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Comprehensive Treatment from Our Team of Breast Care Experts
Breast cancer and other breast diseases often require treatment from many different specialists and medical professionals. Maryland Oncology Hematology brings together the most advanced treatment therapies, diagnostic technologies, breast care experts and comprehensive supportive care, providing a total treatment program.
Our multidisciplinary team of breast specialists is comprised of recognized experts in breast surgical oncology, medical and radiation oncology, diagnostics, pathology, genetic risk evaluation and supportive care―all collaborating to deliver unparalleled continuity of care. This unique integrated care model reduces patient stress, makes care more efficient and ensures our breast patients achieve the best possible results. From diagnosis to survivorship, we’re by your side every step of the way.
Breast Care Services
From diagnosis to treatment to recovery, we can help patients every step of the way.
- Diagnostic and treatment services for non-cancerous breast conditions such as dense breast tissue, nipple discharge, atypia, inflammatory lesions and adenosis.
- Advanced surgical procedures including breast-conserving lumpectomy, nipple-sparing and skin-sparing mastectomy, lymph node surgery, oncoplastic surgery, and reconstructive surgeries.
- Onsight diagnostic imaging including PET and CT to assist in evaluation and treatment planning
- Medical oncology experts for chemotherapy, hormone therapy and immunotherapy treatments.
- Radiation oncology team with access to leading-edge technology and treatments like Intensity-Modulated Radiation Therapy (IMRT), Image-Guided Radiation Therapy (IGRT), and brachytherapy.
- Supportive care addressing emotional, financial and nutritional needs of patients.
- Clinical trials providing access to promising new therapies for breast cancer.
- Genetic testing and counseling to help identity risk for hereditary cancers and to create more personalized treatment strategies.
- Resources for second opinions for patients and their referring providers.
- Survivorship programs to support patients after their treatment ends.
Maryland Oncology Hematology Breast Surgery Services: Unsurpassed expertise in advanced surgical procedures
Choosing a Breast Surgery Specialist
Surgeons play a critical role in breast cancer treatment, and choosing your breast surgeon may be one of the most important decisions you will make concerning your care. Since breast cancer treatment frequently begins with surgery, surgical outcomes pave the way for the treatment to follow. That’s why it is extremely important to choose a highly qualified and experienced surgeon who specializes in breast cancer surgery.
Many surgeons occasionally operate on breast cancer, typically handling only a few cases a year. However, when it comes to breast cancer surgery, practice makes perfect. Research shows that patients who have surgeries done by physicians who perform a high volume of breast cancer surgeries have a better prognosis than patients of lower volume surgeons.
Surgeons who specialize in breast cancer have dedicated their professional careers to the disease, performing hundreds of breast cancer surgeries every year. With years of rigorous training and education focused on breast disease, they have an in-depth knowledge of cancer biology, genetics and the most advanced surgical options to help patients achieve the best possible results.
Breast Cancers and Complex Breast Diseases
Breast cancer occurs when healthy breast cells undergo a change and grow out of control, usually forming a mass called a tumor. Breast cancer is the most common cancer among American women, except for skin cancers. About one in eight U.S. women will develop invasive breast cancer during her lifetime, or roughly 12% of all women. There are many different types and subtypes of breast cancer. The cancer specialists at Maryland Oncology Hematology have extensive experience and expertise treating patients with all different forms of the disease.
There are also many complex breast diseases that never develop into breast cancer. Benign breast conditions, or benign breast diseases, are very common. Women’s breasts are constantly changing, especially through pregnancy and menopause, due to varying levels of female hormones. Fortunately, most changes that occur are non-cancerous and not life-threatening. Some changes, however, may increase the risk of eventually developing breast cancer. Benign breast conditions may also occur in men, although they are less common.
Some changes in the breast do not cause symptoms but may be discovered during a mammogram, while others cause discomfort or pain and may require treatment. Some symptoms can be similar to those from breast cancer, so it can be difficult to tell the difference based on symptoms alone. In these cases, screening tests and other procedures may be required to make an accurate diagnosis.
Maryland Oncology Hematology multidisciplinary breast specialists are recognized experts in all aspects of breast health, and they play an important role in the assessment, treatment and ongoing surveillance of patients with complex breast issues, benign breast diseases, and those with high risk profiles
Common Breast Cancers
Breast cancer can be either invasive or noninvasive. Invasive breast cancer spreads to nearby tissues, while noninvasive does not progress beyond the milk ducts or lobules in the breast. Most breast cancers start in the ducts or lobes and are called ductal carcinoma or lobular carcinoma:
Ductal carcinomas start in the cells that line the milk ducts. These cancers make up the majority of breast cancers.
