Breast cancer care

Breast cancer is a disease where cells in the breast begin to grow out of control, forming tumors. These abnormal cells can be found in either the ducts or the lobules of your breast tissue. Sometimes they are in both areas. One in eight women and about 2,400 men are diagnosed with breast cancer each year in the United States.  

After you find out you have breast cancer, you may feel overwhelmed or confused. Your Allina Health care team will help you through this time. You and your health care team will work together to develop a breast cancer treatment plan. This plan will be unique to your needs, concerns and preferences.  

Finding breast cancer early—before it can spread to other parts of the body—is the key. There are several ways to screen for and detect breast cancer. 

• 2-D mammography: This is a low-dose digital X-ray of your breast. 
• 3-D mammography (tomosynthesis): Where a standard mammogram takes flat images, a 3-D mammogram takes many images from several angles, which are combined by a computer to produce a three-dimensional image of your breast.  
• Breast ultrasound (sonography): This technology uses sound waves to “see” the inside of your body. A computer monitor shows the images from the sound waves. These images can provide information to help diagnose and treat cancer. 
• MRI (magnetic resonance imaging): An MRI uses a magnetic field and radio waves to make three-dimensional (3-D) images of your breasts on a computer. It is often done after a diagnosis to assess the size of tumors and see if any cancer cells have spread.  

A biopsy takes a small sample of tissue from the breast, either through a needle or through a minor surgical procedure. The sample will be sent to the lab to see if it is cancerous. The radiologist and/or your health care provider may recommend a biopsy if your breast imaging test showed an abnormal area. Before the procedure, it is natural to wonder what percentage of breast biopsies are cancer. The answer is about 20 percent, or one in five. Here are a few common types of biopsies for breast cancer: 

• Stereotactic biopsy. This procedure is performed with the patient sitting upright in a chair or laying prone on a special table. During this type of biopsy, the radiologist (the doctor who performs the biopsy) will take small samples of breast tissue with a needle-like device. He or she will numb the biopsy area with lidocaine. They may make a small nick in your skin and will insert the needle-like device into your breast, using t X-rays and computer images to get to the correct biopsy location.  The procedure usually takes about an hour.  You will be able to continue most of your normal daily activities. 

• Biopsy using ultrasound guidance. This procedure is performed with the patient lying on their back or side on an exam table.  During this type of biopsy, the radiologist (the doctor who does the biopsy) will take small samples of breast tissue with a needle-like device.  He or she will numb the biopsy area with lidocaine.  They may make a small nick in your skin and will insert the needle-like device, using ultrasound (sound waves) to get to the correct biopsy location.   You will be able to continue most of your normal daily activities.  

• Surgical breast biopsy. This is a minor surgical procedure where your surgeon will remove the area of concern (a lump or tissue) and send it to the pathology laboratory. 

The “stage” of breast cancer refers to how large a tumor is or how advanced or widespread the cancer is within the body. It is a guide that you and your health care team can use to help make decisions about treatment.  

Stage 0. Describes cancer that has not spread beyond the area of tissue it started in. 

Stage I. This is a cancer that has spread into the fatty tissue of the breast, with a tumor that is less than two centimeters across. 

Stage II. This is cancer that has spread into the fatty tissue of the breast, with a tumor that is two to five centimeters across. 

Stage III. The tumor is more than five centimeters and the cancer may have spread to nearby lymph nodes. 

Stage IV. This is when the cancer has spread into other parts of the body—often into the lungs, liver or bones. 

If you receive a breast cancer diagnosis, your Allina Health care team will present you with breast cancer treatment options based on your unique situation.  Using a shared decision-making approach—where your goals, values and wishes are at the center—you and your team will create a breast cancer treatment plan together. Your nurse navigator, genetic counselor, medical oncologist, surgeon and other members of your team will make sure that you understand each treatment option and that you are prepared for the options you choose. 

Surgery. There are two types of surgery to treat breast cancer:  

• Lumpectomy. This is a surgery to remove part of your breast. It removes the cancer along with some healthy breast tissue around the cancer. 

• Mastectomy. This is a surgery to remove your entire breast. This may include your nipple and areola. After a mastectomy, you will have a scar on your chest where your breast was and you will lose your breast’s natural feeling and look.  

