Breast cancer is cancer in the cells of the breast. It is most commonly diagnosed on screening mammograms in women without symptoms.
Early breast cancer detection with screening mammograms, combined with a better understanding of the different types of breast cancer and the availability of targeted treatments, have significantly improved our diagnosis, treatment and survival rates. You don’t have to let a breast cancer diagnosis stop you from living your extraordinary life.
Breast cancer: learn more
Providing better breast cancer care
Early breast cancer detection with screening mammograms, combined with a better understanding of the different types of breast cancer and the availability of targeted treatments, have significantly improved our diagnosis, treatment and survival rates.
You don’t have to let a breast cancer diagnosis stop you from living your extraordinary life.
Expert diagnosis and treatment at UCHealth
If you are concerned about possible symptoms like a lump in your breast, our breast imaging specialists will promptly perform a diagnostic evaluation that may include a mammogram and ultrasound.
If you have already been diagnosed with breast cancer and have been referred to us, our multidisciplinary breast cancer team is ready to help.
Breast cancer: what you should know
Breast cancer is the second-most common cancer diagnosis in women, affecting more than 260,000 women in the U.S. every year.
There are several risk factors for breast cancer, although many women who develop breast cancer have no known risk factors. Regular screening mammography helps detect a breast cancer at an early, treatable, and curable stage. Breast cancer survival rates continue to improve, with 5-year survival over 90%.
If you are concerned about possible symptoms like a lump in your breast, our breast imaging specialists will promptly perform a diagnostic evaluation that may include a mammogram and ultrasound. Our breast cancer specialists have deep experience to accurately diagnose your case.
If you have already been diagnosed with breast cancer and have been referred to us, our multidisciplinary breast cancer team is ready to help. Our program has experts in breast surgery, medical oncology, radiation oncology as well as plastic surgery who dedicate their practices to treating breast cancer. We also offer integrative medicine specialists who can incorporate options such as massage therapy, acupuncture, and exercise consultation into your personalized treatment plan.
Signs and symptoms of breast cancer
The earlier breast cancer is found and diagnosed, the better your chances of beating it. Start including a breast self-exam in your monthly health care routine, and if you’re over 40 or at a high risk of breast cancer, get an annual mammogram and physical exam by your doctor. If you experience breast changes at any time, see your doctor right away.
Breast cancer symptoms vary widely, and some breast cancers have no obvious symptoms at all—a lump may be too small for you to feel, or to cause any unusual changes you can notice on your own. That’s why regular checkups and mammograms are so important.
Usually the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard and has uneven edges is more likely to be cancer, but cancers can be tender, soft, and rounded.
According to the American Cancer Society, any of the following unusual changes in the breast can be a symptom of breast cancer:
- Breast pain, usually present in the case of inflammatory breast cancer.
- Lump in the underarm area.
- Nipple discharge other than breast milk.
- Nipple pain or the nipple turning inward.
- Redness, scaliness or thickening of the nipple or breast skin.
- Skin irritation or dimpling.
- Swelling of all or part of the breast.
If you notice any of these, come see us for an exam right away.
Breast cancer: questions and answers
For most patients, we are not able to pinpoint what caused their breast cancer. Although we have identified hormonal, lifestyle and environmental factors that can increase the risk of breast cancer, some people with these risk factors never develop it while some people who have no risk factors do develop it. Only about 10% of breast cancers are hereditary.
We estimate that 5% to 10% of breast cancers are linked to gene mutations passed through generations of a family. The most well-known mutations are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast, ovarian cancer, and other cancers. If your family has a history of breast cancer or other cancers, you should consider getting a blood test to help identify specific mutations in BRCA or other genes. Your primary care provider can give you a referral to a genetic counselor who can discuss the benefits, risks and limitations of genetic testing.
