Treatment is Based in Part on the Type of Breast Cancer
At Northwest Cancer Centers, the care team creates breast cancer treatment plans based on the type, stage, and hormone receptor status. For invasive breast cancers, patients are likely to need a combination of a few of the following cancer treatments:
Learn more about breast cancer treatments.
- Breast cancer surgery such as lumpectomy or mastectomy
- Radiation therapy
- Hormone therapy
- Targeted therapy
How Is Breast Cancer Diagnosed?
Most women, starting by age 40, should have an annual mammogram to screen for breast cancer. A clinical breast exam is also an important part of screening. During an in-office breast exam, both of your breasts are checked by your doctor — usually a gynecologist. This may include raising your arms over your head, letting them hang by your sides, or pressing your hands against your hips.
In addition to looking for differences in size or shape between your breasts, your doctor will check your breasts' skin for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid. If your doctor detects something abnormal during a breast exam, further tests are needed to make an accurate diagnosis.
What is a Mammogram?
A mammogram is an x-ray picture of tissues inside the breast. They can show a breast lump before it can be felt. If something is identified by the radiologist who reviews the images, your doctor will recommend additional testing. In some cases, it’s simply calcifications, but it’s important to find out.
Women should get regular screening mammograms to detect breast cancer early— even before they have symptoms. According to the American Cancer Society:
- Women between the ages of 40 to 44 have the choice to start yearly mammography
- Women aged 45 to 54 are recommended to receive a mammogram every year
- Women age 55 and older can switch to having a mammogram every two years or continue yearly screening if they choose
Women under the age of 40 who have risk factors for breast cancer should ask their health care provider about when to start mammograms.
Some doctors will also recommend a baseline mammogram at age 35, so they can compare future mammograms to one when you were younger.
Breast Biopsy & Lymph Node Biopsy
If an abnormal area is found during a diagnostic mammogram or breast MRI, you will likely need a biopsy. A biopsy is the removal of tissue from the breast to determine if the unusual area contains cancer cells. It is the only way to tell for sure if cancer is present.
The breast surgeon removes fluid or tissue from your breast using a thin needle. This is a short, outpatient procedure. A pathologist will check the tissue or fluid removed from your breast for cancer cells as well as hormones and the cell pattern to determine the type. From this, the pathologist will produce a report that the oncologist will use to create a personalized breast cancer treatment plan.
Sentinel Lymph Node Biopsy
There is often a lymph node biopsy performed at the same time as cancer removal surgery. Not only will the surgeon remove the breast cancer tumor, but they will also test to see if there are cancer cells in the lymph nodes near the breast.
The surgeon injects a radioactive substance and/or a blue dye near the tumor to locate the position of the closest lymph node to the area of concern. This is called the “sentinel lymph node.” Once the sentinel lymph node is found, the surgeon makes a small incision in the overlying skin and removes the node to test it for cancer cells. If the results come back showing that cancer is present in the lymph node, the treatment plan will be adjusted to target cancer cells that may have moved through the body via lymph fluid.
Determining Hormone Receptors and HER2 Status
If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed, including:
- Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option.
- HER2 test: HER2 is a protein found in or on some breast cancer cells that fuels growth and can make breast cancer spread quicker. If the test shows you are HER2 positive, a special drug targeting the HER2 protein is recommended.
All of these diagnostic tests may not happen at once. It can sometimes take a few weeks to get all of the information needed to fully develop the treatment plan for your type of breast cancer. However, this doesn’t mean the treatment will necessarily be put on hold. Most oncologists recommend a treatment plan that begins shortly after diagnosis to begin the process of shrinking the breast tumor.
Hormone Status and Breast Cancer
In addition to understanding the type of breast cancer and the stage, it’s critical that your oncologist knows which hormones, if any, are involved in the growth of the breast cancer. The results play a role in creating the best treatment plan for you.
The hormone receptor status of your breast cancer refers to whether your breast cancer cells are fueled by estrogen and/or progesterone, naturally occurring hormones in both women and men. Due to special proteins inside the tumor cells, called hormone receptors, the hormones attach to the tumor cells and fuel the cancer’s growth.
Breast cancer patients are given either hormone receptor status that is either hormone receptor (HR) positive or hormone receptor (HR) negative:
- Hormone receptor-positive breast cancer means that the cancer cells have the protein in or on them that attracts estrogen, progesterone, or both hormones.
- Hormone receptor-negative breast cancer means that no estrogen or progesterone receptors are present. These types of cancers will not benefit from hormone therapy drugs and typically grow faster than HR-positive cancers.
Hormone Receptor Categories of Breast Cancer
Your oncology team will run tests and give you at least one of the following hormone receptor categories: