A breast cancer diagnosis doesn’t have to be devastating. Breast cancer survival rates have climbed significantly and breast cancer survivors now represent the largest number of cancer survivors in the country. Options for therapy are improving your choices and minimizing the disruption you’ll experience during treatment. At UC San Diego Health, we're pioneering new technologies, new therapies and new approaches, and our patients have first access to them.
Most important, we understand that breast cancer is not a single disease. Our physicians and researchers keep current on innovative ways to identify and treat your particular breast cancer, and we discuss every patient during our weekly Breast Conference with the entire medical team.
Your Treatment Plan
We make every effort to see new patients within a few days of diagnosis. You will usually first meet with a surgical team member to discuss what our pathologists have found out about your cancer and review recommendations and options for treatment. Many factors are analyzed, including:
- Size and location of the lesion
- Biopsy results (cancer cell composition, stage and constitution)
- Involvement of lymph nodes
- Type of cancer and how aggressive it is
It is at this point that surgical options are discussed. Many patients may be candidates for breast conservation instead of a mastectomy. Some patients may qualify for pre-surgical clinical trials that are testing ways to diminish tumors before surgical removal.
Types of Treatment
Approaches to breast cancer surgery are becoming less invasive and far less radical than former standards of care. Breast cancer surgery often can be accomplished through a lumpectomy or segmental mastectomy (removal of only the affected tissue), allowing breast conservation. It's also possible to combine lumpectomies with breast reduction surgery.
Our surgeons are also expert in a procedure called
sentinel node biopsy, which involves finding and removing the first lymph node to which a tumor is likely to have spread. This "sentinel" node is quickly biopsied to determine whether lymph nodes need to be removed during surgery.
For patients who require a mastectomy (removal of the entire breast), there are new techniques in reconstructive surgery to restore the breast’s appearance. Surgery can reconstruct a breast, including the size, shape, nipple and areola (shaded skin surrounding the nipple). The surgery often can be performed immediately following the mastectomy, while you are still sedated, and is performed by a qualified plastic surgeon. This approach usually provides a better outcome and eliminates a subsequent operation and the additional recovery process. For more information, see
After surgery, we will have more definitive results and a better profile of your disease. For more information on follow-up care or further treatment, see
After Breast Surgery and the treatment options below.
Radiation therapy is recommended for many patients with breast cancer to reduce the risk of cancer recurrence and improve patient survival. The specific radiation treatment plan that your medical team will recommend will depend on your particular situation. The radiation oncologists at Moores Cancer Center offer among the best care in the nation because of their level of specialized medical expertise, engagement with the scientific community and access to advanced technologies, such as AccuBoost and prone breast treatment. With our strengths, we are able to offer our patients the safest and most targeted treatments, sometimes earlier than most other cancer centers. We were, for example, one of the nation's first centers to offer high dose rate brachytherapy via the SAVI applicator, a device that delivers precisely targeted doses of radiation to tissues surrounding a lumpectomy cavity while minimizing radiation to healthy tissue. We remain one of the busiest and most diverse brachytherapy programs in the country. For more information, see Radiation Therapy for Breast Cancer.
Medical Therapy: Chemotherapy, Endocrine Therapy, Immunotherapy, Biologic Therapy
Medical therapy does not always mean chemotherapy delivered via infusion. Many medications can be taken at home, and may include endocrine therapy, immunotherapy, or biologic therapy.
If you do need infusion therapy, which is a course of drugs delivered intravenously, you’ll come to our dedicated infusion center for breast cancer patients at Koman Family Outpatient Pavilion. You’ll see windows overlooking canyons and comfortable chairs that let you put up your feet as you read a book, chat with a family member or talk to other patients. The center provides snacks or you can bring your own luncheon with you or purchase something from the coffee cart.
Infusion Center nurses can equip you with a central catheter line for your safety and convenience. If you’re having regular treatment or need frequent blood draws, this option may be more comfortable and efficient for you.
Our understanding of breast cancer, including how genetics contribute to the disease, is advancing rapidly. We now use genetic testing to predict who will respond to a certain treatment. The goal is to match each patient with the best drug for a particular tumor. (For more about this process, see Moores Cancer Center's
Personalized Cancer Therapy.)
Over the last decade, researchers have been studying the changes in cancer cell DNA, identifying extra copies of genes (known as amplification), in particular a gene called HER2 (human epidermal growth factor receptor-2) that controls how cells grow, divide and repair themselves. Knowing specific profiles of cancer cells can signal clinicians about the optimal treatment approaches to take.
UC San Diego Health has been integrally involved in the development of Herceptin, a targeted therapy that’s demonstrating dramatic effectiveness in curing localized HER2-overexpressing breast cancer.
Dr. Richard Schwab, a UC San Diego oncologist, puts it: “We are changing the natural history of breast cancer by identifying specific changes and providing individual care.”
In addition to standard approaches to treating your breast cancer, you may qualify for a clinical trial, which is a final stage of research that involves patient participation in the most promising therapies and advanced technologies. Your provider will advise you if you qualify for one or more of the studies currently being conducted. For more information, see
Research and Clinical Trials.
Weekly Breast Conferences (Tumor Board)
One of the hallmarks of treatment at UC San Diego Health is the weekly Breast Conference, also called Tumor Board, a meeting of the minds of breast cancer clinicians who review each breast cancer case in depth.
This is where the entire medical team – radiologists, pathologists, surgeons, medical oncologists, radiation oncologists and advanced practice providers – collaborate to review and discuss findings and options, reviewing individual cases and sharing opinions and information.
“Breast cancer is a complicated disease,” said
Anne Wallace, M.D., FACS, surgical oncologist, reconstructive surgeon and director of the Comprehensive Breast Health Center. “It’s easy to miss something. Each patient needs a lot of time and a lot of expertise.”
Wallace believes that these multidisciplinary case reviews provide patients with the most comprehensive and circumspect evaluation and monitoring of their individual case, resulting in optimal care through integration of the clinical care team.
In addition, the physicians also have a monthly Breast Research Conference with the Clinical Trials Office, where they discuss clinical trial progress and new clinical trials they want to bring to UC San Diego Health patients.