Breast cancer has a nearly 100 percent survival rate when caught early. The key is accurate detection, expert diagnosis, personalized treatment options, and survivorship support for every patient. It’s what Saint Luke’s calls precision medicine: the right treatment for the right patient at the right time.
Our program features:
- Medical oncologists and hematologists who subspecialize in breast cancer
- Access to more than 200 National Cancer Institute-sponsored clinical trials and industry-led studies through our agreement with the internationally recognized Washington University School of Medicine
- One of the nation’s first centers dedicated solely to the treatment of metastatic breast cancer
- Genomic sequencing and precision oncology services for advanced cancers
- A Multidisciplinary Breast Clinic where patients meet with a team of specialists in one comprehensive appointment
- The region’s largest network of 3-D mammography centers for early detection of the smallest tumors
- Nurse navigators who serve as patient resources and advocates through treatment and beyond
- Supportive Oncology and Rehabilitation Services program to help patients overcome the physical and emotional challenges that often follow diagnosis and treatment
Breast Cancer: Early Detection
You have a better chance of surviving breast cancer if your doctor finds and treats it early, while it’s small and hasn’t spread. The best way to detect breast cancer early is to be screened regularly. Screening means being checked before you have any symptoms. Screening isn't possible for many kinds of cancer, but it is with breast cancer. Screening doesn't guarantee that you won't get cancer or die from it, especially if it's found after it has spread. But regular screening may help find the cancer earlier.
How is screening for breast cancer done?
Screening for breast cancer in women of average risk can include a combination of these:
Breast self awareness. In the past, a breast self-exam was recommended. The exam was a precise method of examining your breasts, about once a month. Most medical organizations now advise breast self-awareness instead. This means having a sense of what is normal for your breasts so that you can notice even small changes and report them to a healthcare provider right away.
Clinical breast exam (CBE). The American Congress of Obstetricians and Gynecologists (ACOG) advises CBEs every 1 to 3 years for all women in their 20s and 30s. ACOG advises CBEs every year for women 40 and older. Other medical organizations disagree that there is enough evidence to assess the value of CBEs for women age 40 and older. Women should talk with their doctor about their risk factors and make a decision about whether to have a CBE.
Mammography. A mammogram is a kind of X-ray used to help find breast tumors before symptoms of cancer appear. During the test, your breast is placed between 2 metal or plastic plates that flatten and spread the tissue. Low levels of radiation are used to take a picture of the inside of your breast. Some facilities have digital mammography. This displays results on a computer instead of on film. The test can be uncomfortable, but it only lasts a few moments.
Breast MRI. An MRI uses magnets, radio waves, and a computer to make detailed pictures of the inside of the breast. Before the MRI, you may be injected with a contrast dye. This helps to better outline the breast tissue and possible tumors.
These screening methods can improve your chances of catching cancer early. Women at high risk for breast cancer may be advised to start breast cancer screening at a younger age, and have an MRI in addition to a mammogram. For some women with dense breast tissue, ultrasound may be done in addition to a mammogram. And for some women at high risk for breast cancer, a screening MRI may be advised along with mammograms.
More about mammograms
The benefits and limits of a mammogram vary. They’re based on factors such as age and personal risk. Experts have different advice for who should have mammograms. The USPSTF advises screening every 2 years for women age 50 to 74, with the choice to start getting mammograms every 2 years starting at age 40. The ACS advises yearly screening for all women ages 45 to 54, then a choice of screening every 2 years or every 1 year for women age 55 and older. Women should talk with their doctor about their personal risk factors before making a decision about when to start and how often to get a mammogram.
A mammogram detects tumors and calcium deposits in the breast. Most calcium deposits are not cancer. But a cluster of very tiny specks of calcium (microcalcifications) can be an early sign of breast cancer. If your mammogram shows anything abnormal, you may need more tests.
Although a mammogram is the best way to find breast cancer early, it may not always detect cancer. And in some cases, it may find an abnormality that turns out not to be cancer. This is called a false positive. Some people worry about the radiation. But the radiation levels are about the same as those you'd be exposed to during a flight from New York to California.
Grades and Stages
Breast Cancer: Grades and Stages
Once your healthcare provider knows you have breast cancer, the next step is to find out more about your specific cancer cells. This includes the stage of the cancer, as well as other factors. This information is learned from tests done on cancer cells that were taken out of your body in a procedure called a biopsy.
We’ve learned a lot about the biology of breast cancer: gene changes and other details that make breast cancer cells different from normal cells. In the past, breast cancer was staged based mostly on tumor size and spread (the TNM system). Today we use prognostic stage groups that also look at breast cancer cell biomarkers. In fact, these may be even more important than tumor size when looking at each woman’s likely outcome, the best medicines/chemo to use, and the value of local (tumor-focused) treatments like radiation.
