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What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in the breast. These cancer cells can spread within the breast to nearby lymph nodes and other tissues and parts of the body. Besides skin cancers, breast cancer is the most frequently diagnosed cancer in women. Regular screening mammograms should be routine even if you don't have any breast cancer symptoms. Mammograms can detect early variations in breast tissue and help catch breast cancer in its earliest, most curable stages.

Types of breast cancer include:

  • Ductal carcinoma—Beginning in the lining of the ducts, this is the most common form of breast cancer. Ductal carcinoma in situ has not spread beyond the milk duct into surrounding tissue. Invasive ductal carcinoma is a cancer that has spread through the wall of the milk duct and has begun to invade the tissues of the breast
  • Lobular carcinoma—Another common type of breast cancer which occurs in the lobules (milk-producing glands). Lobular carcinoma in situ is when the cancer remains inside the lobule and has not spread to surrounding tissues. Invasive lobular carcinoma begins in the milk-carrying ducts and spreads beyond them.
  • Paget's disease—A rare form of breast cancer that starts in the glands in or underneath the skin. It is often identified by irritated, red patches on the skin. The patches can appear in sweat glands, in the groin or near the anus. Paget’s disease originates from breast duct cancer, which is why the eczema-like cancer typically appears around the nipple.
  • Inflammatory breast cancer—A rare, invasive breast cancer. Typically, there is no lump or tumor; instead, this cancer gives the skin of the breast a red look and a warm sensation. The breast skin also has a thick and bumpy appearance, similar to an orange peel.
  • Triple negative breast cancers—These are types of breast cancer that don’t have estrogen receptors and progesterone​ receptors and do not have additional amounts of the HER2 protein on the surface of the cancer cells. These breast cancers are common in younger women and in African-American women. They have a tendency to spread faster than other types of breast cancer.
  • Phyllodes tumors—Rare breast tumors that contain two types of breast tissue: stromal (connective) tissue and glandular (lobule and duct) tissue. When breast cancer spreads outside the breast, cancer cells can be found in the lymph nodes under the arm. When cancer has reached these nodes, it could mean that cancer cells have spread to other parts of your body.

Cancer that spreads is still the same disease and has the same name as the primary, or original, cancer. When breast cancer spreads, it is referred to as metastatic breast cancer, despite the fact that the secondary tumor is in another organ. This can also be referred to as "distant" disease.

Our approach

Northwell Health takes a comprehensive approach to treating breast cancer at the dedicated Breast Cancer Center, part of the Northwell Health Cancer Institute, which has achieved accreditation by the National Accreditation Program for Breast Centers (NAPBC). Our multidisciplinary team of specialists has unparalleled experience diagnosing and treating a high volume of breast cancers at one of the largest cancer programs in the New York metro area.

We offer specialized therapies available at only a few cancer centers in the nation, including: 

  • Tomosynthesis (3D mammography)
  • Full field digital mammography (FFDM)
  • Ultrasonography

Our Breast Cancer Center provides the most advanced diagnostic mammograms for women with current symptoms or previous breast cancer. If you have been diagnosed with breast cancer, our oncologists can explain all your treatment options and create a treatment plan tailored to your specific needs and goals. Throughout your treatment, you will work closely with a multidisciplinary, integrated team of specialists in medical oncology, surgical oncology and radiation oncology who collaborate to ensure seamless coordination of your care.

Because every breast cancer diagnosis is unique, the physicians providing your treatment will meet once a week to share ideas and review every step of your care. Convenience is also a primary focus throughout your treatment, so every effort is made to provide services in one location. 

Research at Northwell

As part of your breast cancer treatment plan, you may have opportunities to participate in clinical trials. These trials study new chemotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

It is important to see your doctor if you experience symptoms of breast cancer, such as:

  • A lump or thickening in or near the breast or in the underarm area
  • Changes in the breast size or shape
  • A dimple or puckering in the breast skin

Be aware that these symptoms could be due to conditions other than breast cancer, so it’s best to see a doctor right away. It’s important to see your doctor if you have any of these symptoms, even if you have had a mammogram that was negative.

Causes

Doctors don't know exactly what causes breast cancer. But some things are known to increase the chance that you will get it, such as your age and health history.

Risk factors

Factors that can contribute to your risk of developing breast cancer include:

  • Family history
  • Inherited genes, such as the BRCA1 and BRCA2 genes
  • Radiation exposure

With genetic testing, you may be able to learn more about your specific breast cancer risk. Learn more about genetic counseling at Northwell Health.

How common is it?

Breast cancer is one of the most common cancers in women. The lifetime risk of breast cancer for families with BRCA1 mutations can be as high as 80 percent, whereas BRCA2 risks can be around 45 percent.