- Ductal carcinoma in situ is cancer confined to the milk duct and is the most common type of non-invasive breast cancer. It is considered non-invasive because it has not spread beyond the milk duct. Most women with this early stage cancer have a good prognosis, but their risk for developing invasive disease later may be increased.
- Invasive or infiltrating ductal carcinoma is cancer that has spread beyond the duct. It is the most common type of invasive breast cancer. Cancer cells break through the wall of the duct into the breast tissue and may spread to other parts of the body through the bloodstream or the lymphatic system.
Lobular carcinoma cancers starts in the lobules or milk-producing glands of the breast.
- Lobular carcinoma in situ (LCIS) is located only in the lobules. While LCIS is not considered cancer, it is a risk factor for developing invasive breast cancer in both breasts.
- Invasive lobular carcinoma begins in the milk-producing glands (lobules) of the breast and escapes out of the lobule, potentially spreading to the lymph nodes and other parts of the body.
Less Common Breast Cancers
Inflammatory breast cancer
Inflammatory breast cancer is a rare, fast-growing type of cancer that accounts for about 1% to 5% of all breast cancers. Symptoms are similar to a breast infection, including redness, tenderness, swelling and breast pain; however, the condition does not respond to antibiotic treatment. Cancer cells block the breast lymph vessels, causing fluid backup and breast swelling. Because this cancer is very aggressive and has a high risk of spreading, a combination of treatment modalities is often used.
In Paget’s disease, cancer cells form in or around the nipple, spreading to the nipple surface and the areola. The nipple and areola can become irritated with scaly, red, itchy areas. It is a rare form of cancer, accounting for less than 5% of all breast cancers. Although it is usually in situ, or confined to the site where it started, the disease can also be invasive.
Breast cancer subtypes
Breast cancer is a general term used to describe any cancer that starts in the breast tissue. It is not a single disease. Among the same type of breast cancer, there are subtypes of the disease that are determined by sampling the tumor. The pathology results from these tests help physicians learn more about the specific cancer, enabling them to develop the most effective treatment plan. There are three main subtypes of breast cancer:
Hormone receptor-positive cancers express estrogen receptors (ER) and/or progesterone receptors (PR). The receptors are proteins found in and on cells. Tumors that have estrogen receptors are referred to as “ER-positive” while tumors with progesterone receptors are called “PR-positive.” Only one of these receptors needs to be positive for a cancer to be called hormone receptor positive.
HER2-positive cancers rely on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers have excessive numbers of HER2 receptors or copies of the HER2 gene. This gene makes a protein found on cancer cells that plays a role in tumor cell growth. HER2-positive cancers tend to grow quickly.
When a tumor does not express estrogen, progesterone and/or HER2, it is called “triple-negative.” About 15% of invasive breast cancers are triple-negative, and treatment is complex. This cancer appears to be more common in younger women, particularly those with a mutation in the BRCA1 and BRCA2 genes. Patients with triple-negative breast cancer should be tested for BRCA gene mutations.
The American Society of Clinical Oncology, with support from the Conquer Cancer Foundation, provides up to date, comprehensive, oncologist-approved information about various types of cancer on their website. It is an excellent resource for cancer patients and their families to help them understand their disease and make informed care decisions.
Additional information on breast cancer that is reviewed and approved by medical professionals is available from the American Cancer Society.
Non-cancerous Breast Conditions
Benign breast conditions are very common, and many women experience them. These breast changes are not life-threatening, however some may be associated with a higher risk of eventually getting breast cancer.
There are many different types of benign breast conditions. Even though they are non-cancerous, some may require treatment. It is important to have them evaluated by a breast health professional to ensure proper assessment, develop treatment strategies if necessary, and plan ongoing screening and surveillance activities. Following are a few of the benign breast conditions commonly seen and treated by our breast specialists:
Hyperplasia is an overgrowth of cells that occurs most often on the inside lining of the lobules or milk ducts in the breast. There are two primary types of hyperplasia, referred to as usual and atypical. Both can increase the risk of developing breast cancer, but atypical hyperplasia is associated with a higher risk.
Breast cysts are fluid-filled sacs that are common in women before menopause. They are almost always benign, and they do not increase the risk of breast cancer. Most cysts do not require treatment. They are less common after menopause.
Fibroadenomas are solid benign tumors and are very common. A fibroadenoma usually does not require removal unless it becomes large or causes discomfort. These tumors occur most frequently in women ages 15-35 and generally do not increase breast cancer risk.
Occurring in the milk ducts of the breasts, intraductal papillomas are small growths that are usually located close to the nipple. They can cause pain as well as a discharge from the nipple, and the patient may feel a lump in the breast. They occur most often in women ages 35-55. Patients with only one intraductal papilloma are not at a higher risk of breast cancer unless abnormal cells are found or there is cancer in the nearby tissue. Patients with five or more intraductal papillomas may have an increased risk.