- A family history of breast cancer and certain inherited genes
- A personal history of breast conditions or breast cancer
- Being female
- Beginning menopause at an older age
- Beginning your period before age 12
- Dense breasts
- Drinking alcohol
- Having never been pregnant
- Having your first child after age 30
- Increasing age
- Postmenopausal hormone therapy
- Radiation exposure in childhood or young adulthood
- Ductal carcinoma in situ (DCIS)
- Invasive ductal cancer
- Invasive lobular carcinoma
- Lobular carcinoma in situ (LCIS) – this is not breast cancer
- Male breast cancer
- Paget’s disease of the breast
- Rare types: Angiosarcoma
- Recurrent breast cancer
- Special types:
You should get regular screening mammograms. Regular mammograms are recommended to help find breast cancer before you can even feel a lump. It is important to be aware of what your normal breast feels like and to note any changes. If you have any concerns, your provider can perform an exam to check for breast cancer.
Almost always not. However, some types of breast cancer can cause pain in the early stages in lumps, nipples, lymph nodes or general pain.
For all stages of breast cancer combined, the 5-year relative survival rate is 90%. For localized only where cancer has not spread outside the breast, the 5-year relative survival rate is 99%.
Source: American Cancer Society
If you are at an average risk for breast cancer, you can help reduce your risk with these steps:
- Eat a healthy Mediterranean diet.
- Exercise most days of the week (at least 30 minutes of moderate exercise 5 days per week).
- Limit or avoid alcohol.
- Limit postmenopausal hormone therapy.
- Maintain a healthy weight.
If you are at a high risk, talk to your doctor about these options:
- Enhanced screening. Some women at higher risk for breast cancer can consider supplementing their annual mammogram with an annual MRI or other advanced imaging technologies.
- Preventive medications (chemoprevention).
- Preventive surgery. You may choose to have your healthy breasts removed (prophylactic mastectomy), and to have your healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer. These preventive surgeries are typically only considering for women with known hereditary cancers.
Yes, but it is far less common than in women. The lifetime risk for men is about 1 in 833.
Source: American Cancer Society
Breast cancer diagnosis and staging
Leading-edge technology means better diagnostic accuracy
Because no two people develop breast cancer in the same way, we offer a wide array of leading-edge technology to properly evaluate your situation. We use that information to create personalized treatment options. Any combination of these tests and procedures helps us diagnose and classify (stage) cancer:
Breast ultrasound. Uses sound waves to make an image of areas inside the body; shows whether a lump is solid or a fluid-filled cyst. Ultrasound can be used to evaluate the breast tissue as well as the lymph nodes in the armpit area.
Mammogram. A form of X-ray that examines breast tissue for abnormal areas. Digital mammography is faster and uses less radiation than film mammography, and it records images directly to a computer, which means images can be stored and sent electronically so your entire care team can view them. Digital mammograms are generally more effective at detecting cancer in younger women, women with dense breasts, and pre-menopausal women. 3-D mammography, available at UCHealth since 2012, creates three-dimensional images of the breast and helps find cancers that may be missed by other devices
MRI (magnetic resonance imaging). Uses a magnetic field instead of X-rays to provide detailed images of body structures. For women with high genetic risk of breast cancer, screening trials show that combining breast MRI with mammography is the most effective way to find breast tumors.
We remove cells or tissues for viewing under a microscope to check for signs of cancer. The types of biopsy used to diagnose breast issues include:
- Fine needle aspiration (FNA). We remove individual cells for viewing under a microscope. Often, you receive the results for this test at UCHealth on the same day you visit our clinic.
- Core biopsy. We remove a tissue sample about the size of pencil lead. Results typically take two to five days. Core needle biopsy is the preferred biopsy technique to evaluate abnormal findings on a mammogram or ultrasound.
- Excisional biopsy. Surgical removal of a tissue sample from an area in question. Results typically take five to seven days. Excisional biopsies are rarely performed as the first step since needle biopsies provide highly accurate information and are less invasive than surgery.
- Genetic test. We analyze a sample of blood or saliva. This helps us detect BRCA 1 and BRCA 2 early.
Staging. Once you have been diagnosed with breast cancer, our specialists need to know where it may have spread. This is the “stage” of the cancer. The lower the number, the less it has spread. Knowing the stage allows your medical team to determine the best possible treatment plan for you.
The stages of breast cancer
UCHealth follows the American Joint Committee on Cancer (AJCC) cancer staging system. The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This ensures that the results of treatment for all people can be compared and understood.