Diagnosis

The first step in making a diagnosis of breast cancer is education. Knowing the right time to self-exam and addressing any concerns in a timely manner is key for early detection and early treatment.

Your doctor’s first step in the diagnostic process is usually a physical, which is when a doctor examines the breasts and surrounding areas to detect enlarged lumps, nodules, swelling or thickening of breast tissue.

Specialists use a variety of tests, typically outpatient procedures, to deliver an accurate breast cancer diagnosis. These include: 

  • Screening mammogram—As you age, our experts believe it is vital to get a screening mammogram every year. This is a crucial step toward early detection of breast cancer.
  • Diagnostic mammogram—Mammograms can also be used to diagnose breast cancer when a lump or other abnormality is found.
  • 3D mammography (digital breast tomosynthesis)—3D technology is used to detect lesions and reduce false alarms.
  • Full field digital mammography (FFDM)—FFDM produces exceptionally sharp digital images with less radiation exposure.
  • Ultrasonography—High-frequency sound waves determine if a mass is benign or suspicious.
  • MRI scan (magnetic resonance imaging)—A powerful magnet, radio waves and computer imaging combine to create highly detailed 3D breast tissue images.
  • CT or CAT scan (computerized axial tomography)—A combination of X-rays and computer technology produces detailed 3D images to determine whether the cancer has spread.
  • PET scan (positron emission tomography)—Small amounts of radioactive sugar are injected to highlight cancer and see whether it has spread.
  • Bone scan—An injection of low-level radioactive material helps detect if breast cancer has spread to the bones.
  • Biopsy—Choosing from different types of biopsies, a doctor takes a tissue sample for further examination under a microscope by a pathologist to determine the type of cancer.
  • Lab tests—If breast cancer is discovered, additional tests will be given to gather additional information about the cancer:

Hormone receptor tests are also used to measure the amount of estrogen and progesterone receptors that are in the cancer tissue. More estrogen and progesterone receptors than normal mean the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.

Genetic tests are also conducted to measure the activity of genes and whether certain proteins are evident in tissue. These tests determine whether the cancer will spread more quickly and narrow down options for treatment.

Treatment types

As one of the most progressive breast cancer centers in the country, the Northwell Health Cancer Institute gives you access to the most advanced, least-invasive breast cancer treatments, including:

Surgery—Surgery is used to remove breast cancer tumors, some of the surrounding healthy tissue and sometimes nearby lymph nodes. Types of surgery include lumpectomy (to remove the tumor and a small, cancer-free margin of healthy tissue around the tumor) and mastectomy (the surgical removal of the entire breast). If you undergo a lumpectomy or mastectomy, breast reconstruction is an option. In some cases, reconstruction can happen at the same time, known as immediate reconstruction.

Chemotherapy—Used to destroy cancer cells by stopping their ability to grow and divide, chemotherapy can be given before breast cancer surgery to shrink a large tumor or after surgery to reduce the risk of recurrence. Chemotherapy is often used in conjunction with radiation therapy, following surgery. 

Hormonal therapy—For some women who have tested positive for either estrogen or progesterone receptors, hormonal therapy can be an effective treatment to shrink tumors and make surgery easier.  

Targeted therapy—These are advanced treatments that target the genes, proteins or tissue environment that contribute to the growth of the cancer. 

Radiation—Radiation therapy uses high energy X-rays or other particles to destroy cancer cells. As part of your treatment team, you may have a radiation oncologist who will plan and administer this treatment.

At the Northwell Health Cancer institute, you will have access to the most advanced radiation therapy treatments, including:

  • Brachytherapy—An internal form of radiation therapy used to place radiation inside or next to the area requiring treatment
  • Hypofraction radiation therapy—A type of radiation therapy that is effective as whole breast radiation therapy but is administered over a shorter period of time
  • Intensity-modulated radiation therapy—An advanced way to give external beam radiation therapy to the breast
  • Partial breast irradiation—Radiation therapy given directly to a targeted tumor area, instead of the entire breast
  • Prone breast radiation therapy—A unique approach to radiation treatment that is administered as you lie face down, to lessen the amount of damage to surrounding breast tissue
  • Proton therapy—A type of external-beam radiation therapy that uses protons instead of x-rays to destroy cancer cells

Living with breast cancer

  • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects.
  • Follow your doctor’s instructions to relieve pain. Pain from cancer and surgery can almost always be controlled. Use pain medicine when you first notice pain, before it becomes severe.
  • Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
  • Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
  • Do not smoke. Smoking can make your cancer worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Take steps to control your stress and workload. Learn relaxation techniques.
    • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
    • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
    • Express yourself through art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
    • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and can help reduce stress.
    • Get help if you need it. Discuss your concerns with your doctor or counselor.
  • If you are vomiting or have diarrhea:
    • Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
  • If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.
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