Breast cancer

Treatment for breast cancer

There are more treatment options today than ever before to control breast cancer or put it into remission, even if you have metastatic disease (cancer that has spread to another part of the body).

Our breast cancer specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for breast cancer and offer you access to the latest innovations through clinical trials.  

People with breast cancer are living longer, healthier lives. 

Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.
“What makes us unique is our ability to do clinical research that brings leading-edge therapies from the lab into the clinic so we can offer them to patients. We are the place for people seeking new options.”
— Jennifer M. Specht, MD, medical oncologist
At BCSC first appointments, you meet the team of physicians who will be working together to provide your cancer care. Medical oncologist Jennifer M. Specht, MD, explains what to expect.

Where you will be seen

At our South Lake Union Clinic, we have several clinics for people with breast cancer. When you start care here, we will match you with the best place to meet your current needs. 

Breast Cancer Specialty Clinic (BCSC)

The Breast Cancer Specialty Clinic is a multidisciplinary center for people with non-metastatic invasive breast cancer. At the BCSC, your team will include a nurse navigator, breast surgeon, medical oncologist and radiation oncologist. These experts will work together, listening to your needs and preferences, to make a treatment plan that is right for you.

A BCSC visit takes about half a day. A nurse navigator will meet with you first to go over the plan for the day, give you educational and support materials and answer your questions. A resident or fellow (a physician who is doing extra training to specialize in cancer) will examine you and talk with you about your medical history. Then, while you take a break, Fred Hutch’s full team of breast cancer specialists will meet to talk about your treatment options.

Next, your physicians will come to see you in an exam room. Often, they will examine you together to make sure they agree about the best therapies to treat your disease. Then each physician will meet with you one-on-one. They will explain the specific treatment they recommend and what will happen next. This is also a time for you to ask any questions you may have. 

Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
NOW Clinic

The NOW Clinic is for people with newly diagnosed breast cancer. At the NOW Clinic, advanced practice providers (APPs) who specialize in breast cancer usually see you just a few days after you request an appointment. They will give you information and support, prepare you for what comes next and answer your questions. 

Your APP will also find out if you need any tests or scans before you come to see your team of physicians. They will help you set up these tests and scans so your physicians will have as many details as possible when you see them. 

Breast Medical Oncology Clinic

This clinic focuses on medicine-based treatments, like chemotherapy, endocrine therapy, targeted therapy and immunotherapy. Most people with breast cancer will get one or more of these. If you have metastatic breast cancer, it is likely that all your treatment will be medicine-based.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Breast Health Clinic/Surgery Clinic

The Breast Health Clinic is for people who have a breast health concern, are higher-risk for breast cancer or are having breast cancer surgery.

The team at the Breast Health Clinic diagnoses and treats a full range of breast concerns. We look at patients who have a breast lump or other symptom or an abnormal screening mammogram. We also do imaging tests, clinical breast exams and biopsies.

If you have a higher risk of breast cancer, our team can make a screening and follow-up plan just for you. We will design your plan to give you and your health care team the best chance of finding breast cancer early, when it is easier to treat. We will also help you reduce your risk and connect you with other Fred Hutch services.

UW Medicine surgeons who do breast cancer surgery see patients at the Breast Health Clinic. Our team also provides care before and after breast surgery. If you have already been diagnosed with breast cancer and you need surgery, you will come to the Breast Health Clinic for the care you need in order to get ready for surgery and recover afterward.

Learn More

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
“First appointments are a chance for everyone to get to know each other. I want not only to understand your medical situation but also to get a better sense of who you are and what your goals are.”
— Jennifer M. Specht, MD, medical oncologist

Specialized services

People with breast cancer have a range of needs based on their disease stage, their age and other factors. Fred Hutch has many specialized services to provide the care and support that are right for you.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
For those with metastatic breast cancer

If cancer has spread from your breast to distant parts of your body, you have options. New treatments at Fred Hutch may put your cancer into remission and give you a good quality of life for decades. 

Many people who started treatment somewhere else come to Fred Hutch if their breast cancer comes back or spreads. They come here because of our experts and our focus on research to improve outcomes.

Our ASSIST Program helps people with metastatic breast cancer. ASSIST stands for Advanced Stage Support Information Symptoms Trials.

A nurse from ASSIST will contact you before your first appointment with your Fred Hutch medical oncologist. The nurse will talk with you about supportive care services that might help you, like nutrition counseling and physical therapy.

If you feel overwhelmed, or if you need help understanding how care works at Fred Hutch, ASSIST can help with this, too. We can connect you with a social worker or a patient navigator.

