Breast Cancer Services at Providence

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Providence Cancer Institute Orange County

Providence Cancer Institute Orange County

Where bright minds and big hearts come together

At Providence, we see more than a patient with a breast cancer diagnosis, we see the life you’re fighting for — and we have for nearly 100 years. That’s how long we’ve been providing world-class cancer care in Orange County. Today, we’ve strengthened our commitment to you by integrating three nationally accredited cancer programs — Mission, St. Joseph and St. Jude.

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Recognized and accredited for the best cancer care and treatment options available.

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Cancer navigators who provide individual support, compassionate care and coordination every step of your cancer journey.

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Access to the most advanced technology and treatment options, including research, precision medicine, genetic counseling and clinical trials.

Every woman is at risk for breast cancer. One in eight will develop the disease, and 85% of those who are diagnosed have no family history of breast cancer. This is why Providence encourages every woman to talk to her doctor, beginning at age 40, about when to start breast cancer screening through regular mammograms.

The benefits of early detection

Early detection is the best defense against breast cancer. When breast cancer is found early, before it has spread beyond the breast, the five-year survival rate is nearly 100%.

Regular screening can help detect breast cancer before you might notice any symptoms. Providence offers these lifesaving screenings in multiple locations throughout Southern California. Using the advanced imaging and diagnostic technologies listed below, Providence’s dedicated breast radiologists are able to discover small cancers in their earliest, most treatable stages. Throughout your screening visit, our emphasis is on your comfort, privacy and dignity.

Types of screening
  • Mammography

    Screening mammogram: This routine screening tool takes low-energy X-ray images of the breasts to look for early signs of cancer in women who aren’t having any symptoms. The goal of this procedure is to detect cancer as early as possible. Thanks to the increase in women who routinely get screening mammograms, more breast cancers today are being caught in the earliest, most treatable stages.

    If you have a screening mammogram scheduled, but you develop a symptom before your appointment, please let the technologist know before the start of your exam.

    Diagnostic mammogram: If you have a breast lump or other breast symptoms, or if a screening mammogram has revealed something unusual, your doctor may schedule a diagnostic mammogram. This is the same as a screening mammogram, except that the X-rays will focus specifically on the suspicious area, taking magnified images from several angles.

    Diagnostic mammograms can help determine whether the area in question is normal or requires further testing. Fortunately, most painful breast lumps, as well as “calcifications” found on mammograms, are not cancer. 

    3D digital mammogram: In 3D mammography, also known as digital tomosynthesis, the procedure is similar to getting a standard 2D mammogram. The difference is that the X-ray takes more images and combines them to create a clearer, three-dimensional view of the breast. Studies have found that 3D mammograms identify more cancers, result in fewer false positives, and are more effective in women who are 65 and older. They also may be more beneficial than 2D mammograms for women with dense breast tissue.

  • Breast ultrasound

    Breast ultrasound: This imaging technique is often used after a mammogram to provide more information, such as whether a lump is solid (potential cancer) or filled with fluid (a cyst). During this painless procedure, a lubricating jelly is spread over the area to be evaluated, and a wand-like instrument is moved over the area, sending sound waves into the breast, which then reflect an image of the area onto a screen.

    Automated breast ultrasound: Automated breast ultrasound is an automated machine that uses ultrasounds to look at breast tissue. As a screening tool it is most useful in women who have dense breast tissue done in conjunction with their screening mammogram. Dense breast tissue can sometime make it hard to see subtle finding in at mammogram. This technique has been shown to be helpful as an additional screening tool since is allows for detection of small masses or lumps despite the density of the breast tissue.

  • Breast MRI

    Breast MRI: Magnetic resonance imaging uses magnets and radio waves rather than X-rays, so it doesn’t involve any radiation. It takes longer than a mammogram — about 30-45 minutes — and may be used to more closely evaluate patients in special circumstances. These may include patients who:

    • Are at especially high risk for breast cancer
    • Have been newly diagnosed with breast cancer
    • Are at risk for recurrence after treatment
    • Have had abnormal findings on a mammogram or ultrasound
    • Have silicone breast implants

Providence provides expertise in treating all types of breast cancer, including rare forms.

