast cancer treated?

Women with breast cancer have many treatment options. The treatment that’s best for one woman may not be best for another.

Surgery to Treat Breast Cancer

The word mastectomy often evokes fears of deformity or permanent disfigurement. While a mastectomy does remove breast tissue, it does not necessarily result in an unsightly appearance. In fact, most women in our area choose immediate breast reconstruction. In many cases, the skin and nipple can be preserved, with only the internal breast tissue removed and replaced. The decision-making process includes consultations with both a breast surgeon and a reconstructive (plastic) surgeon.

There are several reconstruction options, with implant-based reconstruction being the most common. In this approach, the breast surgeon performs the mastectomy, and the plastic surgeon reconstructs the breast using either a temporary implant (later exchanged for a permanent one) or a permanent implant at the time of surgery. Another option is autologous reconstruction, which uses your own tissue—typically from the abdomen (similar to a tummy tuck), back, or thighs—to create a new breast shape.

Choosing the best reconstruction method depends on multiple factors, including whether additional treatments such as chemotherapy or radiation are needed, as well as your lifestyle and body type. These decisions are made collaboratively with your care team. Breast reconstruction is covered by insurance, and procedures on the opposite breast to improve symmetry are often covered as well.

Some women choose not to have immediate reconstruction. Alternatives include wearing a breast prosthesis or opting not to replace the breast at all. Prostheses can be worn inside specially fitted bras to achieve a natural appearance, and both bras and prostheses are typically covered by insurance. Each option has advantages and disadvantages, and what works for one woman may not be right for another. The most important point is that nearly every woman treated for breast cancer has choices.

Breast reconstruction can be performed at the time of mastectomy or delayed until a later date. If radiation therapy is part of the treatment plan, reconstruction may be postponed until radiation is complete. Even if delayed reconstruction is planned, it is helpful to meet with a plastic surgeon before mastectomy to discuss options.

Reconstruction techniques include implants filled with saline or silicone gel, as well as procedures using tissue from another part of the body, such as the abdomen, back, or buttocks. Your plastic surgeon will explain the risks and benefits of each option and help determine what is best based on your age, body type, and cancer treatment.

All decisions regarding breast surgery and reconstruction are individualized. Our team works closely with you to provide care that best meets your medical needs and personal goals, while supporting you and your family throughout the process.

Radiation Therapy to Treat Breast Cancer

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the area.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

External radiation therapy: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for 4 to 6 weeks. External radiation is the most common type used for breast cancer.
Internal radiation therapy (implant radiation therapy or brachytherapy): The doctor places one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and the substance is removed. When it’s removed, no radioactivity remains in your body. Internal radiation therapy may be repeated every day for a week.

Hormone Therapy to Treat Breast Cancer

Hormone therapy may also be called anti-hormone treatment. If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. (See Lab Tests with Breast Tissue.) Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Options before menopause

If you have not gone through menopause, the options include:

Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells that are in the body. It’s a pill that you take every day for 5 years.

In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts. Consider reading the NCI fact sheet Tamoxifen.

LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain.
Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body’s main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn’t benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. The side effects are often more severe than those caused by natural menopause. Your health care team can suggest ways to cope with these side effects.

Options after menopause

If you have gone through menopause, the options include:

Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol.
Tamoxifen: Hormone therapy is given for at least 5 years. Women who have gone through menopause receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years. See above for more information about tamoxifen and its possible side effects.

Chemotherapy to Treat Breast Cancer

Chemotherapy uses drugs to kill cancer cells. The drugs that treat breast cancer are usually given through a vein (intravenous) or as a pill. You’ll probably receive a combination of drugs.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor’s office, or at home. Some women need to stay in the hospital during treatment.

Some anticancer drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. You may become infertile (unable to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.

On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.

Targeted Therapy to Treat Breast Cancer

Some women with breast cancer may receive drugs called targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells. (For information about HER2, see Lab Tests with Breast Tissue.)

Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2:

Trastuzumab: This drug is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills. Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Trastuzumab also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs. The NCIfact sheet Herceptin® (Trastuzumab) has more information.
Lapatinib: The tablet is taken by mouth. Lapatinib is given with chemotherapy. Side effects include nausea, vomiting, diarrhea, tiredness, mouth sores, and rashes. It can also cause red, painful hands and feet. Before treatment, your doctor will check your heart and liver. During treatment, your doctor will watch for signs of heart, lung, or liver problems.

Cancer Treatment Options

Most treatment plans combine several of these approaches. Your Virginia Cancer Specialists care team builds a plan around your specific diagnosis — explore each option below, or browse all treatments & services.

