What to Know About Breast Cancer Management

Second only to skin cancer, breast cancer is the most commonly diagnosed cancer among individuals assigned female at birth (AFAB) in the United States. Although it is most frequently identified in those who are middle-aged and older, it can also occur in younger patients. This article presents an overview of the condition, examines staging and diagnostic methodologies and outlines current treatment approaches.

 

What is breast cancer?

Breast cancer occurs when cells in the breast divide and grow uncontrollably, often forming tumors that can impact the body’s function and overall health. While the majority of breast cancer patients are AFAB, those assigned male at birth (AMAB) can also be affected, though this is rare.

Breast cancer can develop in specific parts of the breast, and its origin often determines how it is classified. Some examples include:

• Lobular carcinoma: Begins in the lobules, which are the glands responsible for producing breast milk.
• Paget disease of the breast: A rare form of cancer that typically starts in the nipple and may extend to the surrounding areola.
• Ductal carcinoma: Originates in the milk ducts, which carry breast milk from the lobules to the nipple. This is the most common type of breast cancer.
• Phyllodes tumor: A rare tumor that develops in the breast’s connective tissue, or stroma, which surrounds the lobules and ducts.
• Angiosarcoma: An uncommon cancer that begins in the lining of blood vessels or lymph vessels within the breast.
• Subtypes: Besides the location of the cancer cells, breast cancer is further categorized by subtype—for example, whether it has specific hormone receptors or proteins that the cancer cells rely on for growth. This subtype is important, as it helps determine treatment methods.

 

Breast cancer diagnosis

There are multiple methods to diagnose breast cancer. Here is a brief overview of each.

Breast exam

Some patients discover breast lumps or irregularities during a self-breast exam, while others may receive a clinical breast exam as part of routine medical care or screenings. The breasts, nipples, underarms and collarbone areas are assessed for abnormalities, lumps or other changes that could indicate a tumor. It’s worth noting that most breast lumps are benign. If a lump is found, additional testing is typically performed.

Breast imaging

There are multiple imaging methods that can help diagnose breast cancer, including:

• Mammograms: Used for both routine screening and diagnostic purposes, this is the most common breast imaging method for identifying lumps and irregularities. It uses low-dose X-ray technology to create internal images of the breast. 2D mammograms are standard, though 3D mammograms may be used when more detail is needed.
• Breast ultrasound: A breast ultrasound uses high-frequency ultrasonic waves that bounce off internal structures and echo back to create images for analysis. It is especially useful for distinguishing between a benign breast cyst and a solid mass.
• Breast MRI: Magnetic resonance imaging (MRI) uses radio waves and strong magnets to create detailed internal images of the breast. It is often used to assess the extent of cancer within the breast and nearby tissues. A contrast agent may be injected to enhance image detail, if needed.

 

 

Biopsy

One of the most definitive ways to diagnose breast cancer is with a biopsy. This involves collecting a small sample of breast tissue to be analyzed in a laboratory for possible cancer cells. It’s typically done using a thin, hollow needle, guided by an MRI or other breast imaging. A fine-needle biopsy may be used for smaller samples, while a core needle biopsy is preferred for collecting larger ones. In rare cases, a surgical biopsy may be performed if the doctor wants to remove the entire lump for analysis. Nearby lymph nodes may also be biopsied to determine whether the cancer has spread.

Often, during the biopsy, a small metal marker is placed in the area where the tissue sample was taken. Because this marker shows up on breast imaging, it serves as a helpful way to monitor and evaluate the specific area for any future changes.

 

How is breast cancer staged?

Breast cancer staging is an important part of both diagnosis and treatment. The tissue sample taken from the biopsy is evaluated not only for cancer cells, but also for details on subtypes and if there are hormone receptors or proteins that are feeding the cancer. This is often called a biomarker test. There are other methods to help stage breast cancer, including:

• CT scans: Computed tomography uses X-rays, similar to mammograms, but compiles numerous images into highly detailed “slices,” making it more effective for assessing how far cancer may have spread.
• PET scans: Positron emission tomography involves injecting a radiotracer made of slightly radioactive sugar into the patient. A gamma camera then tracks how much of the tracer is absorbed by cells. Because cancer cells often absorb more sugar than normal cells, this helps doctors determine whether the cancer has spread. Often, CT and PET scans are performed at the same time.
• Blood tests: These can help evaluate how well organs like the liver and kidneys are functioning, which may offer insight into cancer stage and overall health.