As part of ASSIST, our clinical trials team will look at your medical history to see if you can join a clinical trial. If you can, your medical oncologist will talk with you about your options.

People with advanced breast cancer often get treatment in clinical trials. These studies can give you access to new options that are not available any other way. If standard treatments are not working for you, a clinical trial at Fred Hutch may provide you with another choice. 

Before we recommend trials or any type of therapy, we will test your cancer for features that affect how well various treatments work. These features — like your hormone-receptor status, HER-2 status and genomics — can be very complex. They can also change over time. By doing tests after cancer comes back or spreads, we can plan the best treatment for you. 

At Fred Hutch, we have a monthly advanced molecular tumor board. This is a meeting where our experts talk about the best ways to treat people who have the most challenging metastatic breast cancers.

Call (206) 606-6487 to learn more about ASSIST. 
 

For younger people with breast cancer (age 18-40)

Some forms of cancer treatment may affect fertility. If you would like to know about options for preserving your fertility, talk with your care team and ask about our Oncoreproduction Clinic. 

We also offer a support group for young adults, aged 18–40, who are in active treatment at Fred Hutch. The group gives you a place to talk with people who understand what you are going through. You can share your experiences and connect with others who are living with a cancer diagnosis.

For older people with breast cancer (65 or older)

Fred Hutch uses a special risk-assessment tool to help plan care for older patients with breast cancer. If you are 65 or older with non-metastatic disease, your team may give you this tool to fill out. We may ask you to do this before you visit the Breast Cancer Specialty Clinic. This way, your care team can use your answers to understand your exact needs and personalize your care. 

For breast cancer survivors

After cancer treatment, we are still here for you. In fact, it is important to keep getting care from experts who can guide your full recovery. Fred Hutch has teams to support you.

  • For ductal carcinoma in situ (DCIS) or atypia (atypical hyperplasia) on a biopsy, the team at our Breast Health Clinic will provide follow-up care related to breast health. 
  • For invasive breast cancer, you will get follow-up care from the same physicians who treated your cancer. For most people, this means seeing your medical oncologist for five years after treatment ends.
  • For wellness-focused follow-up, the Fred Hutch Women’s Wellness Clinic serves people who are at least five years out from treatment. You can get routine checkups, a wellness plan, help with any lasting side effects and more.
Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Medical oncologist Jennifer M. Specht, MD, discusses treatment improvements for breast cancer.

Treatment plan

Breast cancer treatment at Fred Hutch is highly customized to meet each patient’s needs.

How do we create your treatment plan?

At Fred Hutch, breast cancer specialists — including surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and researchers — work together to make a custom treatment plan for each patient. 

Twice a week, our breast cancer experts gather in a meeting called a tumor board to get ready for the Breast Cancer Specialty Clinic. Together, team members from different areas of breast cancer care discuss their patients’ treatment plans. This approach gives you the benefit of everyone’s knowledge and experience. 

We also have a monthly advanced molecular tumor board. This is a meeting where Fred Hutch physicians review advanced genomic testing on breast cancer to figure out the best ways to treat people who have the most challenging metastatic breast cancers.

The Fred Hutch experts at these meetings, including your physicians, will:

  • Talk about all possible treatments for your situation
  • Decide which therapies will be most promising for you
  • Check if any clinical trials match your needs, so you can think about joining them

At your first appointment, your breast cancer physician will walk you and your caregiver through the treatment plan we recommend for you. It is important to us to learn about each patient’s goals, needs and concerns to make the best treatment plan. You will have a chance to share your personal preferences, and you will decide together what happens next.
 

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Why do treatment plans differ?

The treatment plan we design for you depends on many things, including:

  • Your subtype of breast cancer, such as if your cancer cells have estrogen or progesterone receptors that can be treated with endocrine therapy
  • If the cancer is slow-growing and less likely to spread (low-grade) or fast-growing and more likely to spread (high-grade)
  • The stage of the cancer 
  • The risk of the cancer spreading or coming back, based on profiling tests
  • The presence of mutations (changes) in genes like BRCA1 or BRCA2 that may increase risk for future cancers
  • If you have had treatment for breast cancer in the past
  • Your age, overall health and menopause status
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial
Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What is the standard therapy for breast cancer?

Because breast cancers have different features, there is no one way to treat everyone. However, the standard therapy for most patients with early-stage breast cancer is surgery to remove the tumor, which is often followed by radiation therapy and medicine-based treatments. These include chemotherapy, endocrine therapy, targeted therapy and sometimes immunotherapy. Physicians can use these one at a time or combine them. 