Chemotherapy

Chemotherapy uses powerful medicines to destroy cancer cells or slow their growth, and it remains one of the most widely used and effective cancer treatments. It can be given on its own or alongside surgery, radiation, or other therapies.

Given by IV infusion or as pills, in planned cycles with recovery time between
Delivered in our offices by our medical oncology team, close to home
Often used to shrink a tumor before surgery or lower the risk of recurrence after

Radiation Therapy

Radiation therapy uses precisely targeted, high-energy X-rays to destroy cancer cells while sparing nearby healthy tissue. Virginia Cancer Specialists offers advanced, state-of-the-art radiation for a wide range of cancers and select benign conditions.

Painless outpatient treatments that usually take only minutes a day
Planned and delivered with image guidance by our APEx-accredited radiation oncology team
Can be the main treatment, or support surgery and chemotherapy

Surgery to Treat Cancer

Surgery is one of the oldest and most effective treatments for cancer. For many cancers, removing the tumor offers the best chance for a positive outcome, often combined with other therapies before or after the operation.

Used to diagnose, stage, and treat cancer, and to relieve symptoms
Minimally invasive and robotic-assisted techniques when appropriate
Coordinated with your medical and radiation oncologists as one care plan

Immunotherapy

Immunotherapy helps your body’s own immune system recognize, target, and destroy cancer cells. Over the past decade it has transformed treatment for many types of cancer.

Works with your immune system rather than attacking cells directly
Usually given by IV infusion in our offices
May be used alone or with chemotherapy, radiation, or targeted therapy

Targeted Therapy

Targeted therapy focuses on the specific genes, proteins, and other molecular features that help cancer cells grow and survive. By attacking what makes a cancer unique, it can be highly effective with fewer effects on healthy cells.

Guided by biomarker and genomic testing of your cancer
Taken as pills or given by infusion
Often paired with chemotherapy, hormone therapy, or immunotherapy

Hormone Therapy

Hormone therapy treats cancers that use the body’s natural hormones to grow — most commonly breast and prostate cancers — by lowering hormone levels or blocking their effects.

Usually pills or injections rather than infusions
Can lower the risk of recurrence after surgery or radiation
Managed by your medical oncology team, sometimes over months or years

Specialized Programs

CAR T-Cell Therapy Program — one of the most advanced treatments for certain blood cancers: your own immune cells, re-engineered to fight the disease.

Scalp Cooling — cold-cap therapy that can significantly reduce hair loss during many types of chemotherapy.

Clinical Trials & Research — access to tomorrow’s treatments today through the Virginia Cancer Specialists Research Institute.

Physicians

Find physicians and care teams who support this specialty area.

Locations

Find Virginia Cancer Specialists locations connected to patient care across the region.

Alexandria

Hours of Operation
Monday through Friday 8:30a.m. to 4:30p.m.

Phone
571.350.8400

Fax
703.823.5723

Address
4660 Kenmore Ave., Suite 1018

Alexandria, VA 22304

Alexandria Old Town

Hours of Operation
Monday through Friday 7:30a.m. to 4:30p.m.

Phone
571.350.8400

Fax
571.366.5793

Address
277 S. Washington St. Suite 100

Alexandria, VA 22314

Arlington

Hours of Operation
Monday through Friday 8:30 a.m. to 5:00 p.m.

Phone
571.350.8400

Fax
703.528.0338

Address
1100 N. Glebe Rd., Suite 1600, 3 Ballston Plaza

Arlington, VA 22201

Bristow

Hours of Operation
Monday through Friday 8:30 a.m. to 5:00 p.m.

Phone
571.350.8400

Fax
571.222.2202

Address
9450 Innovation Drive

Manassas, VA 20110

Our Supportive Cancer Care Team

The Supportive Cancer Care Team works in close partnership with each patient’s primary oncology team to ensure patients receive coordinated, comprehensive, seamless support that complements their current medical treatment. Patients have easy access to a team of compassionate experts – palliative care physicians, pain management specialists, social workers, nutritionists, nurse navigators, clinical coordinators, research coordinators, financial counselors, and many others who provide guidance, education, and emotional support every step of the way.

TODO: Text needed here.

Goals of Supportive Cancer Care

Virginia Cancer Specialists’ Supportive Cancer Care Program has 3 key goals:

Hallmarks of Our Supportive Cancer Care Program

While the primary goal is to improve quality of life for the patient and family throughout the treatment process, there are various ways in which this can be accomplished:

Focusing on symptom management, including treating pain, insomnia, anxiety, respiratory and gastrointestinal problems
Fostering open and honest communication
Understanding the patient’s hopes and expectations
Facing the realities of treatment and how it affects one’s life, including finances, employment, and more
Providing support to caregivers and family