Breast cancer

Treatment

Today, women facing breast cancer have more treatment options than they did even a few years ago.

At Seattle Cancer Care Alliance (SCCA) our breast cancer experts understand that every woman’s cancer is different, as are her genetics, lifestyle, and personal preferences. We work together as a team to design an individualized treatment plan specifically for you—using the most advanced therapies—and to surround you with the support you need.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Breast cancer expertise at SCCA

Breast cancer survival rates

Data collected from cancer centers across the country show that people who begin their breast cancer treatment at SCCA have higher survival rates on average than those who started treatment at other centers.

Everything you need is here

Our surgeons, radiation oncologists and medical oncologists are UW Medicine doctors who specialize exclusively in breast cancer and have extensive experience with every type, grade and stage of the disease. We have the most advanced diagnostic, treatment, recovery and support programs.

Breast cancer treatment tailored to you

To formulate your personal treatment plan, your team members meet in the same room to share their expertise. Based on your unique needs, we combine and carefully coordinate treatments — surgery, radiation therapy, chemotherapy, hormonal therapies and targeted biological therapies — to achieve the best results for you, including if you have metastatic breast cancer. 

Innovative breast cancer therapies

SCCA patients have access to advanced therapies being explored in clinical studies for breast cancer conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

Team-based approach

Your personal team includes more than your breast cancer doctors. For medical and emotional support, we connect you with a range of experts — like nutritionists, physical therapists, social workers, chaplains and palliative care specialists who care for you alongside your oncology team.

Ongoing care and support

Nearly all breast cancer survivors can look forward to a long life after their treatment is complete. You’ll receive follow-up care to monitor your healing, watch for signs of possible recurrence and enhance your well-being through our Women’s Wellness Clinic.

Treatment types

Surgery

Nearly all women with breast cancer have surgery as part of their cancer treatment.

Surgery for SCCA patients is performed by UW Medicine breast surgeons who are fellowship-trained in breast surgery/surgical oncology. They perform breast surgeries exclusively, and they partner with UW Medicine breast reconstructive surgeons for patients who want reconstruction.

Your first step toward surgery is to meet with your breast surgeon, who will carefully review your imaging and biopsy results, evaluate your health needs, ask about your personal preferences and explain your options, the type of surgery we recommend for you and what to expect.

  • If you have ductal carcinoma in situ (DCIS), you may be able to have a lumpectomy, depending on the size of the cancer and whether the surgeon can get cancer-free margins (called negative margins). The margins are important in ensuring that no cancer is left behind. Some women with a large area of DCIS need a mastectomy. 
  • If you have invasive breast cancer, you may be able to have a lumpectomy, or you may need a mastectomy. The decision depends in part on the size of the tumor compared to the size of your breast and whether the cancer is in more than one segment of your breast.

Lumpectomy

The goal of a lumpectomy is to remove your tumor completely while leaving as much of your healthy breast tissue as possible — an approach called breast-conserving surgery.

Some women who need a lump removed have surgery called donut mastopexy to remove their tumor with negative margins while preserving the shape and appearance of their breast. 

If your cancer doesn’t form a lump that surgeons can feel, they need guidance to locate and remove exactly the right tissue.

At SCCA, we offer SAVI SCOUT Surgical Guidance System.

  • Up to 30 days before your surgery, a breast radiologist uses ultrasound or other imaging to locate your tumor and insert a tiny infrared chip into it through a needle.
  • During your surgery, your surgeon scans your breast with a small wand that emits a radar signal. The signal bounces back from the chip so your surgeon can precisely locate the tissue you need removed.

If SAVI SCOUT is not the best option for you, your surgeon may pinpoint your cancer using wire localization.

  • On the morning of your surgery, a breast radiologist uses mammography or ultrasound to locate your cancer and insert a thin guide wire into your breast to mark the cancer.
  • During your surgery, your surgeon uses the guide wire to tell which tissue to remove.

 

Mastectomy

If a lumpectomy is not an option for you or if you would rather have all breast tissue removed to reduce your risk of cancer recurring in your breast, you may have a mastectomy. You might need a mastectomy if:

  • You have certain types of breast cancer, such as inflammatory breast cancer.
  • Your cancer has advanced and is quite large when it’s diagnosed.
  • Your cancer is in more than one-quarter of your breast.

There are several choices for how the surgery can be done. Your surgeon will talk with you about which option they recommend for you and why.