Sclerosing adenosis consists of small breast lumps located in a lobule, a milk-producing gland of the breast. Patients may feel a lump and also experience pain, however the condition usually does not require treatment. Sclerosing adenosis may be found on a mammogram, and unfortunately, it may be mistaken for breast cancer. A biopsy may be required to check for cancer. There is no consensus on whether or not this condition increases breast cancer risk.
The above information presents some of the more common benign breast diseases. For more comprehensive information, including details on many other non-cancerous breast conditions, visit the American Cancer Society’s website.
Breast pain is extremely common and occurs in women of all ages. The pain can be quite alarming and cause much anxiety in women who worry they may have breast cancer. However, breast pain by itself is usually not a symptom of the disease and is more commonly caused by a benign breast condition, chest wall pain, or other non-cancerous factors.
Our breast specialists are available to assess patients with breast pain to try and determine the cause.
This often involves taking a history of the of the pain episodes, including how often the pain occurs, how long it lasts, how severe it is and if it is linked to menstrual cycles. In the majority of cases, the pain is the result of normal changes in the breast. While gaining a better understanding of breast pain may not cure it, it does offer reassurance to patients that they do not have breast cancer. Our breast experts may also be able to offer strategies, treatments and suggestions for lifestyle changes to minimize or eliminate the discomfort.
Three main categories of breast pain have been identified:
Cyclical breast pain
Cyclical breast pain is associated with changing hormone levels that occur during a woman’s menstrual cycle. Hormonal changes can make the breast tissue more sensitive, which may trigger pain. Roughly two out of every three women will experience this type of breast pain at some point in their lives.
Non-cyclical breast pain
This pain is not linked to a woman’s menstrual cycle, and it can occur before and after menopause. Women may experience a continuous pain or the pain may be intermittent. The precise cause is unknown, but it may be associated with such factors as benign breast conditions, previous breast surgery, breast injury, having large breasts, or stress. Side effects from some antidepressant drugs and herbal remedies, such as ginseng, are also possible causes.
Chest wall pain
Chest wall pain, also called extra-mammary pain, is pain that feels like it is coming from the breast, but actually originates somewhere else. A pulled muscle in the chest can cause breast pain in addition to pain in the ribs and chest wall. The pain may also be caused by another medical condition, such as gallstones.
Procedures and Treatments for Breast Cancer and Complex Breast Diseases
Imaging tests are used to detect and diagnosis breast disease. Sometimes these tests are used proactively to screen for breast cancer or breast disease even if no symptoms are present. These tests are also used after cancer is suspected, to confirm a diagnosis and get a more accurate understanding of the disease stage and type to plan for treatment.
Maryland Oncology Hematology utilizes the very latest imaging technologies and minimally invasive procedures to diagnose and treat breast diseases. Our breast specialists collaborate to develop a diagnosis, assess the patient’s risk of developing breast cancer, and formulate a treatment strategy, if required, ensuring the most appropriate screening schedule, treatment modality and surveillance activities are in place for each patient.
Following are a few of the more commonly used state-of-the-art imaging technologies and procedures employed by our breast team:
A mammogram is an X-ray that looks for changes in the breast that might be a sign of cancer of other disease. Mammograms are considered the best breast cancer screening tool available, and the American Cancer Society recommends annual mammograms for women over 45 who are at average risk for breast cancer. This can help detect breast cancer early, when treatment is more likely to be successful.
A breast ultrasound uses sound waves to make images of the breast. The technology is non-invasive and is commonly used as a follow-up test when an abnormal finding occurs on a mammogram, breast MRI or clinical breast exam. It may also be used to help guide various needle biopsy procedures.
Breast magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to create detailed pictures of the intricate structures within the breast. The technology is primarily used as a supplemental tool to mammography or ultrasound to screen women at high risk for breast cancer, assess the extent of cancer following diagnosis, or further evaluate abnormalities detected by mammography. Breast MRI uses an IV contrast agent, so it is more invasive than mammography.
Molecular breast imaging
Molecular breast imaging (MBI) uses a radioactive tracer that “lights up” specific areas of cancer detected inside the breast. The tracer is given in the arm by IV. Breast cancer cells absorb the radioactive substance much more than normal cells do, illuminating cancerous cells. A nuclear medicine scanner then scans the breast, identifying areas where the radioactive substance is concentrated. MBI is often used to screen women who have dense breasts and are at higher-than-average risk for cancer, as tumors are difficult to spot on mammograms in women with dense breast tissue.
A biopsy is used to detect and diagnosis breast cancer and breast disease by removing a cells from a suspicious area and examining them in a lab to see if disease is present. Needing a biopsy does not necessarily mean that you have cancer. Many biopsies do not result in a cancer diagnosis.
