Breast Cancer Services at Providence

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With an emphasis on patient dignity and comfort, the Margie Petersen Breast Center at Providence Saint John’s Health Center offers some of the finest breast care in Southern California. We want to change the way women look at breast health and can identify and treat breast issues from pain and discharge to cancer. In fact, we have a dedicated Breast Health Center designed to function like a breast urgent care. Should a person find a lump or change in their breast, this program allows the patient to come in within 24 hours to have an evaluation.

Personalized care

For those diagnosed with breast cancer, we focus on caring for the whole person: mind, body and spirit and provide access to medical expertise, innovative treatments, and support services. Our doctors and nurse navigator make sure to provide each patient, and their families, a comprehensive and personalized path to the most effective treatment. This includes combining quality care with integrated practices such as mindfulness and yoga. From the moment you walk through our doors, you can expect to find compassion and a tranquil environment.

What you can expect from the Margie Petersen Breast Center at Providence Saint John’s Health Center
  • The same comprehensive, cutting edge services offered by major academic centers, provided in the community hospitals you know and trust
  • A team of specialists in every aspect of breast care who collaborate across multiple locations to provide convenient, connected care close to your home or work
  • World-class treatment options, including the latest clinical trials 
  • Personal support, beyond treating the disease, that eases the ripple effects on your emotions and your life

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 the Margie Petersen Breast Center at Providence Saint John’s Health Center 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. Changes in your imaging study may be needed if you are experiencing symptoms.

    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 detect more cancers in patients with all levels of breast density and in all age groups. are more effective in women who are 65 and older.

  • 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 breast implants
  • 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 sometimes make it hard to see subtle findings in a 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.

Already a leader in breast cancer treatment, the Margie Petersen Breast Center at Providence Saint John’s Health Center also offers a cancer prevention program to shift the focus to prevention of breast cancer, especially in those with hereditary risk.

Assessing genetic and hereditary cancer risk

Cancer risk assessment, genetic testing and education are available at the Margie Petersen Breast Center, which employs a full time board-certified physician who is a specialist in clinical cancer genetics, risk assessment and prevention. Our cancer geneticist is able to test for all of the hereditary cancer syndromes with available tests–such as the BRCA mutation test–although nearly 25 different genes are involved in cancer syndromes. Through the Cancer Prevention Program, patients can be assessed for a variety of cancers and testing is not limited to breast cancer alone. For more information about our services, please download our program flier or visit Providence Center for Clinical Genetics and Genomics.

Cancer care tailored for you

At Providence Saint John’s, we believe that treatment is only half of the story and that prevention is the other half. This program is a natural step in our goal of advocating for personalized care by thoroughly assessing individual risk based on both personal and family history, and of providing education and resources to reduce that risk. 

If you are interested in learning more about cancer prevention or want to schedule a cancer risk assessment please call, 310-582-7100.

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.

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 of 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.

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 the Margie Petersen Breast Center at Providence Saint John’s Health Center 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 we 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.

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
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy (endocrine therapy)
  • Targeted therapy
  • Clinical trials
  • Surgery

    There are several options for removing cancer surgically, including removing the entire breast (mastectomy) or just the tumor (lumpectomy or partial mastectomy). 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/Partial mastectomy: 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.

    Oncoplastic surgery: After lumpectomy, the appearance of the breast is sometimes affected by the cavity left behind when the lump was removed. Oncoplastic surgery is a new approach that removes the tumor using plastic surgery incisions and techniques which allows for reshaping of the breast to preserve the breast’s appearance at the time of the cancer procedure. Surgeons completely remove the cancerous area 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.

    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 at the time of cancer 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 of 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.

    Chemotherapy 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.

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:

  • A lump in the breast or armpit area
  • Thickening or redness of the breast skin
  • Swelling in all or part of the breast
  • 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
  • Bloody nipple discharge or unilateral discharge other than breast milk

These symptoms may be signs of breast cancer in men as well as women.

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 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.

The latest research

Thanks to our dedication to advancing health for our breast cancer patients, the breast center offers the most recent medical developments and clinical trials. Clinical trials help doctors and scientists find better ways to diagnose, treat and prevent disease. Individuals who volunteer for clinical trials play an active role in their own health care and help others by advancing medicine.

Many of the physicians and surgeons who are treating and caring for patients in the Margie Petersen Breast Center at Providence Saint John’s are also faculty, adjunct faculty and physicians in a fellowship program affiliated with the Saint John's Cancer Institute. The Saint John's Cancer Institute is a cancer research organization dedicated to the understanding and curing of cancer in order to eliminate patient suffering worldwide.

View some of the current breast oncology research efforts at the Saint John's Cancer Institute.

Learn more

Clinical trials

View a list of clinical trials associated with the Saint John's Cancer Institute and Providence Saint John’s Health Center. See all clinical trials.