But standard therapy can be different for different people. People with early-stage cancer may need only surgery. Often, people with advanced or metastatic cancer are best treated with systemic, medicine-based therapies. When you come to see us, we will explain the standard therapy for your situation.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to receive promising new breast cancer therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Integrative medicine Combines conventional (standard) medical treatment with complementary and alternative (CAM) therapies that have been shown to be safe and to work. CAM therapies treat the mind, body and spirit. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Standard treatment A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support. 

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.
Caregiver icon
Caregiving around appointments

As a caregiver, you can give your loved one both emotional and practical support around the time of health care appointments. Ask them if you can help with things like these:

  • Helping them manage their stress, worry or other feelings.  
  • Planning how to get to and from the appointment, what time to leave home and where to park.
  • Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered. 
  • Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.

Resources for Caregivers

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.

Treatment process

Different breast cancers start, progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your situation. Your care team will make sure you understand each type of treatment and all of your choices.

Surgery for breast cancer

Breast surgery is very personal, and we want to help you make decisions you feel comfortable with. We will take the time to talk with you about your options, what to expect and any questions you have.

You may be able to have surgery to remove your cancer and keep your healthy breast tissue (lumpectomy), or you may need surgery to remove the entire breast, including the cancer (mastectomy). This will depend mainly on the size of the cancer, where it is and if you have one tumor or several tumors in the breast.  

If you have metastatic disease, meaning the cancer has spread to other places in your body, your cancer cannot be fully removed by surgery. So your care team will probably not recommend this form of treatment. However, we may suggest surgery to help with symptoms. 

UW Medicine breast surgeons do surgery for Fred Hutch patients at UW Medical Center – Montlake and UW Medical Center – Northwest. All of our surgeons are fellowship-trained in breast surgery/surgical oncology, which means that they are physicians who have done extra training to specialize in cancer surgery. 

Your first step will be to meet with your breast surgeon. They will carefully look at your imaging, biopsy results and health needs. They will tell you about your surgery options and explain what we recommend for you and why. 

For patients who want it, our breast reconstructive surgeons, who are also from UW Medicine, offer many options. These include same-day reconstruction, which means that reconstruction can be done at the same time as the cancer is removed. Some people decide they do not want reconstruction (also known as “going flat” or aesthetic flat closure). We support whatever you choose.

Our team at the Fred Hutch Breast Health Clinic specializes in helping you prepare for surgery and recover afterward. We are here to understand your needs and help you heal. 

Lumpectomy

The goal of a lumpectomy is to remove all your tumor while leaving as much healthy breast tissue as possible.

If your tumor is larger compared to your breast but you do not need a mastectomy, you may have another option. It is called oncoplastic surgery. In this approach, a breast surgeon takes out the cancer, and in the same operation, a reconstructive surgeon reshapes the breast. Sometimes they reshape the other breast too, reducing or lifting it to even out the breasts. 

Sometimes, cancer does not make a lump that surgeons can feel. In this case, they need help to locate and remove exactly the right tissue. At Fred Hutch, we have two methods to choose from:

  • SAVI SCOUT® surgical guidance — Before your surgery, a breast radiologist will use ultrasound or mammogram to see where your tumor is. They will put a tiny radar-reflecting chip (SAVI SCOUT®) into the tumor through a needle. During surgery, your surgeon will scan your breast with a small wand that sends out a radar signal. The signal bounces back from the chip, showing your surgeon which tissue to remove.
  • Wire localization — On the morning of your surgery, a breast radiologist will use mammography or ultrasound to see where your cancer is. They will insert a thin guide wire into your breast to mark the cancer. During surgery, the wire will show your surgeon which tissue to remove. 

Mastectomy 

If a lumpectomy is not an option for you, you might have a mastectomy. Also, some patients who could have a lumpectomy choose to have a mastectomy instead. A mastectomy is when all breast tissue is removed. 

You might need a mastectomy if:

  • You have certain types of cancer, like inflammatory breast cancer.
  • Your cancer has advanced and is large compared to your breast size.
  • You already had a lumpectomy and radiation of your breast.

There are many ways to do the surgery. Your surgeon will talk with you about the options, what you prefer and what we recommend for you. Whatever you choose, we will take care to remove your cancer and still get you the best cosmetic results. 

Non-skin-sparing mastectomy

This means your surgeon will remove all your breast tissue. This is also called a total mastectomy. This type of mastectomy provides an aesthetic flat closure. They also remove your nipple and the first lymph nodes where your cancer might have spread (sentinel nodes). 

You might have a total mastectomy if you do not want reconstruction the same day or if you cannot have it the same day for health reasons. 