While this detailed information allows doctors to use more personalized or focused treatment that’s designed for each woman based on the changes seen in her cancer cells, it also makes breast cancer staging very complex.
Here you will find more on the many different factors that are used to find each woman’s breast cancer prognostic stage group. Knowing these details can help you better understand your diagnosis and help you make treatment decisions that are best for you.
Stage is a way to note the size of the tumor and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body.
The most commonly used system to stage breast cancer is the TNM system from the American Joint Committee on Cancer. Here's what the letters stand for in the TNM system:
T tells how far the main tumor has spread into nearby tissue.
N tells if the lymph nodes in the area of the original tumor have cancer in them. Lymph nodes are part of the immune system. They help the body fight infections.
M tells if the cancer has spread (metastasized) to distant organs in the body, such as the liver, lung, bone, or brain.
Numbers or letters after T, N, and M provide more details about each of these factors. There are also 2 other values that can be assigned:
X means the provider does not have enough information to assess the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).
0 means no sign of cancer, such as no sign of spread to the lymph nodes (N0).
Your doctor may call this the cancer’s anatomic stage because it’s based on the anatomy or structure of the cancer. TNM staging helps to decide the type of surgery, if surgery to remove lymph nodes is needed, and if more treatment is needed after surgery.
The grade refers to how the cancer cells look when compared to normal breast cells. The grade of your cancer will help your doctor predict how fast the cancer may grow and spread.
A scale of 1 to 3 is used to grade breast cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer is less likely to spread and may be easier to treat and cure. Grade 3 cancer cells look very different from normal cells. This grade of cancer is more likely to grow quickly and spread.
Grade is written as G1, G2, and G3. Sometimes GX is used if the grade isn’t known.
HER2 stands for human epidermal growth factor receptor-2. Breast cancer cells that have a lot of this protein are called HER2-positive. (Results are either positive or negative.) They tend to grow faster and are more likely to spread to other parts of the body.
There are medicines that target and block HER2 to slow or stop cancer cell growth. If a woman’s breast cancer is HER2-positive, she should be treated with one of these medicines to get the best possible treatment outcomes.
Hormone receptor status
Some breast cancer cells have hormone receptors. When the female hormones estrogen (ER) or progesterone (PR) attach to these receptors, they help the cells grow more quickly.
Tests can be done to see if a woman’s cancer cells have high amounts of hormone-receptors. The results will be ER-positive or negative (ER+ or ER+) and PR-positive or negative (PR+ or PR-).
This information is used to predict the cancer cell response to medicines that target these receptors. Medicines that block these receptors can slow or stop the growth of these cells. These medicines don’t work on breast cancer cells that are ER- and PR-negative.
Prognostic stage groups
All of the above information is put together into what’s called the prognostic stage group. These groupings give an overall description of your cancer.
A prognostic stage group can have a value of 0 to 4, and they're written as Roman numerals 0, I, II, II, and IV. The higher the number, the bigger the cancer is and/or the more it has spread beyond the breast. Letters are used after the Roman numeral to give more details.
All the details used in prognostic stage grouping help doctors choose the best treatments for each woman’s cancer and, as a result, get better treatment outcomes. These details also keep women from getting treatments that aren’t needed or won’t work.
Other important factors
Ki-67 is widely used as a marker of cancer cell proliferation–how fast the cancer cells are dividing. High Ki-67 levels mean that the cancer cells are dividing fast and certain chemo medicines (called anthracyclines) will work well to kill them. There’s no agreed standard use for this test at this time.But it can help guide treatment decisions and may also help predict overall outcomes.
Cancer cell gene tests
Tests that look at patterns of many different gene changes at one time are becoming another important part of managing some early stage breast cancers (stages 0, I, and II). They’re useful because it’s not always clear that chemo is needed after surgery for these cancers.
These tests are often called multigene assays or gene expression assays. They look at changes in certain genes in breast cancer cells. The results can be used to help predict likely outcomes after treatment and the need for more treatment after surgery. The main thing the tests used today show is a woman’s risk of cancer coming back after treatment.
For instance, the test may give a recurrence score. This is a measure of the woman’s risk of the cancer coming back in the next 10 years. Other tests may give a risk assessment of how likely it is that the cancer will come back in another part of her body.
These test results can be very helpful when deciding if more treatment is needed after surgery. If the risk of recurrence is low, chemo is probably not needed. But if the risk is high, chemo could help keep the cancer from coming back.
Talking with your healthcare provider
Breast cancer staging is very complex. Remember the key information that’s needed includes:
The TNM values
Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand. Make sure to ask any questions or talk about your concerns.
Breast Cancer: Risk Factors
What is a risk factor?
A risk factor is anything that may increase your chance of having a disease. Risk factors for a certain type of cancer might include smoking, diet, family history, or many other things. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer.
Things you should know about risk factors for cancer:
Risk factors can increase a person's risk, but they do not necessarily cause the disease.
