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The main treatments for breast cancer patients are surgical removal of tumors, radiation therapy, chemotherapy and, possibly, reconstructive surgery.
General surgeons and plastic surgeons form the core of the patient's surgical team and work together to provide the best care. After the cancer has been removed, Mayo Clinic pathologists and/or radiologists immediately evaluate the tissue and report results directly to the surgeon while the operation is still under way. Direct, face-to-face contact with the pathologist allows the surgeon to verify the tumor's margin (edges) and other important pathology details.
Mayo Clinic offers a full range of the latest surgical techniques and procedures to treat breast cancer. Physicians at Mayo Clinic treat a large volume of patients, performing approximately 750 surgeries for breast cancer per year. Research has demonstrated that patients who have breast cancer treatment at high-volume-centers have better outcomes. Mayo Clinic's state-of-the-art equipment, facilities and research activity also play a role in successful diagnosis and treatment of breast cancer. This research includes current clinical trials in two new surgical approaches to breast cancer: radioactive seed localization and MR-focused ultrasound ablation of tumors.
Surgical options available at Mayo Clinic include lumpectomy, simple or total mastectomy, modified radical mastectomy, skin-sparing mastectomy and sentinel lymph node biopsy. Patients may also be evaluated for prophylactic mastectomy. Patients diagnosed with breast cancer often can be scheduled for surgery the next day, if desired. Surgeons provide patients with individualized information to help them decide which treatment is best for them.
Frozen sections. Mayo Clinic has the benefit of its unique frozen section pathology lab, which allows for rapid and accurate microscopic analysis of tissue while a patient is still in the operating room. This capability allows doctors to know whether they have removed all of the cancer (achieved negative margins) within minutes of removing the tissue. Without frozen section analysis, determining whether all of the cancer has been removed may take days, causing a patient to undergo multiple surgeries. Mayo Clinic physicians routinely use frozen section evaluation of tissue during breast cancer surgery to avoid the need for additional surgeries.
Localization. When a breast tumor that shows up on a mammogram cannot be felt, a process called localization is used to pinpoint the location of the tumor for the surgeon. Before surgery, a radiologist uses either mammography or ultrasound to insert a fine wire that the surgeon follows to locate and remove the targeted area. An alternative involves use of a wire to place a radioactive seed the size of a grain of rice at the tumor site. This "seed" is a metal capsule that contains a small amount of radioactive material. In the operating room, the surgeon can find the seed with a hand-held Geiger counter. This procedure, currently available through clinical trials, can reduce the surgery time because the seed can be placed a day or more before the scheduled surgery.
Evaluation of lymph nodes. If breast cancer spreads, it usually spreads first to the axillary lymph nodes located under the arm. Therefore, when an invasive cancer is found in the breast, the surgeon will recommend removing some underarm lymph nodes to see if the cancer has spread. Surgeons at Mayo Clinic use three procedures to evaluate the lymph nodes, including sentinel lymph node biopsy, fine needle aspiration and axillary lymph node dissection. Fine needle aspiration may be performed before surgery if lymph nodes appear abnormal by ultrasound exam. Axillary lymph node dissection is performed when it is known that cancer has spread to the lymph nodes. The majority of all patients with breast cancer are unlikely to have cancer in the lymph nodes, and for this group sentinel lymph node biopsy is the recommended procedure.
Breast reconstruction after cancer surgery is feasible in some cases. Surgical options offered at Mayo Clinic include reconstruction with implants and reconstruction using the patient's own tissue (autologous reconstruction) including TRAM surgery, DIEP surgery, SIEA surgery, and reconstruction of the nipple and areola.
A Mayo physician may recommend chemotherapy (drugs) following surgery to kill any cancer cells that may have spread outside the breast. These drugs may be administered intravenously, in pill form or both. Chemotherapy may also be recommended before surgery when the breast tumor is large (having a diameter greater than 5 cm), when the tumor is attached to the chest wall muscles, and in cases of inflammatory breast cancer.
Most patients receive chemotherapy after they heal from the operation and prior to radiation. The physician chooses the chemotherapy drugs and sequence of treatment based on the details of each case. In some cases, the chemotherapy may be given before surgery (but after a biopsy) to try to shrink the tumor, allowing for a simpler and possibly more effective operation.
Mayo Clinic researchers conduct many clinical trials to find drug combinations and treatment sequences that result in improved outcomes for patients who have breast cancer. Physicians talk with many patients about participating in a clinical trial.
Radiation therapy uses high energy X-rays to kill cancer cells and shrink tumors. An oncologist will likely recommend radiation if treatment includes a lumpectomy, or if at the time of the mastectomy the size of the tumor is greater than 5 centimeters and/or multiple lymph nodes contain cancer cells. Those who undergo radiation consult with a radiation oncologist prior to the start of treatment.
Hormone therapy involves taking drugs that block estrogen from reaching breast cells to reduce the chance that cancer will recur. Hormone therapy may be appropriate if the cancer cells are sensitive to hormones. Mayo researchers conduct many clinical trials on hormone therapy, and patients may be offered the opportunity to participate.
For premenopausal women whose tumor is sensitive to hormones, one form of hormonal therapy stops the hormone production in the ovaries. Options include surgical removal of the ovaries or medications that stop estrogen production. This approach may then be combined with pills that further help to reduce estrogen production. Several clinical trials are available to further study this treatment.
Mayo's clinical trials include experimental treatments, often unavailable elsewhere, which frequently lead to improved patient care for people worldwide. Mayo offers many experimental therapies, including Herceptin therapy. A Mayo physician can advise about experimental treatments.
In addition to these standard procedures, Mayo Clinic offers patients the opportunity to participate in the Familial Cancer Program, which helps to identify people at higher risk for breast cancer related to family history. A team of nurses, doctors and geneticists evaluate the patient and family. They determine risk potential cancer risk and develop a customized cancer screening plan for families at increased risks. Consultations in the Familial Cancer Program are offered to those who have been diagnosed with cancer and to family members who have not had cancer.
The Mayo Clinic Women's Cancer Program works to understand and manage breast and gynecological malignancies. Multidisciplinary teams in the Women's Cancer Program work together to identify the genetics associated with women's cancers, define the biology of women's cancers, better identify women at increased risk for breast and gynecologic cancers, and develop and test innovative treatment of women's cancers.
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