Skin-sparing mastectomy

For this option, your cancer surgeon will make an incision (cut) around your nipple and areola (the darker skin around your nipple). They will remove the nipple and areola. They will also remove your breast tissue through this small opening. During the same operation, your reconstructive surgeon will use the small opening to reconstruct the breast. They will put in tissue from your abdomen, or they will put in a tissue expander (a temporary inflatable implant that makes space for a future implant). 

This may be right for you if your cancer does not involve your skin and you want breast reconstruction right away.

Nipple-sparing mastectomy

This surgery involves making an incision (cut) under the fold of your breast or a vertical incision below the nipple. Your nipple and areola will stay intact. This is an option for many patients with cancer that does not involve the nipple or areola. Like a skin-sparing mastectomy, a nipple-sparing mastectomy is combined with immediate breast reconstruction.

This type of surgery is also an option if you are having a preventive mastectomy. Some people choose this because they have genetic changes or a family history that raises their breast cancer risk. 

Sentinel lymph node biopsy

The sentinel lymph nodes are the first lymph nodes in the armpit that breast cancer would spread to. Typically, surgeons remove these nodes for testing to check if breast cancer has spread there. 

The fewer lymph nodes that are removed, the lower your risk of side effects. (Side effects can include nerve problems or lymphedema, which means swelling in the arm.) This is why we do sentinel lymph node biopsy whenever possible rather than automatically removing more nodes. 

If the sentinel lymph nodes are cancer-free, you do not need to have any more taken out. If the sentinel lymph nodes have cancer, you may or may not need to have more taken out.

Lymphedema

Lymphedema is a type of swelling that can happen after surgery or radiation therapy that affects lymph flow. Our breast and reconstructive surgeons offer advanced ways to prevent or treat this condition. Preventive techniques include axillary reverse mapping (ARM) and microsurgery to restore lymph flow (known as LYMPHA), which is done at the same time as lymph nodes are removed. We also offer surgery to treat lymphedema after it starts, such as lymphovenous bypass (also called lymphaticovenular anastomosis, or LVA) and microsurgical transfer of lymph nodes to the affected area (vascularized lymph node transfer, or VLNT). At Fred Hutch, we also have physical therapists who know how to prevent, detect and treat lymphedema.

Lymphedema Care at Fred Hutch 

 

Guide to Your Breast Surgery (PDF) 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Mammography The use of film or a computer to create a picture of the breast. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Sentinel lymph node biopsy The removal and examination of the sentinel node(s), the first lymph nodes to which cancer cells are likely to spread from a primary tumor. The removal and examination of the sentinel node(s), the first lymph nodes to which cancer cells are likely to spread from a primary tumor. To identify the sentinel lymph nodes, the surgeon injects a radioactive substance, blue dye or both near the tumor. Next, the surgeon uses a probe to find the sentinel lymph nodes containing the radioactive substance or looks for the lymph nodes stained with dye. Then the sentinel nodes are removed to check for the presence of cancer cells. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography. Axillary reverse mapping A method to locate lymph vessels by injecting dye during surgery. This helps surgeons preserve the lymph vessels. LYMPHA Surgery to connect small lymph vessels to blood vessels so lymph has a path to drain into the bloodstream. LYMPHA stands for lymphatic microsurgical preventive healing approach.
Surgery for breast cancer

Nearly everyone with non-metastatic disease has their tumor removed. For metastatic disease, surgery is sometimes done to help with symptoms. 
Breast reconstruction

The surgeon will go over a range of options with you and explain the timeline for reconstruction so you have all the information to make a decision that meets your goals.  

Typically, this visit about reconstruction will happen after your cancer care team makes your treatment plan. This gives you a chance to think about the plan and then decide the next step. We will schedule your reconstruction visit to meet your needs.

It is normal for your first consultation to be just the start. Patients often have more than one visit with their surgeon to talk about and think through all their choices.

Our plastic surgeons are all UW Medicine physicians. They are highly skilled in both ways to restore your breast — with either implants or natural tissue. Implants use synthetic materials (like saline or silicone) to reconstruct the breast. Natural-tissue methods restore your breast using tissue from your own body. 

Based on your needs and wishes, we offer reconstruction on the same day as your cancer surgery (while you are still under anesthesia) or later, after you finish cancer treatment. We use many advanced techniques to get the best outcomes. This includes complex options for people with different body types or health concerns and people who want breast reduction.

If you decide not to have reconstruction (also known as “going flat” or aesthetic flat closure), we support you in making the choice that is right for you.  

Oncoplastic surgery

If you are having a lumpectomy, your surgeons may be able to remove your cancer and also reshape one or both breasts. 

