Breast Cancer

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:

Early Detection

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 cancer, the next step is to find out the grade and stage of the cancer. Stage is a way to note the size of the tumor, and if it has spread. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging and grading of cancer is important for deciding how to treat it, and how curable it is. The stage of a cancer is more important than grade in deciding on treatment.

Staging and grading is done by a pathologist. This is a doctor with special training in identifying cells by looking at them under a microscope. When the pathologist has examined the cells removed during a biopsy, he or she will issue a report that includes the cancer's grade and stage.

Grades of breast cancer

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 can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Grade 3 cancer cells look very different from normal cells. This grade of cancer is more likely to spread.

What is staging?

The stage of a cancer is how much 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 stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

Stages of breast cancer

The stage of your cancer describes the size of a tumor, and how much it has spread. Doctors use different rating systems to stage cancer. The system used most often for breast cancer is the TNM system:

  • T stands for tumor. This category notes the size of the tumor and if it has spread into nearby areas.

  • N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.

  • M stands for metastasis. This category notes if the cancer has spread to other organs in the body. This may include a lung, your bones, liver, or brain. It also includes lymph nodes that are not near your kidneys.

Numbers from 0 to 4 are then assigned to the T, N, and M categories. This information is then put together into what’s called stage grouping. The stage grouping is used to determine your overall stage.

Stage groupings for breast cancer

The stage groupings for breast cancer are:

  • Stage 0. This means that ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), or Paget's disease of the nipple has been found. There is no actual tumor, and there are no signs of cancer spreading to lymph nodes or tissue beyond the breast. With LCIS, you are at increased risk for breast cancer, but no cancer is actually present.

  • Stage IA. No cancer cells are found in the lymph nodes or distant sites. The tumor is less than 2 centimeters (cm) (3/4 of an inch) across.

  • Stage IB. Tiny amounts of cancer cells are found in 1 to 3 lymph nodes in the arm pit, but not in distant sites. The tumor is no more than 2 cm (3/4 of an inch) across.

  • Stage IIA. There is either no tumor or the tumor is less than 2 cm across, but there are cancer cells in the lymph nodes. This stage grouping also includes a tumor that is between 2 and 5 cm across. The cancer has not spread to distant sites.

  • Stage IIB. The tumor is 2 to 5 cm across, and has spread to lymph nodes. Or the tumor is more than 5 cm (2 inches) across, but it has not spread to the lymph nodes or to the chest wall or skin. The cancer has not spread to distant sites.

  • Stage IIIA. The tumor is not more than 5 cm (2 inches) across. The cancer in the underarm lymph nodes is extensive, or it has spread to other lymph nodes. Or the tumor is more than 5 cm (2 inches) across, and it has spread to other lymph node areas but not to the chest wall or skin. The cancer has not spread to distant sites.

  • Stage IIIB. This stage includes cancer that has spread to the chest wall or skin and possibly to nearby lymph nodes. Inflammatory breast cancer is a type of breast cancer in this stage, unless it has spread to distant lymph nodes or organs.

  • Stage IIIC. This stage includes tumors of any size and cancer in many different lymph nodes but not in distant sites.

  • Stage IV. This is cancer that has spread to other organs and maybe to distant lymph nodes. In this case, the size of the tumor and the extent of the spread to the lymph nodes are less important than the fact that cancer has spread from the breast to other organs of the body. When breast cancer spreads, it's called metastatic cancer. The first place that breast cancer usually spreads to is the nearby lymph nodes. In some cases, it spreads to distant parts of the body, like the liver, bones, brain, lungs, or other organs. It may also spread to the skin. Although the cancer has spread, it's not considered a different kind of cancer. For instance, if breast cancer spreads to the liver, it is not considered liver cancer. It's called metastatic breast cancer.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.

Risk Factors

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. 

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Knowing personal risk factors can help a woman and her doctor plan a course of action that may reduce her chances of developing the disease or detect it in its earliest, most treatable stages.

Saint Luke’s Cancer Institute

Saint Luke’s Cancer Institute provides early detection, expert diagnosis, personalized treatment plans, clinical trials, and survivorship support.