Radiation therapy. This treatment uses high-energy radiation (X-rays) to shrink or destroy cancer cells. Healthy cells are also affected by the radiation. 

Chemotherapy. Chemotherapy is medicine given through an IV (intravenous) line to destroy cancer cells throughout your whole body. There are many different types of chemotherapy. You and your medical oncologist will decide if chemotherapy is right for you, along with which type of medicine. 

Targeted therapy. These medicines are designed to target specific features of cancer cells and stop them from growing and spreading. 

Life changes the moment you are diagnosed with cancer. Our goal is to help you and your family manage the impact of your cancer. We will focus on maintaining and improving your quality of life—as you define it—before, during and after your breast cancer treatment. Before your first visit, your nurse navigator will explain what will happen and help you coordinate any pre-visit tasks. 

What to expect  

• Review of your recent medical history. 

• Talk about any physical health changes. 

• Talk about how to manage any side effects of cancer treatment. 

• Provide a survivorship care plan for you and your primary care doctor.  

• Provide education and connect you with the right resources, like: 

  • Courage Kenny Rehabilitation Institute Cancer Rehabilitation Program: Rehabilitation can help you before, during and after cancer treatment 

  • programs that can help with common cancer concerns.  

Questions to ask 

You will have many questions about your diagnosis and treatment. We encourage you to ask anything that’s on your mind—and to think not only about the cancer itself, but also about other support you might need.  

• How treatable is breast cancer? 

• What stage of breast cancer do I have? 

• Can my breast cancer be cured? 

• What are my chances of survival?  

• What is the typical treatment plan for my type of cancer? 

• How will treatment affect my daily life? 

• Should I get a second opinion? How do I do that? 

• How can I get help with insurance coverage and finances for my treatment? 

• Is mental health support available in case I’m anxious or stressed? 

The exact cause of breast cancer is unknown. But there are things that make you more likely to develop breast cancer.  Your breast cancer risk includes many things that you can’t control, such as: 

• family history of breast cancer 

• dense breast tissue 

• older age 

• certain inherited genes  

• exposure to estrogen (early menstruation, older age at birth of first child, late menopause) 

• history of chest radiation, especially at a young age 

• personal history of atypical cells in your breast 

There are some factors you can change, which include: 

• obesity 

• drinking alcohol 

• getting enough exercise 

• smoking 

• hormone replacement therapy that combines estrogen with progestin 

Learn more about breast cancer risk factors, symptoms and prevention.

Whether you have private health insurance, Medicare or Medicaid, the coverage and benefits differ from plan to plan and provider to provider. It is important for you to understand your health care benefits before your treatment. Check with your insurance provider and find out exactly what is and is not covered under your plan, and how much you have to pay yourself.  

It is rare for men to get breast cancer, but it does happen. Men account for about 1 in 100 breast cancers diagnosed in the U.S. The symptoms for men are similar to those for women. Also, breast cancer treatments are the same in men as in women—it depends on the type of cancer, the size of the tumor and how far cancer cells have spread to other parts of the body.  

Signs of breast cancer include a lump or change in the breast. Talk with your health care provider if you have any of the following: 

• a lump or thickening in or near the breast or in the underarm area 

• a change in the size or shape of the breast 

• a dimple or puckering in the skin of the breast 

• dimples in the breast that look like the skin of an orange 

• a nipple turned inward into the breast 

• fluid, other than breastmilk, from the nipple, especially if it's bloody 

• the skin on the breast, areola, or nipple is scaly, red or swollen. 

Early breast cancer usually does not cause pain. However, if you have pain that does not go away, call your health care provider to discuss your symptoms. 

About 5-10 percent of breast cancers are hereditary. This means they are caused by certain genes that run in families. Hereditary risks for breast cancer include: 

• Blood relatives who developed breast cancer before age 50 

• Ashkenazi Jewish ancestry 

• Both breast and ovarian cancer on the same side of the family 

• Other cancers in your family including prostate, melanoma, pancreatic and colon 

• A man in your family has been diagnosed with breast cancer 

Learn how genetic counseling can help you identify your hereditary risks for breast cancer.