Health for Self Newsletter

This part 3 of 3 in the Breast Cancer Series.

Treatment of breast cancer includes the input of surgeons, pathologists, oncologists and radiologists.

Atypical Ductal Hyperplasia

Treatment for such a diagnosis usually requires a lumpectomy to ensure no cancerous cells are present.  After the lumpectomy, the patient must decide with their physician if they will take Tamoxifen. Tamoxifen is an estrogen blocker that has been shown to reduce the risk of breast cancer in patients who took the drug for five years as demonstrated by the Breast Cancer Prevention Trial.  The risks/side effects include vaginal dryness, hot-flashes, blood clots, and an increased risk of cervical cancer that is easily detected and removed.

Lobular Carcinoma in Situ
A diagnosis of LCIS is usually treated with observation after biopsy.  However, tamoxifen has been shown to decrease the risk of developing breast cancer  who were on the drug for 5 years as well.  Even mastectomy in patients who are at an increased risk for breast cancer (BRCA1 and BRCA2 gene mutations) is considered too invasive in patients with this diagnosis.

Ductal Carcinoma in Situ
First step in treatment will be a lumpectomy which should the only surgical treatment needed if the mass is small, has clean margins, and the DCIS cells are a non-aggressive type (non-comedo).  Lumpectomy and radiation is another option in order to reduce the chance of the DCIS recurring.  Radiation is more often used for larger tumors or more aggressive forms of DCIS.  A third choice of treatment is lumpectomy and tamoxifen. Again, tamoxifen has been shown to reduce the chance of recurrence of DCIS after lumpectomy.  Finally, mastectomy will usually be considered in candidates who have a large tumor of DCIS, multiple areas that contain DCIS cells, the lumpectomy has negative margins (cancer located at the periphery of the removed tissue), or you are at an increased risk for breast cancer (BRCA1 and/or BRCA2 gene mutation carrier)

Invasive/Infiltrating Carcinomas
In these cases, mastectomy is usually the standard treatment.  However, a sentinel lymph node biopsy is recommended in most cases.  A sentinel lymph node biopsy entails the first drainage lymph node to be removed in order to determine if it has cancerous cells.  If it does contain cancerous cells, then an axillary lymph node dissection will be required (you lymph nodes located in your armpit will have to be removed).  If the sentinel lymph node biopsy is negative, you do not need such an invasive procedure.  After mastectomy, most patients will under go radiation, chemotherapy, and also tamoxifen for 5 years.

Though the diagnosis if breast cancer is terrifying, it is a very treatable disease if caught in time. Thus, the importance of yearly mammograms cannot be stressed enough.

Of course, you should always speak to your physician if you have any questions regarding breast cancer.