At Mayo Clinic, breast cancer specialists provide personalized, whole-person care to those with breast cancer. Treatment options may include surgical removal of tumors, radiation therapy, chemotherapy and reconstructive surgery.
At Mayo Clinic, breast surgeons and plastic surgeons work together to provide the best care for each person with breast cancer.
The multidisciplinary team may include:
If surgery is the most appropriate treatment option, breast surgeons remove the cancer and specialists in pathology and radiology evaluate the tissue immediately. They report results directly to the surgeon. On-site communication and contact allow the surgeon to verify the tumor's edges (margins) and other details with the pathologist while the surgery is still underway.
Mayo Clinic offers a full range of the latest surgical techniques and procedures to treat breast cancer.
At Mayo Clinic, surgeons provide individualized information, work with you to determine the appropriate treatment and provide timely surgical care.
Surgical options for breast cancer treatment include:
Some people may be evaluated for prophylactic mastectomy — a procedure that reduces the risk of developing breast cancer.
Mayo Clinic surgeons perform many breast cancer operations every year. Research shows that people who are treated for breast cancer at medical centers that treat many cases of breast cancer have better outcomes than do people treated at medical centers that treat breast cancer less frequently.
Mayo Clinic's state-of-the-art research facilities and equipment also help ensure the most appropriate diagnosis and treatment for people with breast cancer. Learn more about cancer research at Mayo Clinic, including clinical trials for new surgical approaches to breast cancer treatment.
Frozen section analysis
Mayo Clinic doctors may use frozen section evaluation of tissue during breast cancer surgery to determine whether all of the cancer has been removed.
Mayo Clinic's unique frozen section pathology laboratory provides rapid, accurate microscopic analysis of tissue during surgery. Mayo Clinic surgeons know if they have removed all of the cancer (achieved negative margins) while you're still in the operating room.
Frozen section analysis may prevent the need for additional surgery.
Localization may be used to pinpoint the location of a breast tumor that appears on a mammogram but can't be felt. In localization, a radiologist uses mammography, ultrasound or MRI to insert a fine wire into the tumor site. During surgery, the surgeon follows the wire to locate and remove the targeted area.
As an alternative, a metal capsule that's about the size of a grain of rice and contains a small amount of radioactive material may be placed at the tumor site. The capsule may be placed a day or more before the operation. The surgeon locates the capsule with a hand-held radioactivity detection device and removes the targeted area.
Evaluation of lymph nodes
If breast cancer is invasive, it usually spreads first to the lymph nodes in the armpit (axillary lymph nodes). When an invasive cancer is found in the breast, the surgeon will recommend removing some axillary lymph nodes to confirm whether the cancer has spread.
Surgeons at Mayo Clinic use several procedures to evaluate lymph nodes:
- Fine-needle aspiration, which is removal of body tissue through a thin, hollow needle. This may be performed before surgery if lymph nodes appear abnormal on ultrasound.
- Sentinel node biopsy, which is recommended for the majority of people with breast cancer who are unlikely to have cancer in the lymph nodes.
- Dissection, which is surgical removal of the axillary lymph nodes. This may be performed when the cancer is known to have spread to the lymph nodes.
Breast reconstruction after cancer surgery is an option for most women undergoing mastectomy. Surgical options offered at Mayo Clinic include reconstruction with implants and autologous reconstruction, which uses your own tissue.
Reconstruction options include:
- Breast implant surgery
- TRAM surgery
- Free TRAM surgery
- Muscle-sparing msTRAM surgery
- DIEP surgery
- SIEA surgery
- Gluteal flap surgery
- Reconstruction of the nipple and areola
Learn more about breast reconstruction with flap surgery and breast reconstruction with breast implants.
After surgery, Mayo Clinic specialists may recommend treatment using drugs (chemotherapy) to kill cancer cells that may have spread outside the breast. The drugs are usually administered into a vein (intravenously).