Your doctor will determine the stage of your cancer. Breast cancer staging looks at the size of the tumor in the breast and whether it has traveled to lymph nodes or other parts of the body. More recently, staging includes looking at the grade of the tumor and the biology of the tumor. Every breast cancer is examined for estrogen and progesterone receptors and HER2/neu. These receptors provide important information about the prognosis of the breast cancer and allowed a more personalized and tailored treatment.
Non-invasive breast cancers, such as ductal carcinoma in situ (DCIS). There is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started or getting through to or invading neighboring normal tissue.
Invasive breast cancer where cancer cells are breaking through to or invading normal surrounding breast tissue. Stage I is divided into subcategories IA and IB.
- IA: the tumor measures up to 2 cm and the cancer has not spread outside the breast; no lymph nodes are involved.
- IB: there is no tumor in the breast; instead, small groups of cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes, or there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells—larger than 0.2 mm but not larger than 2 mm—in the lymph nodes.
Stage II is invasive breast cancer, and is divided into subcategories IIA and IIB.
- IIA: no tumor can be found in the breast, but cancer—larger than 2 mm—is found in one to three axillary lymph nodes or in the lymph nodes near the breast bone; the tumor measures 2 cm or smaller and has spread to the axillary lymph nodes; the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes. Other factors may apply.
- IIB: the tumor is larger than 2 cm but no larger than 5 centimeters; small groups of breast cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes; the tumor is larger than 2 cm but no larger than 5 cm; cancer has spread to one to three axillary lymph nodes or to lymph nodes near the breastbone; the tumor is larger than 5 cm but has not spread to the axillary lymph nodes. Other factors may apply.
Stage III is invasive breast cancer, and is divided into subcategories IIIA, IIIB, and IIIC.
- IIIA: no tumor is found in the breast or the tumor may be any size, and cancer is found in four to nine axillary lymph nodes or in the lymph nodes near the breastbone; the tumor is larger than 5 centimeters cm; small groups of breast cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes and the tumor is larger than 5 cm; cancer has spread to one to three axillary lymph nodes or to the lymph nodes near the breastbone. Other factors may apply.
- IIIB: the tumor may be any size and has spread to the chest wall and/or skin of the breast and caused swelling or an ulcer and may have spread to up to nine axillary lymph nodes, or may have spread to lymph nodes near the breastbone. Other factors may apply.
- IIIC: there may be no sign of cancer in the breast, or if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast and the cancer has spread to 10 or more axillary lymph nodes; the cancer has spread to lymph nodes above or below the collarbone; the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone. Other factors may apply.
Cancer has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.
Source: American Cancer Society
Types of tumors
As part of your testing, you’ll be checked to see if your breast cancer cells have “hormone receptors” — proteins that receive signals that tell the cancer cells to grow — for the two hormones estrogen and progesterone. Breast cancer cells can contain receptors for one, both, or neither of these hormones.
- Estrogen receptor. If the breast cancer has receptors for estrogen, it’s called estrogen receptor positive (or ER positive.) If the breast cancer doesn’t have receptors for estrogen, it’s called estrogen receptor negative (or ER negative.)
- Progesterone receptor. If breast cancer has receptors for progesterone, it’s called progesterone receptor positive (or PR positive.) If breast cancer doesn’t have receptors for progesterone, it’s called progesterone receptor negative (or PR negative.)
Breast cancer that has one or both receptors is called hormone-receptive positive (also called hormone-positive or HR+). Breast cancer that contains neither the estrogen nor the progesterone receptor is called hormone-receptor negative (also called hormone-negative or HR-).
Treatments. For ER positive, HR positive or breast cancer that’s positive for both estrogen and progesterone receptors, treatment could include hormone therapy — drugs that lower estrogen levels or block estrogen receptors. For HR negative, ER negative and PR negative breast cancers, hormone therapy drugs are not effective treatment. Instead, treatments including surgery, radiation therapy, and chemotherapy may be used.
HER2/neu positive. HER2/neu is a gene in breast cells that produces a protein called HER2 that normally controls growth in healthy breast cells. When too much of this protein is produced, it often results in a cancer called HER2 positive. HER2 positive breast cancer is typically treated with therapy drugs that help block HER2 receptors.
