Breast cancer is an abnormal growth of cells within the breast that have moved beyond where they normally grow. There are several forms of breast cancer along with pre-cancerous lesions, or lesions that indicate an increased risk of breast cancer. Fortunately, most abnormalities that are found end up being benign (not a cancer). Typically pre-cancerous and cancerous lesions are removed, sometimes after receiving chemotherapy.
One way to look at the work-up and treatment of a breast lesions is by dividing it into the different stages of work-up.
1- Diagnosis and imaging
In this stage women (occasionally men will have these lesions, but going forward we will refer to women) are typically examined by a physician and receive imaging. This can take the form of mammogram or ultrasound. On occasion, an MRI may also be needed. Some lesions can be felt but not all can be. Often, if there is a concerning lesion, the radiologist (imaging doctor) will perform a biopsy of the lesion and send it for pathology.
2- Surgical consultation and treatment
Once a lesion has been found, patients are usually referred to a surgeon for treatment. The patient is seen and examined by a surgeon who then makes recommendations. Most of the time, the first step in treatment will be removal. Often, a surgeon (typically a General Surgeon) will refer her for evaluation by an oncologist (chemotherapy doctor), a radiation oncologist (radiation doctor), and/or a plastic surgeon (involved in reconstruction of the breast after surgery).
There are three broad categories of surgery- excisional biopsy, breast conservation therapy, or mastectomy. Excisional biopsy is typically used to treat lesions that are not cancer or are at risk for becoming cancer. Most pre-cancers (DCIS) or cancers are treated with either breast conservation therapy or mastectomy. In breast conservation therapy, a patient has the lump removed with or without a lymph node biopsy followed by radiation therapy to the chest wall. She may or may not need chemotherapy after surgery. Patients who elect to have a mastectomy have the whole breast removed, usually with a lymph node biopsy and may or may not need radiation and chemotherapy. There are several reasons why a woman would need a mastectomy instead of breast conservation therapy, but most women can receive breast conservation therapy.
3- Chemotherapy with or without radiation
Not all women need chemotherapy even if she has a cancer. She will be referred to a medical oncologist and this should be considered. However, every patient is different and this will be a decision made with your oncologist.
The final part of the treatment process is monitoring the breast for further cancer and using risk reduction to help decrease the risk of the cancer returning. Women will have regular imaging (mammogram, ultrasound, MRI, or PET scans) along with exams by her surgeon and oncologist. In addition, a lot of women will be placed on a medication that decreases the risk of a return of cancer (this is not a chemotherapy).
Choosing a surgeon to help you navigate this process is very important. It is always appropriate to seek a second opinion (most people get multiple opinions for work done on their houses, it is even more important for the body). There is no reason why a women shouldn’t like and trust her surgeon. This is a long, ongoing relationship that spans years. A lot of women find breast cancer intimidating and scary. It can become a much more manageable process with the right health care team.