Chemotherapy may be recommended before surgery if the breast tumor is large, the lymph nodes are involved or the tumor is attached to the chest wall muscles.
Chemotherapy may also be recommended in cases of inflammatory breast cancer.
Most people receive chemotherapy after they've healed from the operation and before they receive radiation. Mayo Clinic doctors choose the chemotherapy drugs and sequence of treatment based on the details of your tumor characteristics.
Mayo Clinic researchers conduct many clinical trials to find drug combinations and treatment sequences that result in improved outcomes for people with breast cancer. Mayo Clinic specialists often talk with eligible people about participating in clinical trials.
Radiation therapy involves the use of high-energy X-rays to kill cancer cells and shrink tumors. People who undergo radiation therapy consult with a radiation oncologist before treatment begins.
Radiation may be recommended if:
- Breast cancer treatment includes a lumpectomy
- The invasive tumor is more than 5 centimeters in size at the time of the mastectomy
- Many lymph nodes contain cancer cells
Hormone therapy refers to the use of drugs that either block estrogen from reaching breast cancer cells or reduce the amount of estrogen the body produces to help reduce the risk of cancer recurrence.
- Drugs such as tamoxifen and fulvestrant (Faslodex) block estrogen from reaching breast cancer cells.
- Aromatase inhibitors reduce the amount of estrogen the body produces.
Hormone therapy is most effective for people whose tumor cells produce (express) the estrogen receptor. Hormone therapy is not recommended for people who have tumors that are estrogen negative.
For premenopausal women with tumors that are sensitive to hormones — estrogen receptor or progesterone receptor positive — medications or removal of the ovaries (oophorectomy) may be recommended to prevent cancer recurrence.
Mayo Clinic researchers conduct many clinical trials on hormone therapy. Mayo Clinic specialists often talk with eligible people about the opportunity to participate in clinical trials.
Mayo Clinic recommends postmenopausal women undergo testing for the gene CYP2D6 before beginning tamoxifen for breast cancer treatment. This gene creates an enzyme in the liver that converts tamoxifen into a more potent form of the drug (endoxifen). For women who have absent or reduced CYP2D6 activity, tamoxifen may be less effective and other medications should be considered. Drugs that might reduce the activity of CYP2D6 should also be discontinued.
Biological and other therapies
Mayo Clinic offers many other therapies, including lapatinib (Tykerb) and trastuzumab (Herceptin) — a drug often used to treat breast cancers that produce an abnormal amount of human epidermal growth factor receptor 2 (HER2).
Familial Cancer Program
Mayo Clinic offers people with breast cancer the opportunity to participate in its Familial Cancer Program, which helps identify people at increased risk of breast cancer related to family history.
In the program, a team of doctors, genetic counselors and nurses evaluates individuals seeking care and their families to determine potential cancer risk. The team develops a customized cancer-screening plan for families who have increased risks of developing cancer. Consultations are offered to people who have been diagnosed with cancer and to family members who haven't had cancer.
Women's Cancer Program
The Mayo Clinic Women's Cancer Program helps women understand and manage breast and gynecological malignancies. Multidisciplinary teams of physicians and other professionals in the Women's Cancer Program work to:
- Identify the genetics associated with women's cancers
- Define the biology of women's cancers
- Better identify women at increased risk of breast and gynecological cancers
- Develop and test innovative treatment of women's cancers
The Women's Cancer Program at Mayo Clinic brings together doctors and researchers in breast and gynecological surgery, medical and radiation oncology, medical genetics, pathology, and other specialties to develop new therapies for women's cancers. As part of the Mayo Clinic Cancer Center, the Women's Cancer Program offers access to potential new therapies through clinical trials. The Women's Cancer Program also provides emotional and social support classes, a resource center, and educational programs for women and their families.
Mayo Clinic has cancer survivorship clinics specifically designed to help people who have survived breast cancer return to a normal life and develop plans for monitoring their health beyond breast cancer.
Aug. 16, 2016