Some people with 1 or more risk factors never develop cancer. Other people can develop cancer and have no risk factors.
Some risk factors are very well known. But there is ongoing research about risk factors for many types of cancer.
Some risk factors, such as family history, may not be in your control. But others may be things you can change. Knowing the risk factors can help you make choices that might lower your risk. For example, if an unhealthy diet is a risk factor, you may choose to eat healthy foods. If excess weight is a risk factor, your healthcare provider may check your weight or help you lose weight.
Who is at risk for breast cancer?
Risk factors for breast cancer include:
Sex. Breast cancer occurs nearly 100 times more often in women than in men.
Race or ethnicity. Caucasian women develop breast cancer slightly more often than African-American women. But African-American women tend to die of breast cancer more often. This may be partly due to the fact that African-American women often have a more aggressive type of tumor. Why this happens is not known. The risk for having breast cancer and dying from it is lower in women who are Hispanic, Native American, or Asian.
Older age. 2 out of 3 women with invasive cancer are diagnosed after age 55.
History of breast cancer. If you’ve had cancer in 1 breast, you’re at an increased risk of having it in the other breast or another part of the same breast.
Previous chest radiation. If you’ve had high-dose radiation to your chest, you have an increased chance of breast cancer. The risk is even higher if the exposure happened when you were a child. It’s important to remember that this involves high doses of radiation. The small doses used for breast cancer screening do not increase your risk.
Family history. Having a parent, sibling, or child with breast cancer increases your risk.
Benign breast disease. Women with certain benign breast conditions such as hyperplasia or atypical hyperplasia have an increased risk of breast cancer. The only way to know if you have benign breast disease and what kind it is by having a biopsy.
Diethylstilbestrol (DES) exposure. Women who took this medicine while pregnant to lower the chance of miscarriage are at higher risk. Women whose mothers took DES during pregnancy may also have a slightly higher risk.
Early menstrual periods. Women whose periods began before age 12 have a slightly higher risk of breast cancer.
Late menopause. Women are at a slightly higher risk if they began menopause after age 55.
Not giving birth to a child, or giving birth to your first child after age 30. These women have a slightly higher breast cancer risk.
Dense breast tissue. Women whose breasts have larger areas of dense tissue on mammograms are at increased risk for breast cancer.
Recent use (within 10 years) of oral contraceptives. Taking birth control pills slightly increases your breast cancer risk compared with women who have never used them. The risk may go back to normal over time after the pills are stopped.
Drinking alcohol. Breast cancer risk goes up if you drink just 1 glass of wine, beer, or mixed drink a day. The more you drink, the higher your risk. Limit yourself to less than 1 drink per day.
Long-term use of estrogen and progestin medicines after menopause. This is known as hormone replacement therapy (HRT). The hormones are most often used together. If you have had HRT for 2 or more years to relieve menopause symptoms, you may have a higher chance of breast cancer. The longer you’ve used HRT, the higher your risk. If you stop taking the medicines, your risk should go back down to normal after 5 years. Estrogen used alone may not raise your risk much or at all, unless you use it for more than 10 years. If you decide to use HRT, use it at the lowest dose and for the shortest time possible.
Excess weight, especially after menopause. This risk factor is complex. Research shows conflicting results about the link between weight and breast cancer. Overall, your risk of breast cancer is lower if you stay at a healthy weight with a body mass index (BMI) below 25. If you’re overweight and you get breast cancer, the excess weight also affects your chances of being cured.
Certain inherited changes in genes are another risk factor. Hereditary breast cancer accounts for about 5% to 10% of all breast cancer cases. The genes linked to breast cancer include:
BRCA1 and BRCA2 genes. These are tumor suppressor genes that usually have the job of controlling cell growth and cell death. When they're changed, they don't do their job correctly, and cancer tumors may grow. Changes in these genes account for most cases of hereditary breast cancer. They're linked to other kinds of cancer, especially ovarian cancer. In the U.S., BRCA changes are most common in women of Ashkenazi Jewish ancestry.
PTEN gene. This gene helps control cell growth and death. Inherited changes in this gene can cause a rare disorder called Cowden syndrome. People with it have a higher risk for both cancer and non-cancer breast tumors. They also tend to have tumors in the thyroid, digestive tract, endometrium, and ovaries, often at a young age.
TP53 gene. This is a gene that tells cells to make a protein called p53. This protein helps stop the growth of abnormal cells. Inherited changed in TP53 cause Li-Fraumeni syndrome. People with it have an increased risk breast cancer, as well as leukemia, brain tumors, and childhood sarcomas. Less than 1% of all breast cancer is thought to be related to this syndrome.
What are your risk factors?
Talk with your healthcare provider about your risk factors for breast cancer and what you can do about them. There are different tools that can be use to help estimate your risk so that you can set up the best prevention and screening plan for you.