Luminal tumors (A&B)
- Luminal A tumors are hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), HER2 negative. Luminal A cancers grow slower than Luminal B cancers and tend to have a better prognosis.
- Luminal B tumors breast cancer are hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), and either HER2 positive or HER2 negative. Luminal B cancers generally grow faster than luminal A cancers and they tend to have a slightly worse prognosis.
Triple negative breast cancer
Some breast cancers are called triple negative because they don’t have receptors for estrogen, progesterone, or HER2. Because they don’t respond to drugs that target estrogen, progesterone, or HER2 receptors, they can be harder to treat. Chemotherapy is the main treatment option.
When treatment is given before surgery, it’s called neoadjuvant therapy. It can help down stage the disease in the breast and minimize surgical impact and can take the form of chemotherapy, HER2-targeted therapy or hormone therapy.
Breast cancer treatment
The majority of breast cancers are treated successfully. Most breast cancers require a combination of treatments. Almost all patients will undergo surgery of the breast and possibly the lymph nodes.
Systemic therapy refers to medications that treat the entire body. Even if there are no signs that the breast cancer has spread, systemic therapy is prescribed for the majority of patients with an invasive breast cancer in order to reduce the odds it will come back and to improve survival.
Radiation treatments are given after surgery to reduce the odds of cancer reappearing in the breast, surrounding tissue, or surrounding lymph nodes. There are many exciting new targeted therapies for breast cancer, including immunotherapies.
Breast cancer treatments personalized for you
Breast cancer treatments are personalized taking into account the stage of your cancer, the type of breast cancer you have, what the best sequence of treatment will be, and also considering your personal preferences.
Because there are so many factors to consider, treatment for breast cancer can vary greatly from person to person. Your multidisciplinary team of breast cancer specialists will discuss the best combination of surgery, chemotherapy, radiation, hormone therapy, or new immunotherapy approaches to treat or control your cancer.
Surgery, performed by a surgical oncologist who specializes in removal of breast cancer through an operation, is often, but not always, the initial treatment for breast cancer. Surgical options include:
A mastectomy is a complete removal of the breast. There are different types of mastectomy including a simple or total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy. The type of mastectomy is determined based on location and extent of the cancer in the breast, as well as your breast size and whether or not you choose to have breast reconstruction.
Partial mastectomy (also called a lumpectomy).
A partial mastectomy or lumpectomy is a surgical procedure to remove the breast cancer along with a surrounding margin of healthy breast tissue while preserving the majority of your healthy breast tissue. A lumpectomy surgery is typically an outpatient procedure with a shorter recovery than a mastectomy. Importantly, likelihood of curing your cancer is the same, whether the surgery is a lumpectomy or a mastectomy. Most patients who have a lumpectomy will require radiation treatments to the breast after their surgery.
Sentinel node biopsy.
The sentinel lymph nodes are the lymph nodes in the armpit where breast cancer is most likely to spread IF it travels out of the breast. Most patients have 1-3 sentinel nodes. At the time of the breast surgery, the surgeon will inject a low dose radiation called Tc-99 in addition to a blue dye into the affected breast. The lymph circulation transports the Tc-99 and the dye to the sentinel nodes. A small incision is made in the armpit and the surgeon can find the nodes that have been labeled. These nodes are removed and sent for testing to look for spread of cancer. If the sentinel nodes are negative, this confirms an early localized breast cancer. If the sentinel node(s) show signs of cancer, additional treatments after surgery will be considered. In most cases, no further surgery is needed to remove more lymph nodes.
Axillary lymph node dissection.
This is a surgical procedure to remove the majority of lymph nodes in the armpit when cancer has been found to have spread from the breast to the armpit nodes. Typically, 15-20 nodes are removed but the total number will vary from patient to patient. This procedure can cause long-term side effects including numbness on the back of the arm and hand and/or arm swelling. Our specialists may recommend getting systemic therapy before surgery with the goal of clearing cancer out of the lymph nodes so that and axillary dissection can be avoided.
Rebuilds the shape of the breast after a mastectomy. This may be done during the mastectomy or later, depending on your needs and your doctor’s recommendation.
DIEP flap reconstructive surgery.