One option is a breast reduction or breast lift, done at the same time as your lumpectomy, to adjust your remaining breast tissue and give you a natural breast shape and symmetry. Another option is using tissue from the side of your chest wall to fill the space left by the lumpectomy (lateral intercostal artery perforator, or LICAP, flap). This is also known as volume-replacement surgery.

Implants

A saline or silicone implant is another option. Your surgeon can explain the differences and show you samples during a consultation. 

To make room for an implant, most patients need a tissue expander first. This is a balloon-like device. It goes under your skin and is slowly filled with saline over several weeks to months, which stretches your skin (and, if needed, your chest muscle). It can be put in the same day as your mastectomy or weeks, months or years later. When the skin and muscle has stretched enough, your surgeon will remove the expander and put in your implant.

Natural tissue 

After mastectomy, many patients have their breast restored using skin and fat from their own body. The abdomen is the most natural match and is also the most common area to have extra tissue. The name for this method is deep inferior epigastric perforator (DIEP) flap. It is also called tummy-tuck reconstruction. 

There are other options, too. We can use tissue from your upper buttock (superior gluteal artery perforator, or SGAP, flap), your inner thigh (transverse upper gracilis, or TUG, flap), or your back (latissimus flap).

Tissue reconstruction may involve using a tissue expander, like for implants, or it may be done later without needing an expander. 

Wearing a prosthesis or “going flat” or aesthetic flat closure

Keep in mind that many people choose not to have reconstructive surgery. Instead, some people decide to wear a breast form, or breast prosthesis. Others decide to “go flat” and get used to their new chest. This is a personal choice, and only you will know what is right for you. We support whatever you decide.

If you are interested, the American Cancer Society has resources about breast prostheses. Shine, Fred Hutch’s retail store in South Lake Union, has breast prostheses and can do mastectomy fittings (to fit you for a prosthesis and related garments). 

Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Breast reconstruction

Your first step toward reconstruction, if you are interested, is to meet with one of our breast reconstructive plastic surgeons. 
Radiation therapy for breast cancer

Radiation therapy uses high-energy rays to kill cancer cells. Often, it is done to clear cancer cells that may be left behind in your breast, chest wall or nearby lymph nodes after surgery. A radiation oncologist decides on the type, dose and schedule of your treatment.

Your Fred Hutch radiation oncology team specializes in treating breast cancer. We have extensive experience with every type, grade and stage of the disease. To give you the best outcome, we use our expertise along with state-of-the art equipment and technology to carefully plan and deliver your treatment.

Who needs radiation therapy? 

After a lumpectomy, we recommend that most patients have radiation therapy. This lowers the chance of cancer coming back in your breast.

After a mastectomy, some patients with higher-risk features may have radiation to reduce the chance of the cancer coming back in the chest wall or nearby lymph nodes.  

Sometimes, radiation therapy is used to relieve symptoms in people with metastatic breast cancer.

External-beam radiation therapy (EBRT) with X-ray radiation 

For breast cancer, most people who need radiation have EBRT. In this treatment, a machine aims beams of X-ray radiation (photons) at areas that might still have cancer cells. Usually, this means the whole breast, chest wall and nearby lymph nodes. Treatment is done every day, Monday through Friday, for three to seven weeks. Each appointment takes about 30 minutes.

Some patients who have a lumpectomy for early-stage cancer need radiation on only one area of the breast. This is called partial breast irradiation or accelerated partial breast irradiation. Often, these patients can have a shorter course of treatment.

At Fred Hutch, we offer both whole and partial breast radiation therapy.

To make sure your treatment is exact, we use a multi-camera system. It will read the 3D surface of your body when we plan and set up your treatment, and it will do this again each time you come for a treatment session. The system will track your position to within less than 1 millimeter. We use this surface-guidance system along with deep inspiration breath hold to reduce the amount of radiation that might otherwise reach your heart.

High dose rate (HDR) brachytherapy 

Accelerated partial breast irradiation can be done by putting a small radioactive source into the breast for a short time. It is placed through a catheter and sends out radiation from the inside out. 

This type of internal radiation therapy is called brachytherapy. It may be an option for some patients with early-stage breast cancer who have had a lumpectomy.

Treatment is done twice a day for five days. 

At Fred Hutch, we use the SAVI brachytherapy system for accelerated partial breast irradiation.

 

Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Radiation therapy for breast cancer

Having radiation therapy after surgery can help reduce the chances of non-metastatic cancer coming back.
Proton therapy for breast cancer

Proton therapy is like conventional external-beam radiation therapy (EBRT), but it uses beams of protons instead of photons. 

