Breast cancer treatment options
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A breast cancer diagnosis is the start of a long journey that requires a lot of important decisions. Who will be in charge of your breast cancer care? What is the best breast cancer hospital? How will you know which breast cancer treatment is best for you? At Duke, our breast oncologists are nationally recognized for their research and expertise in detecting, evaluating and treating all types of breast cancer. We help you understand your breast cancer treatment options and work closely with you to help you make these and other important decisions about your breast cancer care.
Choosing your breast cancer doctor
When breast cancer is suspected, your primary care doctor will refer you to a breast cancer specialist. Whether that doctor is a medical oncologist or surgical oncologist, he or she will guide you in diagnosing and staging your breast cancer. This breast cancer specialist should also help you pull together the medical team that will coordinate your care. A breast cancer team may include:
- Surgical oncologist. Most breast cancer treatment starts with some type of surgical procedure. Your breast cancer surgeon will evaluate the type and stage of your breast cancer, and recommend the procedure that is right for you.
- Medical oncologist. Chemotherapy, immunotherapies, and targeted treatments are overseen by a medical oncologist if they are part of your breast cancer care.
- Radiation oncologist. Targeted and shortened courses of radiation therapy may be used to shrink tumors before or after surgery. Duke radiation oncologists also teach techniques like breath holding and prone breast positioning to minimize radiation exposure to your normal healthy tissues, including your heart.
- Plastic surgeon. if you require breast reconstruction, a plastic surgeon and help you understand your options.
Why you should choose Duke breast cancer doctors for your treatment:
- You benefit from our advanced training and skills. Our breast oncologists have years of experience working only with breast cancer patients. In addition, our knowledge of the latest advances in breast cancer therapies, and access to breast cancer clinical trials ensures you get the best care possible for your needs.
- Our breast cancer doctors are nationally recognized. Our doctors are included in Time magazine's annual lists of the most influential people because of their contributions to new breast cancer treatment approaches.
- Nationally recognized Duke breast cancer surgeon Dr. Shelley Hwang, MD, explains new thinking about how to treat DCIS with active surveillance, rather than more conventional cancer treatments, including mastectomy.
- Breast cancer oncologist Dr. Kimberly Blackwell, MD, helped to develop a first-of-its-kind, late-stage breast cancer treatment that delivers potent chemotherapy directly to cancer cells while leaving healthy cells relatively intact.
Choosing your breast cancer center
Larger hospitals have more breast cancer specialists who have more experience treating different types of breast cancer, including rare forms of breast cancer. Breast cancer centers that are part of larger hospitals can also offer more services to women and men with breast cancer.
Why you should choose Duke as your breast cancer center:
- Our cancer program is nationally recognized. As a National Cancer Institute-designated Comprehensive Cancer Center, we offer a level of cancer expertise found only in the top cancer centers across the country. The skills and experience of our breast cancer doctors, surgeons, counselors and therapists come from working only with women and men breast cancer every day. Our cancer program is among those nationally ranked by U.S. News & World Report.
- Your convenience and comfort are important. Choosing a breast cancer center near to your home minimizes the impact your breast cancer treatment has on your daily activities and your quality of life. Duke cancer centers are located throughout Cary, Raleigh, Durham and beyond. Imaging, testing and breast cancer treatments are available at our centers.
- You may be eligible to participate in breast cancer clinical trials. These studies give eligible breast cancer patients access to new therapies before they are approved. Duke doctors are investigating new ways to approach breast tumors, how exercise impacts treatment and survival, and how to improve the quality of our patients’ lives. You may be eligible to participate in our breast cancer clinical trials, which are using new vaccines to treat different types of breast cancer, including early stage breast cancer and HER2-positive breast cancer.
- Your special needs are met in highly specialized clinics. We offer clinics devoted to specific types of breast cancer, different age groups, and unique healthcare needs, including sexual health and fertility issues for women in their childbearing years.
- You and your family learn to cope with help from our comprehensive support services. Our cancer support services range from helping to minimize the side effects of treatment to coping with the emotional and psychological effects of diagnosis and treatment. Our breast cancer survivorship clinic also pulls together a range of resources specially designed to help survivors after treatment ends. View all of our breast cancer support groups in our event calendar.
