Editor's note: This article is the part of a monthly series of stories focused on cancer issues. Denver7 is proud to partner with the American Cancer Society, Cancer Support Community, Colorado Cancer Coalition and Sarah Cannon Cancer Institute at HealthONE to bring you these stories, tips and resources.
DENVER -- This year, the American Cancer Society estimates that more than 4,000 women in Colorado will be diagnosed with breast cancer in 2021 and nearly 700 women will die from the disease.
Pandemic-related disruptions have already exacerbated existing disparities in cancer screening and are likely to impact survival across groups of people who have systemically experienced social or economic obstacles to screening and care. These disparities are especially pronounced in Black and Latino communities, where cancer mortality rates for many cancers are highest.
Due to delays in screening, many cancers could be going undiagnosed and untreated and may advance to later stages, which become harder to treat. The American Cancer Society expects that pandemic-related reductions in health care access and cancer screening will result in a short-term drop in cancer diagnoses and a later corresponding increase in late-state diagnoses and potentially preventable deaths.
Breast cancer screening is important and can detect the disease when symptoms appear, or before there are any signs. The following American Cancer Society guidelines are for women at average risk:
- The option to start screening with a mammogram between 40 and 44
- Annual mammogram for women 45 to 54
- Women 55 and older can continue with annual mammograms or switch to mammograms every other year
- Women at high risk of breast cancer should consult their physician.
If a patient had to reschedule their screening in the midst of the pandemic or are due for their screening, they should talk to their health care team. Providers can discuss balancing the risks and benefits of being screened now or postponing for a later date, considering personal and family history, other risk factors, and the timing of the last screening test.
- Prior personal history of breast cancer, or other abnormalities in the breast tissue
- A high proportion of dense breast tissue instead of fatty tissue
- Previous breast exposure to radiation therapy before age 30
- Pregnancy after age 30, or no pregnancy at all
- Absence of breastfeeding
- Overweight, particularly after menopause
- Increased exposure to estrogen, first period before age 13, menopause after age 51, prolonged hormone replacement therapy
- Previous biopsy results that indicate atypical hyperplasia, lobular carcinoma in situ, or radial scar formation
Signs and Symptoms
- It’s important to know how breasts normally feel and to be aware of any changes. A common symptom is a new lump or mass, but other things to be aware of include:
- Breast or nipple pain
- Swelling in the breast
- Dimpling of the skin
- Changes in the skin on the breast or nipple
If you notice any changes, contact your doctor. For details visit https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html
Types of Screenings
- Mammogram: The patient stands in front of the mammography unit, and a technologist uncovers the breast to be scanned and places it on a clear plastic plate. Then a second plate lowers until the breast is pressed between the two plastic plates. Images are taken of each breast from the front and the side. TIP: If your breasts are tender or swollen due to your menstrual cycle, consider rescheduling your mammogram to the week following your menstrual cycle.
- Breast Magnetic Resonance Imaging (Breast MRI): Used for women at higher risk of breast cancer, as a breast cancer staging tool, or to identify lesions in women who have already been diagnosed with breast cancer. The breast MRI creates three-dimensional, detailed images of the breast using a magnet connected to a computer. Sometimes the doctor may order a Breast MRI with contrast, meaning that a contrast dye will be injected into your body through an IV. TIP: Even if you are at higher risk, you still need to have regular mammograms in addition to any other screening tests.
- Breast Ultrasound: Generally used for women with lumps or abnormalities identified during a breast self-exam, clinical breast exam or mammogram. The test bounces sound waves off the breast tissue to create a picture called a sonogram. You'll lie down on a table, raise your hands above your head, and have a water-based gel applied to the area. Then, the radiologist or sonographer will run the transducer over your breast. TIP: A breast ultrasound does not replace regular mammograms.
The Sarah Cannon Cancer Institute at HealthOne also offers additional methods of detecting and diagnosing breast cancer.
Doctors such as those at the Sarah Cannon Cancer Institute at HealthOne will work with you to develop a personalized breast cancer treatment plan. Treatment options may include:
- Medical Oncology Treatment for Breast Cancer
We offer several medical oncology services for the treatment of breast cancer. In addition to medical therapies, our patients have access to additional services, including targeted therapy, scalp cooling for hair loss prevention and precise cancer staging with analysis of lymph node involvement. The type of treatment that is right for you will depend on your specific diagnosis.
- Biological Therapy/Immunotherapy: These therapies use man-made proteins that alter the growth and replication of a cancer cell by interfering with its specific biological pathways. This stops the cancer from growing and spreading.
- Chemotherapy: Chemotherapy is a type of treatment that uses a drug or combination of drugs to treat cancer. The goal of chemotherapy is to stop or slow the growth of cancer cells. These medications may be used in conjunction with other therapies to treat breast cancer.
- Hormonal Therapy: The hormones estrogen and progesterone can stimulate the growth of some breast cancers—which are called hormone-sensitive or hormone-dependent breast cancers. Hormone therapy is used to stop or slow the growth of these tumors.
- Radiation Treatment for Breast Cancer
We offer advanced, specialized radiation treatment options for breast cancer. Your radiation oncologist will help determine which radiation therapy technique will be effective for your type of breast cancer.
- Accelerated Partial Breast Irradiation: This is external or internal beam radiation targeting only the small area where a tumor has been surgically removed. This form of radiation is typically completed with five consecutive daily treatments.