Using protons instead of photons helps because physicians can aim radiation at the target with less radiation exposure for nearby healthy tissues. This has to do with the way protons deliver radiation to your body. A high dose can be sent to the right area, but the radiation does not keep going to other parts of your body. The goal is to kill cancer cells while reducing the risk of side effects.
 

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Advantages of Proton Therapy in Locally Advanced Stage III Breast Cancer

Advantages of proton therapy in locally advanced stage III breast cancer

Proton therapy (right, above) has unique features that reduce radiation exposure for normal, healthy organs. This is especially important in left-sided breast cancer, because the cancer is close to critical organs like the heart and lungs. Patients with left-sided breast cancer are more likely to develop cardiovascular diseases after getting radiation treatment than patients with right-sided breast cancer.

Our radiation oncologists will look at each case, but protons are often useful in treating:

  • Node-positive breast cancer
  • Triple-negative breast cancer
  • Lobular carcinoma
  • Early-stage breast cancer
  • Locally advanced breast cancer (stage II and III)
  • Recurrent breast cancer
  • Certain patients who have had radiation in the past

Fred Hutchinson Cancer Center – Proton Therapy offers a breast cancer clinical trial to qualifying patients

The Patient-Centered Outcomes Research Institute (PCORI) provided $11.8 million to support a study that will give patients and physicians answers to many important questions about breast cancer control and survival. This is the first clinical trial designed to see how well proton beam therapy works, compared to conventional photon radiation therapy, to treat certain breast cancers and reduce radiation exposure for healthy tissue. 

Where will you be seen?

We offer this treatment at our proton therapy facility on the campus of UW Medical Center – Northwest.

If you are ready to request an appointment, you can call us at (844) 538-3485. Keep in mind that we will need your medical records to decide if you are a candidate for proton therapy.

 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Proton therapy for breast cancer

Proton therapy is an advanced radiation treatment that targets the cancer while reducing the amount of radiation exposure for healthy tissues and organs. 
Chemotherapy for breast cancer

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). Your breast medical oncologist prescribes your chemotherapy and other medicine-based treatments. They also set your treatment schedule. 

Chemotherapy can be given by infusion or by mouth. For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Cancer nurses who are experts in infusions give you these treatments. They will also watch over you during the treatment. They will help with any medical issues that come up and will keep you comfortable.

Some types of chemotherapy are given as a pill that you take at home. 

Who needs chemotherapy?

If you are having surgery, your Fred Hutch care team may recommend chemotherapy, targeted therapy or both before surgery. This is done to shrink your tumor. It may be the best choice if any of these is true:

  • The tumor is too large to remove with surgery alone. 
  • You have inflammatory breast cancer or another type that is aggressive or locally advanced. (This means it involves tissue outside but near your breast, like skin or many lymph nodes.)

Shrinking the tumor might mean you can avoid a mastectomy. Instead, you might be able to have a lumpectomy.

Another reason to have chemotherapy (or targeted therapy) before surgery is to see how your cancer responds to the medicine. This may help your team plan your treatment. 

Most people start chemotherapy after they have surgery. If you have early-stage breast cancer, you will probably have four to six cycles of treatment. (Early stage means it is not outside your breast and nearby lymph nodes.) The goal is to keep your cancer from coming back. Chemotherapy may reduce the risk of cancer coming back by 30 to 50 percent.

If cancer has spread beyond your breast to distant parts of your body, doctors often recommend systemic therapies — which include chemotherapy, endocrine therapy and targeted therapies — without surgery. Systemic therapies travel throughout your body and fight cancer cells wherever they may be. The goal is to give you the longest, healthiest life. If your medicine stops working or the side effects are too difficult, you have other options. The next step is to look at switching to another medicine. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Infusion An injection of medications or fluids into a vein over a period of time. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Chemotherapy for breast cancer

We have many chemotherapy options for both early-stage and advanced breast cancers. 
Endocrine therapy for breast cancer

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

Endocrine therapy helps control HR+ breast cancer in two ways. One is that it reduces or blocks the body’s production of hormones. The other is that it reduces or blocks the effects of the hormones. This form of treatment is also called hormonal therapy. 

Who needs endocrine therapy? 

For patients with early-stage HR+ breast cancer, endocrine therapies reduce the risk that the same cancer will come back. They may also lower the chance of getting a new breast cancer.

If HR+ breast cancer is in distant parts of your body, endocrine therapies can help you live longer. They can be effective against tumors for a long time.

Estrogen-receptor blockers 

These medicines bind to estrogen receptors on cells in your breast tissue and keep estrogen from attaching to the cells. This stops cancer cells from being able to grow and divide. The options include medicines called SERMs or SERDs. 