Not all patients will require all of these tests to determine staging. Often the physician will select the ones most applicable to reach a staging diagnosis. Here are the stages to be aware of:

• Stage 0: Abnormal breast cancer cells are confined to the milk duct or lobule and have not yet become invasive.
• Stage 1: Early stage breast cancer that has spread from the milk duct or lobule to nearby breast tissue, and possibly to a lymph node.
• Stage 2: Also considered early stage, this is similar to stage 1 but involves more cancer cells. The tumor may be larger or it may have spread to more lymph nodes.
• Stage 3: This is an invasive breast cancer with a larger tumor and/or greater lymph node involvement. It may also have spread to nearby breast tissue or the chest wall, including areas near the breastbone.
• Stage 4: Also called metastatic breast cancer, this is when the cancer has spread to other areas of the body outside of the breast, such as the brain, bones, liver and other organs.

 

Breast cancer treatment

How breast cancer is treated depends on factors such as stage, type or subtype and grade. Cancer grade is determined by studying biopsied cancer cells and may indicate how fast the cancer is growing. Grade one means the cancer cells look similar to normal cells, suggesting slower growth. Grades two and three are more abnormal in appearance, suggesting faster growth. All of these aspects—including biomarkers and hormone receptors—are taken into account when deciding on treatment. Here are some common treatment methods.

Surgical options

The type of breast cancer surgery will depend on factors such as grading, staging and cancer type. Common surgical methods include:

• Lumpectomy: This breast conserving surgery removes the cancerous area and surrounding tissues, but not the entire breast. It is generally used for smaller tumors or affected regions and is often followed by radiation therapy.
• Mastectomy: This surgery removes the entire breast and can be either a single or double mastectomy. It is typically used for larger tumors or affected areas or in patients with a high risk of recurrence. For those who wish, reconstructive breast surgery may be an option to restore the breast using plastic surgery or other techniques.
• Lymph node removal: If breast cancer has spread to nearby lymph nodes, these may be surgically removed, if necessary.

Chemotherapy

This treatment uses powerful pharmaceutical drugs that may be administered intravenously or in pill form. Chemotherapy is usually given after the surgical removal of the tumor, though it may be used beforehand if the doctor wants to shrink the tumor first. It can also help lower the risk of cancer recurrence or the spread of cancer cells to the lymph nodes. Common side effects may include nausea, fatigue, temporary hair loss and an increased risk of infection.

Hormone therapy

Because some types of breast cancer feed on hormones like estrogen and progesterone, hormone therapy works by blocking these hormones, preventing cancer cells from being fueled by them. Like chemotherapy, hormone therapy is usually given after surgery. It helps reduce the risk of cancer recurrence and is often taken for up to 5 years or more. Possible side effects may include vaginal dryness, hot flashes, night sweats, blood clots and bone thinning.

Targeted therapy

Targeted therapy uses medications that attack specific substances cancer cells rely on to grow, such as the protein HER2. By targeting and blocking HER2, these drugs can cut off the cancer cell’s fuel source, preventing further growth. The type of medication used depends on which substances are being targeted. This therapy may be given before breast cancer surgery to help shrink the tumor, or afterward to reduce the risk of recurrence.

Immunotherapy

Immunotherapy uses special medications to boost the body’s own immune system, helping it more effectively recognize and destroy cancer cells. Since cancer can often hide from the immune system, this treatment helps the body detect and defend against those cells more successfully.

Radiation

Radiation therapy uses strong energy beams, such as protons or X-rays, to destroy cancer cells—often after surgery. There are two types of radiation therapy: external (called external beam radiation therapy) and internal (called brachytherapy). Radiation is often associated with lower rates of cancer recurrence, as it targets and destroys remaining cancer cells after surgery. Common side effects include fatigue, inflammation and sunburn-like skin symptoms.

 

Getting your results

Turnaround times for imaging results can vary widely depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are securely accessible as soon as the report is available, allowing you to review them often before your follow-up visit.

Your imaging results are interpreted by a radiologist—an expert in medical imaging—who carefully reviews your ultrasound and provides a detailed report of any findings. This report is then sent to your referring doctor, who, with a deeper understanding of your medical history, can offer further insights and recommendations.

