Breast Treatments

General Information About Breast Cancer and Breast Surgery

  Breast cancer is diagnosed by the examination of surgically removed breast tissue. A number of procedures can obtain tissue or cells prior to definitive treatment for histological or cytological examination. Such procedures include fine-needle aspiration, nipple aspirates, ductal lavage, core needle biopsy, and local surgical excision. These diagnostic steps, when coupled with radiographic imaging, are usually accurate in diagnosing a lesion as breast cancer.

  Occasionally, pre-surgical procedures such as fine needle aspirate may not yield enough tissue to make a diagnosis, or may miss the cancer entirely. Imaging tests, including chest X-rays, bone scans, Cat scans, MRI's, and PET scans are sometimes used to detect metastasis. While imaging studies like these are useful in determining the presence of metastatic disease, they are not in and of themselves diagnostic of cancer. Only microscopic evaluation of a biopsy specimen can yield a cancer diagnosis. Ca 15.3 (carbohydrate antigen 15.3, epithelial mucin) is a tumor marker determined in blood which can be used to follow disease activity over time after definitive treatment. Blood tumor marker testing is not routinely performed for the screening of breast cancer, and has poor performance characteristics for this purpose.

  The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. At present, the treatment recommendations after breast surgery (adjuvant therapy) follow a pattern. This pattern, however, is subject to change because every two years, a worldwide conference takes place in St. Gallen, Switzerland to discuss the actual results of worldwide multi-center breast cancer studies. Currently, patients are divided into high risk and low risk cases, depending on clinical criteria (age, type of cancer, size, metastasis).  Each risk category follows different recommendations for post-operative breast cancer therapy, including radiation therapy, chemotherapy, hormone therapy, and/or immune therapy.

  In planning treatment, doctors can also use PCR tests like Oncotype DX or microarray tests like MammaPrint that predict breast cancer recurrence risk based on gene expression. In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated.

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