  • Ductal cancers start in the ducts that carry milk to the nipple.
  • Lobular cancers start in the glands, or “lobules,” that produce milk.
  • In situ indicates abnormal or cancerous cells that have not spread beyond the duct or gland.
  • Infiltrating or invasive cancers have spread into surrounding breast tissue.
  • Metastatic cancers have spread beyond the breast and nearby lymph nodes to other parts of the body.

Providence provides expertise in treating all types of breast cancer, including rare forms. The cancers we treat include, but are not limited to:

  • Infiltrating ductal carcinoma (IDC): This is the most common type, making up 70-80% of all breast cancers. It begins in the lining of the milk ducts and then grows through the ducts into the nearby breast tissue. If not treated, it can spread, or metastasize, to other parts of the body.
  • Ductal carcinoma in situ (DCIS): This is a non- or pre-invasive cancer that is still confined to the milk ducts, but that may become invasive.
  • Infiltrating lobular carcinoma (ILC): Another common form of breast cancer, this type begins in the lining of the milk-producing glands and grows into the breast tissue. Without treatment, it can spread outside the breast.
  • Lobular carcinoma in situ (LCIS): These abnormal cells, confined to the milk glands, are not technically considered cancer and don’t typically become invasive. However, they do increase the risk of developing cancer in either breast in the future. 
  • Inflammatory breast cancer (IBC): In this rare and very aggressive disease, cancer cells block the lymph vessels of the breast skin, causing inflammation, swelling, redness and thickening of the skin. This fast-spreading cancer can metastasize without quick treatment. About 1-5% of breast cancers are inflammatory.
  • Metastatic breast cancer (MBC): While breast cancers that have spread to other parts of the body can’t be cured, there are many treatments that can help keep them under control for years.

As a leading health organization spanning six states, Providence leverages a vast network of expertise and the most advanced therapies available to treat breast cancer. And as a caring community throughout Southern California, we provide that care in trusted Orange County hospitals, where your comfort and humanity are always respected. All three of our Orange County hospitals have been accredited by the American College of Surgeons Commission on Cancer and St. Jude and Mission have been recognized by the National Accreditation Program for Breast Cancer.

Our approach

Your personalized treatment plan will depend on factors that are unique to you, from your specific diagnosis to your personal health and preferences. But one thing that most patients can count on is that it will take a team. And that’s where Providence shines.

Your team may include multiple experts who specialize in very specific aspects of treatment, as well as nurses, dietitians, counselors and others, all collaborating on your care. Collaboration is key, and they do it well. One way is through regular case review meetings, where members of your team, as well as Providence experts from outside your team, gather to review patient cases and to share clinical opinions, recommend treatments or symptom-management strategies, suggest opportunities for clinical trials and optimize care coordination.

If this starts to feel overwhelming, rest assured — we’ve got you. To help guide you through the whole process, we team you up with one person — a breast cancer navigator. Your navigator will sit with you through consultations, if you like, and can help schedule appointments, answer your questions, refer you to helpful support services, provide emotional support and much more to help ease the stress of cancer treatment. As one navigator put it, “You’ve got me for the duration.”

Types of treatment

From the latest targeted therapies to the most innovative approaches emerging through clinical trials, Providence leverages the full power of today’s most advanced, evidence-based therapies to treat breast cancer. Your personalized treatment plan may include any or all of the following:

  • Surgery

    There are several options for removing cancer surgically, including removing the entire breast (mastectomy) or just the tumor (lumpectomy or oncoplasty). Your breast surgeon will explain the options and help you decide which approach is best for your cancer, based on its size and location and your medical history.

