Breast cancer overview

If you have recently been diagnosed with breast cancer, you’re probably concerned, worried, anxious, and thinking hard about what to do next. Educating yourself about cancer and understanding your treatment options will help you feel more in control. The most important decision for you to consider is where to get treatment.

Step one

Your first step to getting on the road to recovery from breast cancer is to make an appointment at the Seattle Cancer Care Alliance NOW Clinic.

NOW Clinic breast specialist nurse practitioners, will almost always see you within just a few days from the time you call us. During your appointment, we will provide you with information, prepare you for what’s ahead, and answer your questions to help ease your anxiety about your diagnosis. We will determine if there are any tests or scans that should be completed before you meet with nationally renowned breast cancer treatment specialists at the Breast Cancer Specialty Center (BCSC).

Step two

After your appointment at the NOW Clinic, your second step will be to meet with your physician or BCSC physician team to determine your treatment plan.

If you are scheduled for a BCSC visit, the nursing team will carefully coordinate your care through your next appointment and afterwards. At this appointment you may meet with one or all of your breast cancer doctors—a radiation oncologist, surgeon, and medical oncologist—at the same time. Together they will discuss your options based on your type and stage of cancer while taking into consideration your general health, lifestyle, and personal preferences. Then you will meet your team to determine a blend of treatments and a sequence in which to deliver your treatments, to achieve the best results.

We also monitor women at increased risk for developing cancer. Women who are shifting their focus from cancer treatment to recovery receive a wellness plan and cancer prevention strategies that include information on good nutrition, fitness and emotional support.

Visit the Women’s Wellness Clinic if you

• Want information about cancer prevention—to do everything you can to keep your cancer from coming back
• Would like help dealing with some of the lingering side effects of cancer treatment, such as lymphedema, anxiety, or depression

The Women’s Wellness Clinic offers the care and services you need without leaving the medical supervision of the oncologists you know and trust. Routine checkups, including mammograms, Pap smears, and various scans, are an important part of taking care of yourself after cancer, and all are provided at the Women’s Wellness Clinic.

Women at high risk

Women who are at high risk for breast or ovarian cancer and who have been seen at our Breast and Ovarian Cancer Prevention Program may be referred to the Women’s Wellness Clinic for routine medical exams and close monitoring. You do not have to have had cancer to come to the clinic. You may come for help with cancer prevention

Seattle Cancer Care Alliance (SCCA) and its founding organizations—UW Medicine and Fred Hutchinson Cancer Research Center—have brought together a world-class team of breast cancer experts who focus exclusively on treating women with breast cancer and who provide compassionate, individualized care as well as access to new treatments and procedures.

Your first visit

If you have been newly diagnosed with breast cancer, during your first appointment at the Breast Cancer Specialty Center, you will meet with a team of breast cancer specialists that includes experts in breast cancer surgery, radiation oncology, and medical oncology.

This team will work with you throughout your diagnosis and treatment to determine the best treatment plan for you—one that takes into account the type of breast cancer you have and your values, beliefs and lifestyle. Because our doctors conduct leading-edge breast cancer research as well as treat patients, you can be sure that you will be offered the most promising new treatments available.

Your mammograms and scans will be reviewed by a breast-imaging specialist, who will will discuss your medical records with your team of doctors.

Next your team will review your pathology slides (tissue samples from any biopsies) using a special microscope that allows everyone to see the same image at the same time. 

Then one or more of the doctors on your team will see you for a thorough physical examination.

Finally one or more of your doctors will meet with you (and your family or friends) to discuss the team’s findings, answer all of your questions, and suggest a treatment plan. You will leave at the end of the afternoon with a treatment plan for care either at SCCA or with the doctor who referred you to SCCA.

In addition to doctors who are specialists in various types of breast cancer care, you will have the support of registered nurses, patient care coordinators, social workers, chaplains, psychiatrists, psychologists, and others.

The Breast Cancer Specialty Center is part of the Women’s Center on the third floor of the SCCA clinic on Lake Union.

Once you have a mammogram, you may learn that you have dense breasts. As this information may be confusing, here is patient information on breast density and what you should know. If you are a provider, learn the importance of discussing breast density with your patient.

What is breast density?

Breast density refers to the amount of normal, non-fatty tissue visible in a woman’s breasts on mammograms. Washington state law now mandates that women be directly notified if they have dense breast tissue on a screening mammogram.

There are four categories of breast density: almost entirely fat, scattered fibroglandular, heterogeneously dense, and extremely dense.  If your patients’ breasts are in the higher two categories (heterogeneously or extremely) they are considered “dense.” 

Mammograms can be less accurate in women with dense breasts. The dense tissue looks white on mammograms and can appear similar to breast masses or tumors. Breast density also has been linked to an increase in future risk of developing breast cancer, though it is important to note that breast density alone has only a small impact on breast cancer risk.

Relative risks 

The table below provides relative risks for developing breast cancer by density category*. 

Seattle Cancer Care Alliance mammograms and breast density

The below chart breaks down breast density type from SCCA mammogram patients from 2015 to 2017.

Next steps

We recognize that notifying patients of their breast density may lead patients to have questions on what they should do next. Every woman who receives a mammogram at the SCCA or University of Washington Medicine will receive an information pamphlet on breast density. To assist you with counseling your patient, we encourage you to discuss the following with your patients:

• Reassure your patient that screening mammograms, particularly those with 3D technology, also known as tomosynthesis, remain useful for detection of breast cancer regardless of their density. 
• Explain your patient that the data are not clear on whether supplemental screening of women with dense breasts with additional imaging tests provide greater benefit than harm. The most commonly discussed supplemental examinations are ultrasound and MRI. The UW/SCCA is actively involved in research studies on identifying optimal supplemental screening exams for patients with dense breasts. More information on our active research trials can be found here. 
• Talk with your patient to see if there is anything besides breast density that may increase her risk for getting breast cancer. Women at higher breast cancer risk as determined by a risk assessment model that appropriately weights family history may be eligible for supplemental screening with breast MRI. This approach is supported by robust evidence. 

When to refer for additional screening

You are encouraged to perform your patients' risk assessment using the Breast Cancer Surveillance Consortium Risk Calculator. 

• If the resultant risk is greater than 2.5 percent at five years, you may consider a referral to the SCCA Breast Health Clinic or the UW Roosevelt Women's Clinic for additional risk assessment and counseling. 
• If the resultant risk is less than 2.5 percent at five years, your patient should continue to get yearly mammograms, particularly ones with tomosynthesis technology.

Refer your patient

Our breast health experts provide breast cancer screenings and can help you figure out which screenings are right for your patient based on age, health, risk level and other factors. 

The SCCA Mammogram Van travels around the Puget Sound area so you can conveniently get a mammogram. 

SCCA Mammogram Van Schedule (PDF)