Breast Cancer: Screening, Diagnosis, and Treatment

Aside from skin cancer, breast cancer is the most common cancer among women in the U.S. Individuals can take some of the power back from cancer by undergoing regular screenings and also knowing their personal family history.

“If you come from a family that has significant breast, ovarian, or uterine cancer, it is really important to know what your risk is. The second thing is understanding and knowing your breasts, and being able to identify changes in them that occur that are concerning,” states Dr. Andrea French, board-certified general surgeon with Dignity Health.

Dr. French recommends self-exams that not only look for lumps, but also changes to the nipples, discharge, and dimpling or discoloration of the skin. The earlier women begin self-screening, the better. Mammograms typically don’t initiate until age 40, so any changes prior to that can identify cancer before it progresses any further.

“If there are any changes to your breast, you should immediately see your primary care physician. If a mass is found or if there's skin dimpling, we could get an ultrasound to quantify that mass, because there are a lot of different growths in the breasts that are not cancerous. The ultrasound can help us distinguish what those are,” explains Dr. French.

Should the ultrasound not reveal anything, the next step would be an MRI because it is the most sensitive imaging modality. Women who have a genetic predisposition to breast cancer might undergo MRI as a preventative measure.

BI-RADS: Breast Cancer Screening Scores

When an individual gets a breast image—a mammogram, ultrasound, or MRI—they are given a score called BI-RADS, which ranges from zero to six.

• Zero means more information is needed as the imaging was inconclusive.
• One indicates everything looks totally normal.
• Two means radiologists see something, but they're a hundred percent sure it's not cancer.
• Three occurs when something appears but radiologists are about 95% sure it's not cancer
• Four is when they see something and are about 80% sure it's not cancer.
• Five means they see something and it's a 50/50 chance of cancer.
• Six is a biopsy-confirmed breast cancer.

A person’s specific screening regimen is dictated by the image they get every year. If a biopsy must be performed, the pathologist looks for various factors.

“The pathology is extremely important because we want to know if it is a cancer, what is it coming from? What is its receptor status? If it's benign, is it something we need to take out anyway because it carries a higher risk of malignant cells being close to it? Or, if it's completely benign do we feel safe leaving it alone? All of that information is given to us with a pathology report,” notes Dr. French.

Knowing the receptor status is also essential because it identifies how close it is to the original breast cell. The various profiles dictate how aggressive oncologists need to be in treating the cancer.

Treatment Options, Outcomes

Five different treatment modalities exist: surgery, radiation, chemotherapy, endocrine therapy, and immuno-targeted therapy. “If a patient comes in and has cancer, what we have to determine is the likelihood this is still in the breast or whether or not it's gone out into the body. That dictates what order the treatment occurs,” shares Dr. French.

For example, a person might only need a lumpectomy to remove the cancer along with radiation. In more extreme cases where the cancer has spread, oncologists turn to systemic treatments (chemotherapy, endocrine therapy, immunotherapy)—rather than local options.

“I always like to start with one thing, and that is cancer is a big word that describes a broad spectrum of disease. There are cancers that are very difficult for us to treat, and there are cancers that we're very good at treating. Breast cancer is one of those,” assures Dr. French.

She also wants breast cancer patients to know they have an entire team helping them through this process—a surgeon, oncologist, and radiation oncologist that are all working together to ensure the best possible outcomes.

“For most of the people I see, thankfully, we catch these cancers early and cure rates are very high. So, they're in the 80% to 90%, even in stage I and stage II disease. Our success rate at treating patients is excellent,” she adds. “Even in patients I've seen who have come in with stage IV disease, where there's cancer found in other parts of the body, I've had patients 10 years out present to my office living their normal life.”