    • Lumpectomy: Also called breast-conserving surgery, this operation removes only the tumor, as well as a small “margin” of surrounding tissue to make sure no cancer cells are left behind. Lumpectomy is usually followed by radiation therapy to prevent recurrence near the site of the original cancer. It is often recommended for smaller, early-stage breast cancers, since it is a less-extensive surgery and preserves most of the breast. When paired with radiation, lumpectomy has the same survival rate as mastectomy in people who are candidates for both procedures.
    • Oncoplasty: After lumpectomy, the appearance of the breast is sometimes affected by the cavity left behind when the lump was removed. Oncoplasty is a new option that removes the tumor and preserves the breast’s appearance in a single procedure. Surgeons completely remove the cancerous mass and then reshape the remaining breast tissue, without implants, to fill the gap left by the extracted tumor.
    • Mastectomy: This surgery removes the entire breast, including all of the breast tissue and, in some cases, nearby tissues. Mastectomy is often recommended when there is a large tumor or when the cancer affects more than one area of the breast. Radiation therapy may not be needed after a mastectomy, but it’s sometimes recommended if there are concerns about cancer cells that might remain in the area.
    • Sentinel node biopsy: The "sentinel node" is the first lymph node draining from a breast tumor. If cancer spreads into the lymph nodes, the sentinel node is the first and most likely node to be affected. In a sentinel node biopsy, the surgeon removes this node and looks for cancer cells. If there aren’t any, then no further lymph node surgery is needed. If cancer cells are found in the sentinel node, then more lymph nodes may need to be removed to check for further cancer spread.
    • Reconstructive surgery: Reconstructive surgery is an option for restoring the appearance of the breast after cancer surgery, either with implants or with tissue taken from another part of your body. Sometimes this can be done right after your cancer surgery, sometimes it’s done later, and sometimes it’s done in stages. Be sure to consult with a plastic surgeon before your breast cancer surgery if you might be considering reconstruction.
  • Radiation therapy

    Radiation therapy is an effective way to destroy cancer cells and reduce cancer recurrence. Radiation is carefully directed to reach cancer cells with as little harm as possible to nearby healthy tissues. This therapy is usually given after breast cancer surgery, to eliminate any cancer cells left behind, but in some cases, it is used earlier to shrink tumors before surgery.

    Providence’s radiation oncologists offer expertise in the most advanced radiation therapies, including these:

    • External beam radiation therapy (EBRT): the most common type of radiation therapy for breast cancer, EBRT uses a high-tech X-ray machine to deliver radiation to the cancer site.
    • Intraoperative radiation therapy (IORT): this treatment takes place in the operating room, right after surgery, using sophisticated equipment to apply a single, large dose of radiation directly to the tumor site. Providence St. Joseph was the first hospital in Orange County to offer IORT.
    • Intensity-modulated radiotherapy (IMRT): this technology delivers radiation very precisely to the tumor area, allowing the intensity of the beams to be adjusted for specific areas and reducing the effects on healthy tissues.
    • Brachytherapy: this type of therapy delivers radiation from a device implanted inside the breast, rather than from a machine outside the breast.
  • Chemotherapy

    Unlike radiation, which focuses on the area where your cancer occurred, chemotherapy is “systemic,” which means that it travels throughout your body, looking for stray cancer cells anywhere that they might have spread.

    Chemo involves taking anti-cancer drugs, either intravenously or as pills, to kill cancer cells. It might be used after surgery (“adjuvant” therapy means after surgery) to reduce the risk of breast cancer returning; before surgery (“neoadjuvant” therapy means before surgery) to shrink a tumor and make it easier to remove; or as the main treatment to manage advanced breast cancer. The specific chemotherapy regimen that your medical oncologist prescribes for you will depend on the type and stage of your cancer and your general health.

  • Hormone therapy (endocrine therapy)

    About two out of three breast cancers are fueled by female hormones. We describe these cancers as estrogen-receptor (ER) positive or progesterone-receptor (PR) positive. It means that the cancer cells have receptors on them that react to these hormones in a way that encourages the cancer to grow and spread.

    Hormone therapy, also called endocrine therapy, interferes with this reaction, either by lowering estrogen levels or by blocking the receptors from being affected by the hormones. It is usually taken as a pill for at least five to 10 years to reduce the risk of cancer coming back. It also may be used to treat cancer that has returned or spread.

  • Targeted therapy

    Like chemotherapy, targeted therapy is systemic, traveling through the bloodstream to find cancer wherever it may have spread. But this newer type of therapy works differently, targeting and blocking the specific mechanisms that encourage cancer cells to grow.

    For example, one in five breast cancers is HER2-positive, meaning that the cancer cells carry a protein on their surface called HER2, which makes cancer grow and spread more aggressively. One of the first effective targeted therapies developed for breast cancer, Herceptin (trastuzumab), targets this protein and binds with it, blocking its action. Other targeted therapies block other ways that cancers grow, such as preventing them from forming new blood vessels.