  • SERMS are selective estrogen receptor modulators. Examples are tamoxifen, toremifene and raloxifene. 
  • SERDs are selective estrogen receptor degraders/downregulators. They bind to estrogen receptors and reduce the number and shape of receptors. This makes it harder for cancer to grow and divide. Fulvestrant is a common SERD.

Aromatase inhibitors   

These medicines reduce the amount of estrogen moving through your body. They are helpful in people who have gone through menopause. Options include anastrozole, letrozole and exemestane.

Ovarian suppression   

Before menopause, your physicians might recommend medicine that stops your ovaries from making estrogen. Some examples are leuprolide or goserelin. 
 

Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment.
Endocrine therapy for breast cancer

This treatment is important if your cancer cells have receptors for estrogen or progesterone.
Targeted therapy for breast cancer

Targeted therapies work in one of these ways:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

Sometimes, targeted therapies are a pill that you take at home. Or they can be given by infusion in repeating cycles. They can be used alone or with other treatments. Some can improve the effects of endocrine therapy and are only used along with endocrine therapy.

There are many options for both early-stage and advanced or metastatic breast cancer.

For HER2-positive breast cancer   

Several therapies target breast cancer that is HER2-positive. This means the cancer cells make too much of a protein called HER2/neu. HER-targeted therapies may be given alone or with chemotherapy or another targeted therapy. They include:

  • Ado-trastuzumab emtansine 
  • Fam-trastuzumab deruxtecan 
  • Lapatinib 
  • Neratinib 
  • Pertuzumab 
  • Trastuzumab 
  • Tucatinib 

For HR-positive breast cancer   

Cell-cycle inhibitors are an option for advanced or metastatic breast cancer that is HR+ and HER2-negative. HR+ means the cancer cells have places where hormones can attach. These medicines block proteins in the life cycle of cancer cells. They help stop the growth and spread of breast tumors. Examples include CDK4/6 inhibitors, such as palbociclib, ribociclib or abemaciclib. If cancer cells have changes in the gene PIK3CA, a targeted medication called alpelisib may be recommended.

Everolimus is an mTOR inhibitor. It targets a protein that allows breast cancer cells to grow out of control. Everolimus is sometimes used for patients who are past menopause with advanced cancer that is HR+ and HER2-negative. 

All of these can be used along with endocrine therapy.

For BRCA gene mutations 

Patients with BRCA gene changes may benefit from therapy with PARP inhibitors. These medicines help kill cancer cells by making DNA repair harder for them. Cells that cannot repair their DNA are more likely to be killed by other treatments, like chemotherapy and radiation. PARP inhibitors include olaparib and talazoparib.
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Infusion An injection of medications or fluids into a vein over a period of time. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy for breast cancer

For some cancer subtypes, you may get targeted therapies. These are more exact than chemotherapy, which affects all fast-growing cells throughout the body.
Immunotherapy for breast cancer

A healthy immune system attacks bacteria, viruses and sometimes harmful cells, like cancer cells. It leaves harmless cells alone. Sometimes, cancer cells survive by sending false signals that make them look harmless, which tricks the immune system. 

Medicines called immune checkpoint inhibitors block these false signals. This allows your natural defenses to work better. Immune checkpoint inhibitors are now approved for some patients with triple-negative breast cancer (and many other types of solid tumors). 

Fred Hutchinson Cancer Research Center has been a leader in developing cellular immunotherapy. With this treatment, a patient’s own immune cells (lymphocytes) are genetically changed in a laboratory to attack certain proteins on cancer cells. Examples of cellular immunotherapy include chimeric antigen receptor T cells (CAR T-cell therapy) and T-cell receptor (TCR) therapy. These therapies, while promising, have not been approved for breast cancer yet. Patients may choose to join clinical trials testing these new approaches. 

Which immunotherapy is right for you? 

The options for breast cancer include:

  • Atezolizumab (Tecentriq ®). This is used in people with advanced triple-negative breast cancer that makes the protein PD-L1.
  • Pembrolizumab (Keytruda®). This is used for other cancers that have a certain molecular change called microsatellite instability-high (MSI-H) or DNA mismatch repair deficiency (dMMR). Pembrolizumab is approved for:
    • Patients with advanced triple-negative breast cancer expressing PD-L1 
    • Patients with early-stage triple-negative breast cancer in combination with chemotherapy before surgery 
Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. T cell A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. Also called T lymphocyte and thymocyte. T-cell receptor A group of proteins found on T cells. T-cell receptors bind to certain antigens found on abnormal cells, including cancer cells. This causes the T cells to attack them and helps the body fight the cancer. A group of proteins found on T cells (a type of immune cell that recognizes and binds to foreign substances). T-cell receptors bind to certain antigens (proteins) found on abnormal cells, cancer cells, cells from other organisms and cells infected with a virus or another microorganism. This interaction causes the T cells to attack the abnormal cells and helps the body fight infection, cancer or other diseases. Also called TCR.
Immunotherapy for breast cancer

Immunotherapies use the power of your immune system to find and fight breast cancer cells.
 

