Health Matters 5/31: Understanding a breast cancer diagnosis


By Margaret L. Crivello, M.D.

The American Cancer Society estimates that more than 330,000 women in the United States will be diagnosed with some form of breast cancer this year.

And while a breast cancer diagnosis can be scary, it is important to remember there are more than 3.1 million breast cancer survivors in the United States today.

It’s also important to remember that no two breast cancers are the same and that understanding a breast cancer diagnosis involves a variety of factors unique to each patient. Two of the most important factors are the type of cancer and its biological makeup.

At the Breast Health Center at Penn Medicine Princeton Health, a team of board certified physicians, nurses and radiology technicians offer advanced diagnostic and treatment services for breast cancer, with a dedicated breast health navigator to guide patients through their care.

What type of cancer is it?

One of the first factors to consider in understanding a breast cancer diagnosis is what type of cancer it is. The most common types of breast cancer are ductal carcinoma in situ, invasive ductal carcinoma and invasive lobular carcinoma.

In situ means the cancer has not spread outside of the breast ducts, while invasive means the cancer has spread into the surrounding breast tissue. When a cancer has metastasized, it means it has spread to other parts of the body beyond the primary site.

Ductal carcinoma is cancer that starts in the milk ducts, which carry milk from the milk producing lobules to the nipple. Lobular carcinoma is cancer that begins in the milk-producing glands.

What is its biological makeup?

The biological makeup of a tumor can tell physicians a lot about how it will behave and how best to treat it. In fact, biology is now the main factor in staging cancer and determining a prognosis.

Certain breast cancers may have different proteins called receptors that attach to hormones estrogen and progesterone, and depend on them to grow. Breast cancers that have estrogen receptors are called ER positive and those with progesterone receptors are called PR positive. Tumors can have one, both or none of these receptors.

Depending on the hormone receptor status, targeted hormone therapy drugs can lower hormones or block the receptors, keeping cancer cells from attaching to the hormones and stopping them from growing and spreading.

In addition, certain breast cancers may have higher than normal levels of HER2, a protein that helps control how a breast cell grows, divides and repairs itself.   Cancers with abnormal HER2 levels tend to grow and spread faster than other cancers.

However, HER2 positive breast cancers can respond very well to treatments that target HER2 receptors.

What is the stage?

After breast cancer is diagnosed, physicians will determine the stage, a marker of how much cancer is in the body and how serious it is. Knowing the stage can help form a treatment approach and prognosis.

Stages range from 0 to IV, with 0 being the earliest stage of breast cancer and IV indicating the cancer has spread more.

In years past, staging was simply based on the size of the tumor and whether the cancer spread to the lymph nodes and other parts of the body. Today, the size of the cancer plays less of a role in staging, as doctors are now better able to understand and target the underlying biology.  Some small cancers may be very aggressive while larger cancers may not pose as much of a threat.

What are the treatment options?

Treatment options for breast cancer typically depend on its type, stage and biological makeup. Every cancer is unique, which means the treatment approach should be too.

Most women, however, will typically need surgery to remove as much of the cancer as possible.  Not all though will need a mastectomy or surgery to remove the entire breast.  In many cases, breast conserving surgery (lumpectomy) typically followed by radiation can be performed to remove only the part of the breast containing cancer and is equally effective in treating the cancer.

As the American Cancer Society notes, in most cases, mastectomy does not give women any better chance of long-term survival or a better outcome from treatment. Studies show that when breast conserving surgery can be performed along with radiation, having a mastectomy instead does not provide any better chance of survival.

Often, surgery will be followed with chemotherapy or radiation or a combination of the two to ensure there are no cancer cells left behind. With a variety of chemotherapy drugs now available, doctors are able to target treatment more effectively than ever before.

Additionally, hormone therapy and drugs to target HER2 receptors are increasingly effective in treating breast cancer and stopping its spread.

While it is natural for women to feel scared and anxious about a breast cancer diagnosis, treatment for breast cancer has advanced by leaps and bounds in recent years.

If you or a loved one have been diagnosed with breast cancer, be sure to talk with your breast surgeon and oncologist to get all the facts so you can make an informed decision about treatment. The majority of the time breast cancer is treatable and often even curable.

To find a physician with Penn Medicine Princeton Health, call 888-742-7496 or visit

Margaret L. Crivello, M.D., is a board certified surgeon specializing in breast surgery and is a member of the medical staff at Penn Medicine Princeton Medical Center.