- Breast Brachytherapy: This form of radiation treats breast cancer from within the breast where a tumor has been surgically removed.
- Hypofractionated Radiation Therapy: This radiation treatment uses higher doses over fewer sessions. It still destroys cancer cells and, for some people, may be used as a follow-up treatment.
- Deep Inspiration Breath Hold: This is a specific breathing technique used during radiation treatment. When a breath is taken in and held, it pulls the heart farther away from the chest. This is beneficial for patients with left-sided breast cancer and reduces potential damage to the heart caused by radiation exposure.
- Intraoperative radiation therapy: This treatment allows for the delivery of a concentrated, single dose of radiation delivered directly to the tumor site during breast cancer surgery. Typically, no further radiation therapy will be needed following intraoperative radiation therapy.
- Partial Breast Radiation Therapy: This therapy uses external beam radiation targeting only the small area of the breast where a tumor has been surgically removed. Partial breast radiation therapies significantly reduce the amount of time needed to complete the treatment. They also help limit and prevent radiation exposure to healthy tissue and organs close to the breasts, including the lungs, heart, ribs, muscles and skin.
- Prone Breast Radiation Therapy: This form of radiation is performed while the patient lies face down on a specialized table fitted with a breast board to enhance comfort. Aside from the different position, radiation then continues as normal.
- Whole Breast Radiation therapy: This technique involves external beam radiation therapy that uses radiation from high-energy X-ray beams to kill cancer cells or slow their growth. This treatment covers the entire breast, as well as the chest wall and lymph node areas, as needed. Whole breast radiation therapy is typically completed during a period of six to seven weeks.
- Surgical Treatment Options for Breast Cancer
Many patients with breast cancer need some form of surgery based upon their cancer type and medical history. We provide surgical treatment options to remove as much breast cancer as possible, see if your cancer has spread, relieve symptoms of advanced cancer and restore breast shape after cancer has been removed. We will help you understand all of your options so you and your surgeon can make the right choice for you.
- Lumpectomy: A lumpectomy is a breast-conserving surgery where only part of the breast containing cancer is removed, sparing surrounding healthy breast and nipple tissue. The size and location of your tumor will determine how much breast tissue needs to be removed. For patients who may benefit, we perform reduction lumpectomies. This is a traditional lumpectomy with breast reduction and lift—all of which occur during one procedure.
- Lymph Node Removal: The removal of a lymph node helps your doctor determine the extent of your cancer diagnosis. Lymph node removal may occur during a lumpectomy or mastectomy, or as a separate option.
- Mastectomy: A mastectomy is the surgical removal of an entire breast or both breasts. We perform many variations of this procedure, including:
- Double mastectomy—removes the entirety of both breasts
- Modified radical mastectomy—removes the entirety of the breast while sparing certain shoulder muscles
- Skin-sparing mastectomy—removes less skin during surgery compared to traditional mastectomy and performed in combination with breast reconstruction
- Simple mastectomy—removes all of the breast, excluding the lymph nodes
Total mastectomy—removes all of the breast, including lymph nodes in the underarms
Your surgeons work closely with you to determine the appropriateness of mastectomy and what technique is the best option according to your particular cancer type, stage, genetic risk and personal wishes. Our surgeons have additional training in scar-minimizing surgical techniques, which leave less evidence of surgery after recovery.
Breast reconstruction surgery helps restore the shape of your breasts following a mastectomy or lumpectomy. Reconstruction may take place immediately following your surgery or years later. Not all women opt for reconstruction. Talk to your surgeon about reconstructive surgery before your mastectomy or lumpectomy to determine the treatment plan that is right for you.
- Breast implant removal—removes breast implants following a reconstruction or augmentation procedure
- Implant-based reconstruction—uses breast implants for reconstructive or cosmetic purposes following breast cancer surgery
- Reduction lumpectomy free-flap reconstruction—removes skin and tissue from the abdomen for reconstruction but not muscle, also called deep inferior epigastric artery perforator (DIEP) flap
- Transverse rectus abdominis (TRAM) flap reconstruction—uses excess skin from the abdomen to reconstruct the breast
- Latissimus dorsi flap reconstruction—diverts skin, fat, blood vessels and muscle from behind the shoulder blade to the chest and formed into a breast shape
For some patients, breast reconstruction surgery may occur at the same time as breast cancer surgery. This will depend on individual risk factors and diagnoses.
Mammogram Q&AI'm pregnant or breast-feeding and due for a test. Should I wait?
- If you are pregnant, you should not undergo a mammogram because of possible danger to the fetus. If your gynecologist or obstetrician feels it is important to have a breast screening test during your pregnancy, a breast ultrasound will be ordered.
- If you are breastfeeding, your tissues may appear more dense than usual, making it harder for the radiologist to interpret the results.
I have a breast implant. Can I still get a mammogram?
- While it is safe to have a mammogram when you have a breast implant, be sure to tell the technologist before the procedure since the machine may require special adjustment for the best possible images.
What else should I know?
- You should always receive the results of your mammogram. If there are any abnormalities, your doctor may refer you to a breast specialist or a surgeon for more tests or evaluations. If the results are normal, continue to follow your recommended schedule for the next mammogram.
- If you have breast cancer-related questions, call askSARAH at 844.482.4812 and speak to a nurse available 24/7.