At Boston Medical Center (BMC), the care of patients with breast cancer is a collaborative, multidisciplinary process. BMC’s Breast Health Program incorporates a coordinated multispecialty approach to care, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits.

"I hope you guys never get sick, but if you do Dr. Ko is the best there is she will never stop working to give you the best care there is. She is wonderful and she has a great team everyone is so caring and wonderful I love them."

~ Anonymous

To schedule an appointment or refer a patient, call us at 617.638.2778. All new patients are given expedited appointments in the Belkin Breast Health Center, where they are seen by either a medical or surgical breast specialist.

To learn more about BMC’s Breast Health Program and the Belkin Breast Health Center, 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?


Meet Maria, who fought breast cancer and is now becoming a doctor.

Excluding skin cancer, breast cancer is the most common type of cancer among women in the U.S. (American Cancer Society 2015b).

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 vessels 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 vessels, 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 (noncancerous). 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. There are several types of breast cancer. "In situ" means the cancer is confined to the tissue where it began. "Invasive" refers to cancer that has spread from the layer of tissue where it began into surrounding healthy tissue.

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 and hard and have uneven edges, though this isn’t always the case. It is best to have any new changes in the breast looked at by a physician.

Other symptoms 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.

Causes of Breast Cancer

Although the exact causes of breast cancer remain unknown, certain risk factors—things that increase an individual's chances of developing a cancer—have been identified. While risk factors may be useful in identifying high-risk individuals, they do not determine whether a person develops a disease. Some risk factors, such diet, are within an person’s control, while others, such as age, are not.

Some risk factors breast cancer include

  • Gender: Women are 100 times more likely to develop breast cancer than men (one percent of men get breast cancer) (American Cancer Society 2015a).
  • Age: As women get older, they are more likely to develop breast cancer.
  • Genetic mutations: 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.
  • Family history: Women with close blood relatives who have or have had breast cancer are at increased risk of developing the disease.
  • 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, Caucasian women are slightly more likely to develop breast cancer than African American women.
  • Dense breast tissue: Women, particularly younger women, with dense breast tissue have an increased risk of developing breast cancer.
  • Certain benign breast problems: Having certain benign breast changes may increase a woman’s chances of developing breast cancer.
  • 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 or 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
  • 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 l: There is a slight increase in risk for women who do not have children or begin having them after age 30 (American Cancer Society 2015b).
  • Certain forms of birth control: Breast cancer risk is slightly higher for women actively using birth control pills or depot-medroxyprogesterone acetate (DMPA or Depo-Provera®), an injectable form of birth control.
  • 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 ½ to 2 years (American Cancer Society 2015b).
  • Hormone therapy after 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. 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: The more alcohol a woman consumes on a daily basis, the higher her chances of developing the disease.
  • Being overweight or obese

Patients with a strong family history of breast cancer may be eligible for genetic counseling. For more information, patients can visit Genetic Counseling or talk to their physician to request a referral.

Are You At Risk For Developing Breast Cancer?

References

American Cancer Society. 2015a. Detailed Guide: Breast Cancer. PDF.
https://www.cancer.org/content/dam/CRC/PDF/Public/8577.00.pdf

Overview Guide: Breast Cancer Overview. PDF.

National Cancer Institute. 2012. What You Need To Know About™ Breast Cancer. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human

Services. https://www.cancer.org/cancer/breast-cancer.html

Breast Cancer Stories

Hear directly from patients about their experiences with BMC's Breast Cancer Program. Have a story you'd like to share with us? Email Us!

 

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Conditions We Treat

Treatments & Services

Breast-Conserving Surgery

Breast-conserving surgery (BCS) removes only part of the breast. How much of the breast is removed depends on the size of the tumor and where it is located. The medical term for this kind of surgery is a partial (or segmental) mastectomy. It is also called a lumpectomy or quadrantectomy.