During a core biopsy, a hollow needle is inserted into the lesion to remove a sample of breast tissue for analysis under a microscope. Several samples may be taken at the same time. Since tissue is taken rather than cells, it gives more detailed information than some other types of biopsies.
Vacuum assisted biopsy
Sometimes the suspicious area is difficult to target or a previous biopsy may not have provided a definite result. When this occurs, more breast tissue is needed for a proper diagnosis, and a vacuum assisted biopsy is often done. A small incision is made in the skin after local anesthesia is given. A hollow probe, connected to a vacuum device, is inserted through the incision. Using ultrasound or mammography to guide the procedure, the vacuum sucks breast tissue into a collecting chamber, allowing collection of several tissue samples without removing the probe.
Fine needle aspiration
A fine needle aspiration takes one or more samples of breast cells using a thin needle with a hollow center to remove cells from the suspicious area. This is the least invasive type of biopsy, and usually there is no scarring. Local anesthesia may be given.
Ultrasound-guided breast biopsy
An ultrasound-guided breast biopsy utilizes sound waves to locate the breast abnormality and remove a tissue sample for microscopic examination. This procedure is less invasive than a surgical biopsy, leaving little to no scarring. It does not expose the patient to ionizing radiation. Ultrasound guidance may be used in various biopsy procedures, including core biopsy, vacuum assisted biopsy and fine needle aspiration.
Stereotactic breast biopsy
In stereotactic breast biopsy, a special mammography machine uses low dose x-rays to help locate the breast abnormality and then guide the physician’s biopsy equipment to the site. A tissue sample is then removed for microscopic examination. The procedure is less invasive than surgical biopsy and there is little or no scarring. It is very effective in evaluating calcium deposits or tiny masses that are not visible with ultrasound.
Treatments for Non-Cancerous Breast Conditions
Breast cysts usually do not need any treatment or follow-up, as most go away on their own. However, if a cyst becomes large or causes discomfort, the fluid can be drawn out using a fine needle and syringe. Ultrasound is sometimes used to help locate the cyst and guide the procedure. If the fluid is blood-stained, it is sent to a laboratory for testing.
Cryotherapy of fibroadenomas
Cryotherapy is a safe, effective and virtually painless procedure that is an alternative to surgery for fibroadenomas. It uses extreme cold to destroy tissue. Ultrasound images provide guidance as a probe is inserted through a small incision in the breast. Liquid nitrogen is then pumped into the probe, freezing the breast tumor on the inside. No tissue is removed, and recovery is immediate.
Breast Cancer Treatments
Breast-conserving surgery, a common surgical option for women with early-stage cancer, preserves most of the patient’s breast. The cancerous tumor cells are removed while leaving as much of the normal breast tissue as possible. In most cases, a certain amount of surrounding healthy tissue and lymph nodes are also removed. Tumor size, location and other factors determine how much of the breast may need to be excised. Most women who have breast-conserving surgery will also need radiation.
There are many different types of mastectomies, depending on how much tissue is removed and how the procedure is performed.
- Total or simple mastectomy – A total mastectomy removes the entire breast, including the nipple, areola and skin. Lymph nodes under the arm may also need to be removed.
- Skin-sparing mastectomy – A skin-sparing mastectomy removes only the breast tissue, nipple and areola, while preserving as much of the breast skin as possible. The same amount of breast tissue is removed as with a simple mastectomy. The breast is reconstructed at the time of surgery with implants or tissue from other parts of the body.
- Nipple-sparing mastectomy – This procedure is a variation of the skin-sparing mastectomy. The breast skin and nipple are left in place while the breast tissue is removed. Breast reconstruction usually follows the procedure.
- Modified radical mastectomy – This procure combines a total mastectomy with the removal of the lymph nodes under the arm.
- Radical mastectomy – This is a complex procedure that involves the removal of the entire breast, underarm lymph nodes, and the chest wall muscles under the breast. This surgery is rarely done now, as less extensive procedures have been developed that are just as effective.
- Preventive/prophylactic mastectomy – A prophylactic mastectomy removes one or both breasts to reduce the risk of developing breast cancer.
Advanced oncoplastic surgery
Oncoplastic procedures combine plastic surgery techniques with breast surgical oncology procedures, with a goal of providing improved cosmetic outcomes.
Lymph node surgery
Lymph nodes under the arm are removed and analyzed to determine how far the cancer has spread. This is a critical part of staging the disease, since breast cancer spreads to the glands under the arm first, and then may progress to other parts of the body.
Simultaneous and staged reconstruction
Simultaneous reconstruction rebuilds the breast at the same time the surgery is done to remove the cancer. In staged reconstruction, a temporary tissue expander is put in place during the mastectomy, stretching the skin and muscle to prepare it for an implant or reconstruction at a later date.