  • Total mastectomy — If you don’t want reconstruction at the time of your mastectomy, or if you can’t have reconstruction at the same time for health reasons, your surgeon removes all your breast tissue, your nipple and the first lymph nodes where your cancer might have spread. These nodes are checked for cancer during your surgery. If cancer is present, the surgeon removes more lymph nodes from under your arm.
  • Skin-sparing mastectomy — If your cancer does not involve your skin and you want immediate breast reconstruction, your cancer surgeon makes an incision around your nipple and areola (the darker colored skin around your nipple), removes the nipple and areola, and removes your breast tissue through this small opening. Your reconstructive surgeon uses the same opening to insert tissue from your abdomen (DIEP flap) or a temporary expander (replaced later with an implant). 
  • Nipple-sparing mastectomy — This surgery requires a small incision under the fold of your breast or on the outer side of your breast, leaving the nipple and areola intact. It is an option if you are having a preventive, or prophylactic, mastectomy because you have genetic mutations that put you at high risk for breast cancer or you have a strong family history of breast cancer. It is also an option for many women with small, early-stage cancers that don’t involve the nipple or areola.

Sentinel lymph node biopsy

Your surgeon may remove some lymph nodes under your arm on the same side as your cancer to see if cancer has spread there. 

The fewer lymph nodes you have removed, the lower your risk of side effects, such as lymphedema (swelling) in your arm or nerve injury. This is why SCCA performs sentinel lymph node biopsy whenever possible.

Your surgeon locates and removes only the first lymph nodes where your breast cancer might spread (the sentinel, or gatekeeper, nodes).

  • If the nodes are cancer-free, you do not need any more removed.
  • If the nodes contain cancer, you may need more removed (called axillary lymph node dissection).

Our experienced team of surgeons is led by David R. Byrd, MD, who pioneered sentinel node biopsy in the Pacific Northwest.

Preventing and treating lymphedema

Lymphedema is not common, but it is a possible complication. So after any lymph node surgery, we refer our patients to physical therapists (PTs) with expertise in preventing, detecting and managing lymphedema.

We have several resources for lymphedema treatment, including PTs who provide complete decongestive therapy and specialized reconstructive surgeons who offer advanced surgical treatments, such as lymph vessel reconnection surgery and lymph-node transfer.

Surgery

Nearly all women with breast cancer have surgery as part of their cancer treatment.

Radiation therapy

Radiation therapy clears cancer cells that may be left behind in your breast, your chest wall, or the lymph nodes in your armpit, chest or neck after surgery.

The radiation oncologists on your SCCA team specialize in breast cancer treatment and have extensive experience with every type, grade and stage of the disease. We use state-of-the art equipment and technology to design and deliver treatment that gives you the best possible outcome.

  • If you have a lumpectomy, having radiation therapy after surgery may mean you can keep more of your breast tissue while also significantly lowering the chance of cancer recurring in your breast.
  • If you have a mastectomy, you may not need radiation therapy because all your breast tissue on the side of your cancer was removed. However, some women may be at higher risk for recurrence, so your team may recommend radiation therapy to reduce your risk.

External-beam radiation therapy

Most women with breast cancer receive external-beam radiation therapy to their whole breast. In this form of therapy, a machine generates radiation beams and aims them at your breast, where cancer cells might remain.

  • You will likely have radiation therapy every day, Monday through Friday, for three to six weeks. Each treatment takes only a few minutes.
  • Your radiation oncology team carefully designs and carries out a plan to precisely target the tissue that needs treatment while limiting the effects of radiation to the rest of your body.
  • During each treatment, we use an advanced multicamera system to track your body position to within less than a millimeter and make sure you are lined up the right way for the radiation beam.

Accelerated partial breast irradiation

This is a safe option for some women with early-stage breast cancer who are having a lumpectomy. 

  • Only part of the breast receives radiation, using a device placed inside the breast. 
  • Maximum radiation reaches the tissue at high risk for cancer with less radiation to surrounding healthy tissues. 
  • Treatment is given twice a day for five days.
  • SCCA participated in a national study comparing this approach with standard external-beam radiation therapy.

Tattooless radiation oncology

Patients must no longer get tattoos to identify the precise location for treatment. With tattooless radiation oncology, we are able to scan your breast and record the position of your cancer, so on later visits, the scan is projected onto you for guiding the radiation towards its exact location.

  • You’ll be scanned on your first appointment.
  • All of the remaining appointments will project the scan onto you, so thetherapists can duplicate the exact position for your radiation.
  • Tattoos are no longer used for locating the tissues receiving radiation.
Radiation therapy

Radiation therapy clears cancer cells that may be left behind in your breast, your chest wall, or the lymph nodes in your armpit, chest or neck after surgery.

