Diseases and Conditions
Breast Cancer Patient Care at BMC
Introduction to Breast Cancer Patient Care at BMC
What Is Breast Cancer?
What Are the Symptoms of Breast Cancer?
What Are the Causes of Breast Cancer?
How Is Breast Cancer Diagnosed?
How Is Breast Cancer Treated?
Cancer Clinical Trials
Cancer Support Services
Patient Navigators, Social Workers and Nutritionists
At Boston Medical Center (BMC), the care of patients with breast cancer is a collaborative, multidisciplinary process. Organizing our services around each patient, we bring together the expertise of diverse specialists to manage your care from your first consultation through treatment and follow-up visits.
In our highly supportive and collaborative environment, experts in breast cancer provide you with the most advanced, coordinated and comprehensive medical care available anywhere—treatment that is effective and innovative in curing and controlling cancer and managing its impact on your quality of life.
At BMC, diagnosis and treatment of patients with breast cancer combines the resources of a multidisciplinary clinical center dedicated to personal, patient-focused care with the state-of-the-art expertise and technological advances of a major teaching hospital. As the primary teaching affiliate of the Boston University School of Medicine, BMC is at the forefront of clinical practice, surgical expertise and research in oncology.
Breast cancer is a treatable disease. In our culture of innovation, collaboration and compassionate care, you will receive treatment from physicians who are nationally recognized leaders in the care of patients with all stages of breast cancer.
To schedule an appointment or refer a patient, call us at 617.638.2778. Patients with a diagnosis or strong suspicion of cancer are given appointments within 72 hours.
To learn more about BMC’s breast health program and the Belkin Breast Health Center, winner of the Monroe E. Trout Premier Care Award in 2006 and proud recipient of grants from Susan G. Komen for the Cure and the Avon Breast Cancer Foundation, please visit the Belkin Breast Health Center website.
What Is Breast Cancer?
Breast cancer is a type of cancer that begins in the breasts. Other than skin cancer, it is the most common type of cancer among women living in the United States.
The normal breast is composed of 15 to 20 sections called lobes. Each lobe is made up of smaller sections called lobules. Lobules contain small groups of glands that produce breast milk. Thin tubes, called ducts, carry the milk from the lobules to the nipple. The breast also contains blood and lymph vessels. Lymph vessels are similar to blood vessels, but instead of circulating blood throughout the body, they circulate a clear fluid called lymph. The lobes, lobules, ducts, blood and lymph vessels are surrounded by fatty and connective tissue called stroma.
Cancer cells in the breast form a malignant (cancerous) tumor that appears as a lump. However, not all breast lumps are cancerous. In fact, most breast lumps are benign (non-cancerous). Benign breast lumps are abnormal growths that do not spread outside the breast and are generally not life threatening. They can be caused by fibrocystic changes, a combination of cysts (fluid-filled sacs) and fibrosis (the formation of scar-like tissue) in the breast. Benign lumps can be painful and may cause swelling, particularly when a woman is just about to start her menstrual cycle. These changes can also make the breast feel lumpy and cause a clear or slightly cloudy discharge from the nipple.
Most breast cancers are carcinomas, or cancers that begin in the lining of organs. Cancers that start in the glandular tissue (tissue that releases a substance) are called adenocarcinomas. Cancers that start in the connective tissue are called sarcomas. Only a small number of breast cancers are sarcomas.
There are several types of breast cancer, including ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma and inflammatory breast cancer. The term "in situ" means the cancer is confined to the tissue where it began. The term "invasive" refers to cancer that has spread (metastasized) from the layer of tissue where it began into surrounding healthy tissue.
Ductal Carcinoma in Situ (DCIS)
Cancer that starts in the lining of the duct but does not grow through the walls of the duct into the surrounding breast tissue and beyond is called ductal carcinoma in situ (DCIS). The cancer cells cannot spread to the lymph nodes (small, oval-shaped tissues containing certain infection-fighting immune system cells) or other organs. Ductal carcinoma in situ can go on to become invasive cancer. It is sometimes called a pre-cancer. Almost all women diagnosed with ductal carcinoma in situ can be cured. Many cases are caught by mammograms.
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma (IDC) starts in the lining of the duct but breaks through the wall of the duct into the surrounding breast tissue. From there it can spread to the lymph nodes and other organs. Invasive ductal carcinoma is the most common form of breast cancer. Eight in 10 cases of invasive breast cancer are IDC.
Invasive Lobular Carcinoma (ILC)
Invasive lobular carcinoma (ILC) starts in the lining of the lobules. It breaks through the wall of the lobule into the surrounding breast tissue, and from there, it can spread to the lymph nodes and other organs. Invasive lobular carcinoma accounts for 1 in 10 cases of invasive breast cancer.
Inflammatory Breast Cancer (IBC)
Inflammatory breast cancer (IBC) is a rare but serious form of breast cancer. It accounts for only 1% to 3% of breast cancers. Inflammatory breast cancer causes the skin of the breast to feel warm and look red. It can also give the skin a thick, pitted appearance, similar to the peel of an orange. The breast itself may get bigger or feel tender, itchy or hard. There may not be a single lump or tumor. In its early stages, inflammatory breast cancer is often mistaken for an infection rather than a cancer, and it may not be picked up by a mammogram. The chances of IBC spreading are higher, and the outlook for women who have IBC is worse than for women who have invasive ductal and lobular carcinomas.