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Mastectomy

Mastectomy removes the whole breast. There are multiple types of mastectomy. The two most common types of mastectomy are simple (total) mastectomy and modified radical mastectomy. A simple mastectomy removes just the breast. When the lymph nodes underneath the arm (called the axillary lymph nodes) are removed in addition to the breast, it is called a modified radical mastectomy.

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Lymph Node Surgery

Some breast cancer patients may need lymph node surgery. Lymph node surgery is performed for staging purposes to find out whether the cancer has spread to the lymph nodes under the arm (axillary lymph nodes). One or more lymph nodes may be removed for examination under a microscope in one of two ways:  an axillary lymph node dissection or a sentinel lymph node biopsy.

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Chemotherapy for Breast Cancer

The use of cancer-killing drugs to treat cancer is called chemotherapy. The drugs can be administered intravenously, injected, or taken by mouth as a pill or a liquid. Once the drugs have entered the bloodstream, they circulate throughout the body, making them useful in killing any cancer cells that have spread to other parts of the body.

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Reconstructive or Breast Implant Surgery

Reconstructive or breast implant surgery is not meant to cure cancer. It is done to restore the appearance of the breast(s) after surgery. Depending on whether radiation therapy is part of your treatment plan, it is possible for breast reconstruction or implant surgery to be done at the time of mastectomy or breast-conserving surgery. If radiation therapy is part of your treatment plan, your physician may suggest waiting until after that part of your treatment is complete.

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Radiation Therapy

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).

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Hormone Therapy for Breast Cancer

Hormone therapy is used to treat cancers that are hormone receptor-positive (meaning hormone receptors are present in the cells). Breast cancers can be estrogen receptor-positive (ER-positive), progesterone receptor-positive (PR-positive), or both.

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Targeted Therapy for Breast Cancer

Targeted therapy works differently than chemotherapy. The side effects of targeted therapy drugs are often different and less severe than those of standard chemotherapy drugs.

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Radiation Therapy

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).

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External Beam Radiation Therapy (EBRT) for Breast Cancer

External beam radiation therapy (EBRT) is usually administered in the radiation oncology department five days a week (Monday through Friday) for five to six weeks, though some newer methods have cut down treatment time to a few weeks or less.

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Three-Dimensional Conformal Radiation Therapy

Three-dimensional (3-D) conformal radiation therapy is based on a CT scan of the region of the body being treated. Radiation oncologists use computer software to determine how the patient will look from any angle and identify the best paths to direct the radiation.

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Diagnostics and Tests

How Is Breast Cancer Diagnosed?

There are several imaging tests used to diagnose breast cancer. BMC’s Belkin Breast Imaging Center, designated a Breast Imaging Center of Excellence by the American College of Radiology, offers patients a full range of diagnostic services. A diagnostic work-up may include one or more of the following tests. 

The results of these consultations and procedures are reviewed in the Cancer Care Center’s weekly multidisciplinary Breast Tumor Board meeting. Each patient receives a comprehensive, individualized care plan, designed to meet their specific needs. Following this review, the patient’s BMC physician will discuss the Tumor Board’s recommendations with the patient and her family, and together they will develop a comprehensive treatment plan.

Mammogram

A mammogram is an x-ray of the breast that uses a small amount of radiation. A technologist will position your breast for the test. The breast will be compressed between two plates, and a picture will be taken.

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Breast MRI

Magnetic resonance imaging, or MRI, uses magnets and radio waves to make very precise cross-sectional pictures of the body. For breast MRI, you will lay face-down in a narrow tube with openings for your breasts.

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Breast Ultrasound

Ultrasound uses sound waves to produce an outline of part of the body. A computer picks up the echoes from the sound waves and uses them to generate a picture on the computer screen.

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Fine Needle Aspiration (FNA) Biopsy

FNA uses a thin, hollow needle (thinner than the needles used to draw blood) to draw out fluid or tissue from a lump. Depending on the size and location of the lump, the needle is sometimes directed into the lump simply by feeling it. Other times it may be guided into the lump with the assistance of an ultrasound.