Understanding your breast cancer treatment options
Diagnostic mammography, breast ultrasound, and breast MRI are forms of breast imaging that identify cancer cells and stage types of masses. MRI and ultrasound-guided needle, stereotactic, and sentinel node biopsy are used to extract small pieces of tissue where cancer is suspected. A pathologist uses these tests to evaluate the stage and type of your breast cancer and determine the right breast cancer treatment options.
Why you should choose Duke for your breast cancer treatment:
- Mammography is available at six convenient locations in Durham and Wake counties. Same-day appointments are available, and you’ll get same-day results during our Saturday clinics.
- Our nationally accredited breast imaging program is an American College of Radiology Breast Center of Excellence. This means it has undergone a rigorous review process to ensure it meets and follows national standards and guidelines. It is accredited in breast ultrasound, breast MRI, screening mammograms, and diagnostic mammograms, stereotactic and sentinel node biopsies.
- If you are at risk for inherited breast cancer, you may work with our genetic counselors. If appropriate, they may recommend screening for BRCA1 and/or BRCA2 genes — the most common cause of hereditary breast cancer — and will help you interpret your results. With these facts, they can discuss the options that will keep you and your family healthy.
- Our doctors helped to develop two of the most recently FDA-approved drugs for breast cancer. Ado-trastuzumab emtansine (Kadcyla) has been referred to as a "smart bomb" because it targets the tumor, lacks significant side effects, and offers patients a better quality of life. Lapatinib (Tykerb), also developed by Duke doctors and researchers, is used to treat HER2-positive breast cancer, and targets and blocks the signals that breast tumors need to grow. It’s an added option for women whose breast cancer has stopped responding to other treatments.
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Breast cancer surgery
Breast-conserving lumpectomy removes cancer and a small amount of surrounding breast tissue. A quadrantectomy removes cancer and a larger amount of surrounding breast tissue. When appropriate, we combine these lumpectomy procedures with breast reconstruction or breast reduction.
Often performed when breast removal and breast reconstruction are performed during the same operation. A small incision made around the areola — the dark skin around the nipple — allows the surgeon to remove the entire breast, nipple, and areola without removal of the breast skin. A nipple-sparing mastectomy removes all the breast tissue but spares the nipple or areola. Both approaches optimize cosmetic reconstruction results.
During a modified-radical mastectomy, surgeons will remove the entire breast, including the skin, areola, and nipple, as well as most of the lymph nodes in the armpit area. It is usually performed if the tumor is large and cancer has spread to the lymph nodes. Modified-radical mastectomy is more commonly performed than radical mastectomy, when the entire breast, lymph nodes and chest wall muscles under the breast is removed.
A full spectrum of options is available, including implant reconstruction, as well as techniques that use your own healthy tissue. Our plastic surgeons can also use tissue or unwanted fat from your body to more closely match your other breast. If possible, breast reconstruction surgery can be performed at the time of mastectomy, or after chemotherapy and radiation therapy.
Medical treatments for breast cancer
In addition to a wide variety of chemotherapy regimens, which aim to kill or stop cancer cells from growing, we offer hormone-blocking and endocrine therapies to prevent them from returning or spreading in cancers that respond to estrogen and progesterone.
The placement of low-dose radioactive seeds in suspicious breast tissue replaces the need for guide wires and allows surgeons to pinpoint and remove small breast tumors. The seed can be implanted up to five days before surgery, which minimizes your discomfort and shortens the surgery.
Our radiation oncologists use targeted and shortened courses of external radiation beams to shrink tumors after surgery. Techniques like breath holding and prone breast positioning are incorporated to minimize radiation exposure to normal tissue, including the heart.
Our doctors helped develop two of the most recently FDA-approved drugs for breast cancer. Ado-trastuzumab emtansine (Kadcyla) has been referred to as a "smart bomb" because it targets the tumor, lacks significant side effects, and offers patients a better quality of life. Lapatinib (Tykerb), also developed by Duke doctors, is used to treat HER2-metastatic breast cancer, and targets and blocks the signals that breast tumors need to grow. It’s an added option for women whose breast cancer has stopped responding to other treatments.