  • Clinical trials

    Clinical trials test the safety and effectiveness of new cancer drugs and treatments. They help us find better ways to prevent, diagnose, or treat cancer. Nearly all cancer treatments used today began with clinical trials. Learn more about clinical trials in Orange County.

The earlier breast cancer is found, the better the chances of successful treatment. That’s why it’s so important to pay attention to any changes in your breasts that could be signs of breast cancer. Understanding what is normal for your breasts, and what isn’t, can be lifesaving.

Symptoms to pay attention to

In the very earliest stages, breast cancer has no outward symptoms. Sometimes the earliest sign is a tiny lump, or mass, that’s detectable only on a mammogram. As the disease progresses, however, more noticeable changes might appear. These can vary widely — while a lump is the most common symptom, it is by no means the only one. Any of the following changes could be a warning sign of breast cancer.  These symptoms may be signs of breast cancer in men as well as women:

  • A lump in the breast or armpit area
  • Thickening or redness of the breast skin
  • Swelling in all or part of the breast
  • A breast that feels warm or itchy
  • Dimpling, puckering, irritation or scaliness of the breast skin or nipple
  • Pain or tenderness in the breast or nipple
  • A nipple that turns inward, flattens out, pulls to one side or changes direction
  • Nipple discharge other than breast milk
What to do if you have symptoms

If you notice a potential symptom of breast cancer, or if you’re concerned about any changes in the way one of your breasts looks or feels, please call your primary care provider or breast care specialist. While these symptoms don’t always indicate cancer — sometimes they are signs of something less serious, such as a cyst or an infection — it’s important to have a Providence physician evaluate them right away. Don’t wait to see if they go away on their own. It bears repeating: treating breast cancer successfully is much easier when it’s caught and treated early.

A breast cancer diagnosis can have ripple effects that extend beyond your physical health. Both the diagnosis and the treatment process can wear on you emotionally, financially and personally. At Providence, we treat the whole person, not just the cancer. Throughout your care, you’ll have access to a wide variety of helpful and supportive services, such as these:

  • Cancer navigators
  • Counseling
  • Social work services
  • Financial counseling
  • Support groups and wellness groups
  • Appearance centers (for prostheses, wigs, specialized clothing, cosmetics)
  • Inpatient and outpatient rehabilitation
  • Nutrition services
  • Home health care
  • Palliative care
  • Hospice
Genetic Counseling, Genetic Testing, and Genetic Risk Assessment

Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance. Utilizing advanced conversational AI technology called a CARE chatbot, we screen every patient undergoing mammography.

We screen every patient undergoing a screening or diagnostic mammogram for breast cancer risk. A Tyrer-Cuzick (TC) lifetime risk of developing breast cancer score is calculated and updated annually. Women with calculated lifetime risk of 20% or higher are recommended to consider screening with annual breast MRI in addition to annual mammography, which can provide the highest sensitivity in detecting breast cancer.

We screen every patient undergoing a screening or diagnostic mammogram for inherited risk to identify individuals who meet criteria for cancer genetic risk assessment due to personal and family history of cancer. Patients who meet National Comprehensive Cancer Network (NCCN) Genetic/Familial Risk criteria are given additional information and are contacted by our genetics program for appropriate follow up.

Genetic counseling and testing are available for all hereditary cancer syndromes and familial patterns of cancer. To deliver precision medicine, our genetic counselors combine genetic test results, personal factors, family history, and counseling to generate a personalized genetic risk assessment with estimates of future cancer risks for both individuals and family members. The process of genetic counseling creates risk estimates of increased accuracy as well as improved patient and physician understanding, which leads to individualized medical management, empowered cancer prevention, and appropriate risk reduction strategies.

We offer multiple service options to meet individual needs for genetic testing including:

  • In-person appointments, telehealth appointments, mammography and walk-in clinics.
  • Full-service genetic counseling for comprehensive pre-test and post-test engagement.
  • Walk-in genetics clinics with rapid sample collection for convenient genetic testing that includes expert coordination and oversight by a licensed board-certified genetic counselor.
  • Post-test genetic counseling for individuals who have had previous genetic testing and would like an updated or expert interpretation of their results, would like to consider having updated or additional testing, or would benefit from having a formal comprehensive risk assessment.

We welcome your questions! Call 833-923-3550 for more information or complete the online form.

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