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Core Needle Biopsy

A core needle biopsy uses a thick needle to draw out cores (pieces) of tissue for examination. Because the thicker needle is able to remove more tissue, a core needle biopsy is more likely to provide clear results than a fine needle aspiration.

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Vacuum-Assisted Biopsy

Vacuum-assisted biopsies are done using Suros technologies with the assistance of a mammogram, MRI or ultrasound. A small cut is made in the skin after it has been numbed. A hollow probe is entered through the cut and a piece (or several pieces) of tissue are removed. Vacuum-assisted biopsies generally remove more tissue than core needle biopsies. The medical term for this type of biopsy is a stereotactic biopsy.

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Surgical (Open) Biopsy

The least common type of biopsy, a surgical (or open) biopsy is generally used to remove all or part of the lump for examination under a microscope. When the whole lump is removed, the surgeon may also remove some of the surrounding healthy tissue. Surgical biopsies are generally performed in the hospital’s outpatient centers. Local anesthesia is used in combination with other drugs to make you relaxed and drowsy. The procedure can also be done using general anesthesia.

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Lymph Node Biopsy Breast Cancer

Often done at the same time as the breast biopsy or at the time of surgery, a lymph node biopsy uses a needle to remove entire lymph nodes for examination under a microscope.

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Chest X-ray

Chest x-rays provide an image of the heart, lungs, airways, blood vessels and bones in the spine and chest area. They can be used to look for broken bones, diseases like pneumonia, abnormalities, or cancer.

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Bone Scans

Bone scans involve a low dose of radioactive material that is injected into a vein. Bone attracts this material. Concentrated areas show up on the scan and are referred to as "hot spots." Hot spots may be indicative of a variety of diseases and conditions.

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Computed Tomography (CT) Scan

CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.

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Magnetic Resonance Imaging (MRI)

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken.

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Duplex Ultrasound

A painless procedure where gel is placed on affected area and a handheld device is moved across it in order to obtain a picture of the blood flow in the body.

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Positron Emission Tomography (PET) scan

A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream.

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Our Team

BMC’s comprehensive breast cancer team includes physicians who work in internal medicine, medical oncology, pathology, radiation oncology, radiology/mammography and surgical oncology. Our patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.

Medical Oncologists

Naomi Ko, MD

Director, Inpatient Medical Operations
Assistant Professor of Medicine, Department of Medicine, Boston University School of Medicine

Special Interests

Breast Cancer

Andreea M Negroiu, MD

Assistant Professor of Medicine, Department of Medicine, Boston University School of Medicine

Special Interests

Breast Cancer

Lauren J Oshry, MD

Assistant Professor of Medicine, Department of Medicine, Boston University School of Medicine

Special Interests

Breast cancer, Gynecological cancer, Urologic cancer

Radiation Oncologists

Ariel E Hirsch, MD

Director of Education, Boston Medical Center Radiation Oncology
Associate Professor, Boston University School of Medicine

Special Interests

Genitourinary; Breast and Gynecologic Malignancies; Breast cancer
 

Surgeons

Michael R Cassidy, MD

Medical Director, Belkin Breast Health Center, Assistant Professor of Surgery, Boston University School of Medicine

Special Interests

Surgical Oncology, Breast Cancer, Melanoma, Sarcoma, Gastrointestinal Malignancies

Andrea L Merrill, MD

Assistant Professor of Surgery, Boston University School of Medicine

Special Interests

Breast Cancer, Thyroid Nodules, Thyroid Cancer, Parathyroid Adenoma, Parathyroid Hyperplasia

Patient Resources

Breast Cancer Clinical Trials

BMC offers a number of clinical trials specifically for breast cancer patients. Promising new techniques in the diagnosis, treatment and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing.