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Once a radiologist has determined that further assessment of a suspicious finding by mammography, ultrasonography, or clinical examination is necessary, a tissue biopsy is the next step to confirm a cancer diagnosis.

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‘The biopsy is positive. You have breast cancer.” Chilling words — words more than 215,000 women will hear in 2004. What’s more, among all women with breast cancer — the newly diagnosed and those who already have the disease — 40,000 will die this year, according to the American Cancer Society.

When women first learn that a breast lump is malignant, they face mortality and hope for a cure at the very same moment. They may know someone who has died from the disease. Most also know that advances in oncology have changed protocols for breast cancer treatments at a rapid pace in the recent years and their chances for survival can be good.

Once a radiologist has determined that further assessment of a suspicious finding by mammography, ultrasonography, or clinical examination is necessary, a tissue biopsy is the next step to confirm a cancer diagnosis. The retrieved tissue must be processed and evaluated by a pathologist, who will differentiate breast cancer by type, grade, size, and other markers. Breast cancers are identified by their location in the structures of the breast and by characteristics unique to each patient. These factors demand an individualized plan of care.

Ductal carcinoma in situ (DCIS) is a noninvasive malignancy lining the milk ducts that is confined within the basement membrane of the duct. Invasive or infiltrating cancers may arise from the milk ducts or the lobules attached to the milk ducts. Ductal or lobular breast cancers may be confined to the breast tissue or may have metastasized to other parts of the body. Inflammatory breast cancer is a rare and highly aggressive form that blocks the lymph vessels of the breast; patients usually present with a swollen, red breast.

Surgical options

Generally, the first treatment option for the patient diagnosed with breast cancer is surgery. A few patients with tumors larger than 5 cm or inflammatory breast cancer may undergo neoadjuvant chemotherapy to shrink the tumor before an attempt at surgical removal. The surgical options depend on the type and extent of disease. The physician discusses the options with the patient, detailing the risks and benefits of each procedure. Ultimately, patients must decide which procedure is best for them.

The choices are usually lumpectomy, simple mastectomy, or modified radical mastectomy. Most often, lumpectomy with subsequent radiation is the treatment of choice. Research has shown that the survival rates in patients who have had mastectomies versus those who have undergone breast-conserving surgery followed by radiation are the same. However, lumpectomy may not be an option for patients who have two or more cancer sites that cannot be removed through one incision; those whose surgery will not result in a clean margin of tissue; those who have had previous radiation to the affected breast; or those whose tumors are larger than 5 cm.¹

The patient who opts for a simple mastectomy will have the entire breast removed without dissection of lymph nodes or underlying tissue. The modified radical mastectomy removes breast tissue and lymph nodes in the axilla. After a mastectomy, the patient may opt for breast reconstruction using either breast implants or autologous tissue reconstruction either at the time of surgery or a later date.