Chemotherapy

Your SCCA medical oncologist specializes in breast cancer and has deep knowledge about the latest, most effective drug treatments for your type and stage of cancer, including chemotherapy, hormonal therapies and targeted therapies.

Chemotherapy after surgery

For breast cancer, most chemotherapy drugs are given in cycles by infusion into a vein. Some are taken by mouth in pill form. The standard approach is to have chemotherapy after surgery.

  • If you have early-stage breast cancer (it is not outside your breast and nearby lymph nodes), you’ll typically have four to six cycles of chemo with the goals of eliminating your cancer and keeping it from coming back. Chemo may reduce your risk of a recurrence by 30 to 50 percent.
  • If you have metastatic breast cancer (it has spread beyond your breast  and nearby tissues), you’ll typically have ongoing chemo to give you the longest, healthiest possible life. If your chemo stops working or side effects are too troubling, the next step is to consider switching to a different drug that might be effective.

Chemotherapy before surgery

Your SCCA team may recommend chemotherapy to shrink your tumor before surgery if:

  • Your tumor is too large to remove with surgery alone and still get a result that’s cosmetically acceptable to you.
  • You have inflammatory breast cancer or another form of breast cancer that is aggressive or locally advanced (near your breast but involving other tissue, such as your skin or many lymph nodes).
  • Shrinking the tumor might mean you can have a lumpectomy instead of a mastectomy. 

Another reason for chemotherapy before surgery is to see how sensitive your cancer is to the medicine, which may help your team design your individualized treatment plan. 

Chemotherapy

Your SCCA medical oncologist specializes in breast cancer and has deep knowledge about the latest, most effective drug treatments for your type and stage of cancer, including chemotherapy, hormonal therapies and targeted therapies.

Hormonal therapies

Most women with breast cancer have hormone-receptor positive (HR+) disease. This means your cancer cells have receptors where hormones, like estrogen and progesterone, can attach. These hormones help the cancer cells multiply quickly.

Hormonal therapy, also called endocrine therapy, may prevent HR+ breast cancer or keep it from coming back by reducing or blocking the production or effects of hormones.

  • If you have early-stage breast cancer, hormonal therapies may reduce the risk that the same cancer will come back or a new breast cancer will develop. 
  • If you have a metastatic recurrence (breast cancer returns in distant parts of your body), hormonal therapies may extend your life. They can be effective against tumors for a long time.

Estrogen-receptor blockers

These medicines bind to estrogen receptors on cells in the breast tissue. This keeps estrogen from attaching there, and it shuts down the cancer cells’ ability to grow and divide. Options include:

  • Selective estrogen-receptor modulators (SERMs), such as tamoxifen (Nolvadex), toremifene (Fareston) and raloxifene (Evista)
  • Selective estrogen-receptor downregulators (SERDs), such as fulvestrant (Faslodex), which binds to estrogen receptors and also decreases the number and the shape of receptors, making it harder for cancer to thrive

Aromatase inhibitors

Aromatase inhibitors, which decrease the amount of estrogen circulating in your body, are used in women who’ve gone through menopause. They include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).

Ovarian suppression

If you are premenopausal, your doctors might recommend medicine that stops your ovaries from making estrogen, such as leuprolide (Lupron) or goserelin (Zoladex). 

Hormonal therapies

Most women with breast cancer have hormone-receptor positive (HR+) disease. This means your cancer cells have receptors where hormones, like estrogen and progesterone, can attach. These hormones help the cancer cells multiply quickly.

Targeted biological therapies

Targeted therapies block the growth or spread of cancer cells through a specific pathway or receptor — rather than generally attacking all fast-growing cells the way conventional chemotherapy drugs do.

Target biological therapies use substances, like antibodies, that come from living organisms, or versions of these substances made in a laboratory.

HER2-targeted therapies

Several targeted drugs are approved to treat breast cancer that is HER2 positive (the cancer cells make too much of a protein called HER2/neu). You might receive one of these alone or along with chemotherapy or another targeted therapy:

  • Trastuzumab (Herceptin)
  • Lapatinib (Tykerb)
  • Pertuzumab (Perjeta)
  • Ado-trastuzumab emtansine (Kadcyla)

mTOR inhibitors

Everolimus (Afinitor) targets a protein that can mutate in cancer cells, allowing them to grow out of control. The drug blocks, or inhibits, this mutated protein, known as mTOR (mammalian target of rapamycin, or mechanistic target of rapamycin).

Your doctor may recommend everolimus along with the hormonal therapy exemestane if you are past menopause and have advanced cancer that is HER2 negative and HR+.