To better understand your imaging reports, Report Reader provides clear, straightforward definitions for medical terms. Simply tap or click on any underlined words to reveal their meaning. This is paired with illustrations and highlights of anatomy in your imaging to help you better understand your results and prepare for follow-up appointments.

 

 

Frequently asked questions

Here are some common questions regarding breast cancer.

Who is at higher risk for breast cancer?

Understanding breast cancer risk can be important, as high-risk patients may have increased screening recommendations. Several factors may influence a patient’s risk of developing breast cancer, including:

• Family history: If a close relative has had breast or ovarian cancer, it may increase your risk. A personal history of breast cancer also raises the risk in the other breast.
• Gene changes: Mutations in the BRCA1 and BRCA2 genes may raise the breast cancer risk.
• Lifestyle factors: Obesity, frequent alcohol use and a high-fat diet may increase the risk.
• Hormone replacement therapy (HRT): HRT, such as for menopause, may increase the risk of breast cancer in the future.
• Previous radiation therapy: Patients who had medical radiation therapy before age 30 may have an increased risk of breast cancer.
• Race: White AFAB patients tend to have the highest rates of breast cancer, while Black AFAB patients have higher rates of triple-negative breast cancer, which is more aggressive. This type is negative for hormone receptors and doesn’t produce excess HER2 proteins, making it more challenging to treat.

Is genetic testing important for breast cancer patients?

Mutations in the BRCA1 and BRCA2 genes can increase the risk of breast cancer. For patients who have already undergone genetic testing and haven’t developed breast cancer, it may be worth discussing with their doctor whether they should have more frequent cancer screenings to detect potential cancer cells early.

For patients already diagnosed with breast cancer, genetic testing can help guide treatment decisions and offer insight into whether there is a genetic aspect to their diagnosis. This information can also be useful for family members, allowing them to discuss with their medical provider whether they should be tested for mutations.

What should I know about breast cancer recurrence?

Breast cancer recurrence happens when a previous breast cancer returns. It isn’t a new case of cancer—rather, it means that cancer cells from the original diagnosis were not completely eliminated. Over time, these cells can divide and spread again, leading to a recurrence.

All cancer patients face some risk of recurrence, though in most cases, it does not occur. Recurrence rates depend on the original cancer stage, how it was treated and other individualized factors.

How do dense breasts affect breast cancer?

Breasts are composed of both fatty tissue and fibroglandular tissue. When there is less fatty tissue compared to fibroglandular tissue, they may be categorized as dense. Dense breasts can make it more difficult to detect lumps and irregularities during imaging tests, especially a mammogram. They can also increase a patient’s risk of developing breast cancer.

Over 50% of AFAB patients over 40 have dense breasts, making it a common occurrence. A mammogram or other breast screening should indicate whether or not breasts are dense so patients can be aware of any increased risks. If there are concerns or questions, asking a medical provider about next steps may be a good course of action. They may recommend more detailed breast imaging, such as an MRI.

 

Getting support

Regardless of the stage, a breast cancer diagnosis can feel overwhelming. It’s important to remember that you’re not alone and that there are support systems and resources available. Your medical provider will likely be able to connect you with local options. There are also many online support groups and informational resources. Here are some breast cancer organizations that some may find helpful:

• The Susan G. Komen Foundation: They provide financial assistance, educational resources and tips for getting through treatments.
• Breast Cancer Now: A breast cancer research and support charity.
• SurvivingBreastCancer.org: They offer research information, seminars, online groups and even meditation and expressive writing classes.

 

Take control of your health journey

PocketHealth makes it simple to keep track of your breast scans. All of your vital imaging is in one secure location and can be accessed online anytime. Reports can also be easily shared with other physicians in your care team, if needed. Additionally, it makes it easy to track health changes over time, such as with repeat imaging. When used in conjunction with your medical provider’s professional advice, it is a powerful tool for organizing and understanding your imaging results and your health. For Aileen, easy access to her scans also allowed her to keep her husband informed throughout her metastatic breast cancer treatment.

PocketHealth MyCare Navigator gives personalized insights into your health and identifies any recommended follow-up steps. This feature can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation. A breast cancer diagnosis may feel overwhelming, but working closely with your providers can give you the best chance of managing your condition and protecting your health.

Updated: May 15, 2025