Uses fat and skin from your lower abdomen to create a new breast mound after a mastectomy.
Chemotherapy uses drugs that slow down, damage, or kill cancer cells. It may involve single drugs or combinations of drugs taken intravenously or by mouth. Chemotherapy is often taken in cycles lasting three or four weeks each. Your team may also prescribe drugs to reduce or eliminate chemotherapy’s side effects.
Radiation therapy (radiotherapy) uses X-rays and other types of medical radiation aimed at specific parts of the body. The radiation kills cancer cells, prevents cancer cells from developing or recurring, and improves many of cancer’s symptoms. For certain cancers, radiation therapy is combined with chemotherapy and called chemo-radiotherapy. It’s a very focused outpatient treatment that takes about 15 minutes from start to finish. You are never radioactive and you don’t lose your hair.
Targeted therapies are drug treatments that help the body’s immune system fight cancer. Herceptin® is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.
Immunotherapy uses substances, either made by your body naturally or made artificially, to boost your immune system. Immunotherapy can stop or slow cancer cell growth, can stop cancer cells from spreading to other parts of the body, and can help your body be more efficient at killing cancer cells.
Leading edge diagnosis and treatment
At UCHealth, the same caring team of doctors and support professionals from many fields—including our elite, Magnet-designated nursing staff—work together to develop the best plan of care for you, and they stay with you from your initial appointment through treatment and aftercare. In addition, our special breast cancer nurse navigator helps guide you through the entire process.
Your multidisciplinary medical team might include:
- Behavioral health professionals
- Care team assistants
- Genetic counselors
- Hereditary cancer specialists
- Integrative medicine and complementary care therapists
- Mammography technologists
- Medical assistants
- Medical oncologists
- Nurses or registered nurses (RNs)
- Nurse practitioners (NPs)
- Physical therapists
- Plastic and reconstructive surgeons
- Radiation oncologists
- Social workers
- Surgical oncologists
Breast cancer programs at UCHealth
UCHealth Hereditary Cancer Clinic in metro Denver provides early screenings, risk assessments and education to preserve and support the health of patients who have a higher hereditary risk of cancer.
The Young Women’s Breast Cancer Program at The Borges Lab is focused on the development of novel vaccines and combination immunotherapy for breast cancer as well as potential biologic differences and therapeutic targets for young women’s breast cancer.
Common breast cancer types
Breast cancer ranges from early, noninvasive types to more aggressive types that can spread to other parts of the body.
Ductal carcinoma. The most common type of breast cancers begin with cells in milk-producing ducts, called ductal carcinoma. Ductal carcinoma can be contained inside the duct or non-invasive. This type is called ductal carcinoma in situ. When the cancer cells spread outside of the duct into the surrounding breast tissue, it is called invasive ductal carcinoma.
Invasive lobular carcinoma. The second most common type of breast cancer begins in the glandular tissue, called invasive lobular carcinoma. Invasive lobular carcinoma can be more challenging to find on a mammogram as it tends to blend into the surrounding breast tissue making it more difficult to see.
Lobular carcinoma in situ is not considered a breast cancer. It is a finding in the breast that tells us a woman has a higher risk of developing breast cancer in the future. Our Breast Cancer Risk Assessment and Prevention Program is available for women concerned about their breast cancer risk.
Breast cancer in men. Breast cancer can also affect men, although at significantly lower rates than women. Mammograms are not recommended for men. However, men who feel a breast lump should seek evaluation. Our breast center has expertise in breast imaging and treating men with breast cancer.
Five-year breast cancer survival rates
Number of Patients Diagnosed – UCHealth 3,035 – State of Colorado – 14,137
Number of Patients Surviving – UCHealth 2,631 – State of Colorado – 12,031
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
Center for Disease Control and Prevention (CDC). What Is Breast Cancer? (https://www.cdc.gov/cancer/breast/basic_info/what-is-breast-cancer.htm)
National Cancer Institute (NCI). Breast Cancer (https://www.cancer.gov/types/breast)
National Institute of Environmental Health Sciences. Breast Cancer (https://www.niehs.nih.gov/health/topics/conditions/breast-cancer/index.cfm)