What Are the Symptoms of Breast Cancer?
The most common symptom of breast cancer is a lump or mass in the breast. Cancerous lumps tend to be painless, hard and have uneven edges, though this isn’t always the case. Lumps that are painful, soft or have rounded edges can also be cancerous, so it is best to have any new changes in the breast looked at by your physician.
Other symptoms of breast cancer include:
- Swelling in the breast
- Skin irritation or dimpling
- Breast or nipple pain
- The nipple inverting (turning inward on itself)
- Scaliness, redness or thickening of the breast or nipple
- Nipple discharge that isn’t breast milk
With invasive cancers, it is possible for the cancer to spread to nearby lymph nodes under the arm or around the collarbone. A tumor may form there before the breast tumor is large enough to be felt.
What Are the Causes of Breast Cancer?
Although the exact causes of breast cancer remain unknown, certain risk factors connected to the disease have been identified. Risk factors do not determine whether a person develops a disease, but they can help predict a person’s chances of developing it. Some of these risk factors, such as diet, are within our control, while others, such as age, are not.
Some risk factors for breast cancer include:
Gender: Women are 100 times more likely to develop breast cancer than men (one percent of men get breast cancer). Elevated levels of estrogen and progesterone, naturally occurring hormones in the female body, are thought to be the reason women are so much more likely to develop the disease.
Age: As women get older, they are more likely to develop breast cancer.
Certain genetic mutations (changes in the DNA sequence of a gene), such as mutations in the BRCA1 and BRCA2 genes
, can increase a woman’s risk of developing breast cancer. Inherited genetic mutations (mutations you get from your parents) are thought to account for 5% to 10% of breast cancer cases.
Family History: Women with close blood relatives who have or have had breast cancer are at increased risk of developing the disease. This is not to say women who do not have blood relatives with the disease cannot or will not develop breast cancer.
Personal History: Women who have or have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast or another part of the same breast. This is not the same as having a recurrence. A recurrence is when the same cancer returns.
Race: Overall, white women are slightly more likely to develop breast cancer than African American women. African American women are more likely to die from the disease because they are usually diagnosed later. Hispanic, Asian and Native American women are less likely to develop and die from breast cancer than either white or African American women.
Dense Breast Tissue: Women, particularly younger women, with dense breast tissue have an increased risk of developing breast cancer. This is because having dense breast tissue makes it more difficult to identify the disease with a mammogram.
Certain Benign Breast Problems: Having certain benign breast changes may increase a woman’s chances of developing breast cancer. Some changes are more closely linked with the disease than others.
Lobular Carcinoma in Situ (LCIS): When a woman is diagnosed with lobular carcinoma in situ, it means cells that look like cancer cells are in the lobules, but cannot break through the walls of the duct or spread to other tissues and organs. LCIS can increase a woman’s chances of developing breast cancer later.
Menstrual Periods: Women who started menstruating early (before age 12) or underwent menopause late (after age 55) have a slightly increased risk of developing breast cancer.
Breast Radiation Early in Life: The chances a woman will develop breast cancer are greatly increased if she received chest radiation as a child or young adult (as treatment for another cancer), particularly during the teenage years when the breasts were still developing.
Treatment with DES: Women who were treated with the drug DES (diethylstilbestrol) while pregnant have a slightly increased risk of developing breast cancer.
Not Having Children or Having Children Later in Life: Women who choose not to have children or to have them later in life (after age 30) have a slightly increased risk of developing breast cancer. Conversely, giving birth at a younger age or giving birth to multiple children slightly decreases a woman’s chances of developing the disease. Being pregnant for extended periods of time cuts down on the number of menstrual cycles a woman goes through and thereby reduces her exposure to estrogen and progesterone, lowering her risk of developing the disease.
Using Certain Forms of Birth Control: Breast cancer risk is slightly higher for women using birth control pills or depot-medroxyprogesterone acetate (DMPA or Depo-Provera®), an injectable form of birth control. A woman's risk will gradually return to normal once she stops using the pills or injections.
Breastfeeding Versus Not Breastfeeding: Some studies have linked breastfeeding with a slight reduction in breast cancer risk for women, particularly if the woman breastfeeds for 1.5 to 2 years.
Using Hormone Therapy After Menopause: Some women choose to undergo hormone therapy to reduce the symptoms of menopause. Treatment with estrogen and progesterone together (sometimes referred to as combined hormone therapy) after menopause increases a woman’s chances of developing breast cancer. A woman’s chances of developing breast cancer will gradually return to normal once she has stopped hormone therapy. Taking estrogen by itself does not seem to increase a woman’s chances of developing breast cancer, though it can increase her chances of developing other types of cancer.
Alcohol Consumption: Alcohol consumption is directly linked to a woman’s risk of developing breast cancer. The more alcohol a woman consumes on a daily basis, the higher her chances of developing the disease.
Being Overweight or Obese: Women who are overweight or obese have an increased risk of developing breast cancer. Weight gain in adulthood also increases a woman's risk.
Patients with a strong family history of breast cancer may be eligible for genetic counseling. For more information, please visit Genetic Counseling, or talk to your physician to request a referral.