Cell-cycle inhibitors

These drugs help stop the growth and spread of tumors by blocking one or more proteins involved in the life cycle of cancer cells. 

For advanced breast cancer or metastatic disease that is HR+, your doctor may recommend palbociclib (Ibrance) or ribociclib (Kisqali). They may be used in combination with hormonal therapies.

PARP inhibitors

These drugs help kill cancer cells by making DNA repair harder for them. Cells that can’t repair their DNA are more susceptible to other cancer treatments, like chemotherapy and radiation therapy. 

Several PARP inhibitors are approved to treat ovarian cancer, especially in women with inherited mutations in the BRCA1 and BRCA2 genes. Studies show these drugs are also effective against breast cancer in women with BRCA1 and 2 mutations. PARP inhibitors are being studied in other women with breast cancer too.

Targeted biological therapies

Targeted therapies block the growth or spread of cancer cells through a specific pathway or receptor — rather than generally attacking all fast-growing cells the way conventional chemotherapy drugs do.

Advanced breast cancer

Treating metastatic breast cancer

Metastatic breast cancer can be highly treatable. Recent data show women with metastatic breast cancer are living longer with better quality of life than ever before.

Our goal at Seattle Cancer Care Alliance (SCCA) is to provide the best and longest life possible to every woman who comes to us for care. New treatments available at SCCA may put your cancer in remission and give you a good quality of life for years — even decades. 

At SCCA, you have many options for treatment, including therapies available only through clinical studies designed specifically for women with advanced breast cancer.
Many women who started treatment elsewhere come to SCCA if their disease recurs or spreads, because of our doctors’ expertise and our focus on research into improving outcomes for women with metastatic disease. 
Your team is here to help you and your family cope with the emotional aspects of your health and treatment. We offer resources such as support groups as well as social workers and chaplains specially trained to meet your needs.

ASSIST program 

At SCCA, we recognize that patients with metastatic breast cancer have unique perspectives, care expectations and treatment goals. To help meet those needs, we created the Advanced Stage Support Information Symptoms Trials (ASSIST) program. The goal of ASSIST is to connect you with specialized supportive care from the start, in complete coordination with your clinical treatment. 

Before your first appointment

  • Our nursing team will contact you to discuss which supportive services you might benefit from. This speeds up the process of connecting you with supportive services such as nutrition, physical therapy and others once you arrive. If you’re feeling overwhelmed or need help understanding SCCA’s general process before you get here, they may connect you with a social worker or patient navigator. View more information on SCCA’s Supportive Care Services.
  • Our clinical trials team will review your medical history and see if you are eligible for any of the clinical trials we’re offering. If you are, your provider will review options with you at your appointment.

If you are interested in scheduling an appointment or learning more about the ASSIST program, contact our team at (206) 606-6487 . 

Frequently Asked Questions (FAQs)

What is metastatic breast cancer?

Breast cancer cells can travel through your lymph system or blood to reach other parts of your body, such as your liver, lungs, brain or bones and can form tumors there. This is metastatic breast cancer.

  • In some women, breast cancer has already metastasized, or spread, by the time she learns she has the disease. Doctors sometimes refer to this as de novo metastatic breast cancer.
  • In other women, cancer that was only in the breast comes back in other parts of her body after her initial treatment. This may be called metastatic breast cancer or distant recurrence.
How is metastatic breast cancer treated?

Your treatment  will mostly be drug based — using chemotherapy, hormonal therapies and targeted therapies. These systemic treatments travel throughout your body and can fight cancer cells wherever they are.

There may be times when your SCCA team recommends surgery or radiation therapy, mainly to relieve symptoms, such as radiation therapy to relieve pain by shrinking bone tumors. 

Support and care to reduce symptoms and enhance quality of life (palliative care) are important for everyone with cancer, regardless of the stage of your disease, and are provided by SCCA experts alongside your cancer treatment. 

What clinical trials options are there?

Many women with advanced breast cancer, especially those with metastatic disease, receive treatment in clinical studies looking for tomorrow’s cures.

Taking part in a study can give you access to new interventions that are not available otherwise. If the new intervention proves to be better than standard care, you may be among the first to benefit from it. If standard treatments aren’t working for you, a clinical study may provide you another option.

  • Ask your doctor about taking part in clinical studies of promising treatments. 
  • Find breast cancer clinical trials that are accepting patients at SCCA.
  • Check for phase 1 trials, which test the newest potential therapies.

View Breast Cancer Clinical Trials

View Phase 1 Program Clinical Trials