Monitoring your health

While you are in active treatment, your breast cancer care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We will update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What are the possible results of treatment?

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain, and complete remission means there are no signs or symptoms.
  • Stable disease: No change in the extent or seriousness. The disease is not going away, but it is not getting worse, either.  
  • Disease progression: The disease is getting worse or spreading.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible.

Disease progression When the disease is getting worse or spreading. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Refractory In medicine, refractory disease is a disease or condition that does not respond to treatment. Relapse The recurrence (return) of disease after an apparent recovery. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stable Cancer that is neither decreasing nor increasing in extent or severity. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Caregiver icon
Caregiving during treatment

If your loved one is getting surgery, radiation therapy or medicine-based treatments for breast cancer, there are many ways you can help. Caregiving during active treatment often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning
Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.

Supportive care services

Along with treating your breast cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn More 
 

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.

Managing side effects

You might be wondering about possible side effects from treatment, like lymphedema after surgery or hair loss from chemotherapy. 

You are always at the center of everything we do. Our breast cancer physicians, nurses and advanced practice providers are here to help prevent or manage the side effects of treatment. 
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
How to get help with side effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us. 

We have many tools to help you feel better, such as:

  • Supportive medications to prevent and treat symptoms, like nausea or constipation
  • Antibiotics, steroids and antiviral drugs to prevent or treat infections
  • Transfusions, vaccines and medicines that stimulate the immune system to treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Physical therapy to help you recover from surgery
  • Conventional and integrative therapies for pain

Learn More 
 

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Steroid A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Common side effects of breast cancer treatment

Side effects are different depending on which treatment you get. They also depend on other factors, like how strong your immune system is. These are some of the common side effects of breast cancer treatment:

  • Lymphedema
  • Swelling and sunburn-like skin changes in areas treated with radiation therapy
  • Unusual tiredness (fatigue)
  • Low blood cell counts, which can raise your risk for infection, easy bleeding and bruising, and fatigue 
  • Nausea and vomiting
  • Diarrhea
  • Loss of appetite
  • Mouth sores
  • Hair loss
  • Changes in menstrual periods or early menopause
  • Loss of fertility
  • Numbness, pain, tingling or other nerve symptoms
Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Continuing care

When your breast cancer is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see Fred Hutch breast health experts. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).
 

Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.
Schedule for follow-up visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your breast cancer team will base your schedule on many things, including:

  • Your breast cancer subtype
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Most patients are followed for at least five years. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on. This will depend on your exact needs.
 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What happens at follow-up visits

Follow-up for breast cancer usually means seeing your medical oncologist for a physical exam and having a mammogram. If there is any cause for concern, you might have other tests or scans. Together, you and your physician will talk about the benefits and risks of any follow-up options and decide what is right for you.

If you had ductal carcinoma in situ (DCIS) or atypia (atypical hyperplasia) as a biopsy result, you will get follow-up care at the Fred Hutch Breast Health Clinic.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.
Women’s Wellness Clinic

After breast cancer treatment, you are on a lifelong journey as a survivor. Many people have the sense of moving into a new stage of life and slowly adjusting to a “new normal.”

When it is time to shift your focus to recovery, we encourage you to come to the Fred Hutch Women’s Wellness Clinic. This clinic offers wellness-focused follow-up. It is for patients who are at least five years out from breast or gynecologic cancer treatment. The clinic is a place for you to get care and services you need under the medical supervision of oncologists you know and trust. 

At the Women’s Wellness Clinic, you can get:

  • Routine checkups, tests and scans as well as breast imaging surveillance. (Surveillance is imaging to find second breast cancers in people who have been treated for breast cancer.) 
  • A wellness plan that covers good nutrition, improved fitness and emotional support.
  • Help dealing with ongoing side effects of cancer treatment, such as lymphedema, anxiety or depression.
  • Advice about what you can do to keep your cancer from coming back.

The clinic also sees people who have been to Fred Hutch’s Breast and Ovarian Cancer Prevention Program (BOCPP). BOCPP is for people at high risk.

Call (206) 606-1422 or (206) 606-7222 for an appointment. The Women’s Wellness Clinic is in the Fred Hutch Wellness Center.
 

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