One of the most rewarding parts of my job as a general surgeon is caring for patients with cancer, especially breast cancer. With one in eight women being diagnosed with breast cancer in her lifetime, chances are you know someone who has navigated this difficult diagnosis.

With the prevalence of screening mammography for early detection, the survivability of breast cancer has significantly increased over time. Breast cancer death rates declined 42% from 1989–2021 among women. The key is to detect breast cancer before symptoms occur; early detection can lead to survival rates of 93-98%.

It is recommended that women aged 40–76 get a screening mammogram for breast cancer every year. When it comes to screening for breast cancer, early detection can often mean the difference in getting a less invasive surgery or decreasing the chance of needing chemotherapy.

Cancer stages help determine what treatments options are available. Stages look at the extent of cancer in the body and whether it has spread to other parts of the body.

Cancer Stages

• Stage 0: cancer has not spread and is sometimes called noninvasive breast cancer
• Stage 1: cancer is small and has not spread or is in the breast tissue or lymph nodes near the breast
• Stage 2: cancer is a little larger in the breast and lymph nodes close to breast or both
• Stage 3: cancer may be larger and have spread in lymph nodes close to breast, the skin of breast or the chest wall
• Stage 4: cancer has spread to other parts of the body

There are several different types of breast cancer often making a diagnosis complicated to understand. Breast cancer types are classified based on where the cancer begins (such as ducts or lobules), how it grows and specific biological markers that influence treatment decisions.

Common Types of Breast Cancer

• Ductal Carcinoma In Situ (DCIS): non-invasive breast cancer that starts in the milk ducts and has not grown into the rest of the breast tissue. Often treated and referred to as Stage 0 breast cancer.
• Invasive Ductal Carcinoma (IDC): most common type of breast cancer, comprising about 70–80% of all breast cancers. Invasive breast cancer spreads into the surrounding breast tissue.
• Invasive Lobular Carcinoma (ILC): second most common type of breast cancer. Cancer cells start in the lobules and spread to nearby tissue.
• Triple-negative Breast Cancer: aggressive type of breast cancer, accounting for approximately 15% of all breast cancers. These cancer cells don’t have estrogen or progesterone receptors and don’t make any or much of a protein called HER2.
• Inflammatory Breast Cancer: type of invasive cancer that has spread to the breast skin, making the breast feel warm and look red or swollen.
• Metastatic Cancer: cancer that has spread to distant body parts such as bones, lungs or liver.
• Male Breast Cancer: rare cancer accounting for approximately 1% of all breast cancers and often presents as a hard, painless lump.

Treatment typically begins with surgery to remove the tumor and is followed with therapy. Chemotherapy may be used prior to surgery when the tumor is larger to reduce its size for removal or following surgery to ensure all cancer cells are removed. Chemotherapy is often followed by radiation.  The nuances of which treatments are indicated and in what order are usually decided in a collaborative approach between a medical oncologist, surgeon and radiation oncologist.

Types of Surgery

• Lumpectomy is a breast-conserving surgery that removes the tumor with a small amount of healthy tissue.
• Mastectomy is a removal of the entire breast, including nipple and skin; typically recommended with larger tumors, multiple areas of cancer or if the patient has a predisposition.
• Sentinel Lymph Node Biopsy is a surgery where a limited number of lymph nodes are removed in the underarm closest to the tumor for cancer testing and staging, to help determine what additional treatment is needed after surgery.

Types of Cancer Therapy

• Radiation: typically provided to the breast or chest wall where breast was removed to reduce the chance of breast cancer returning.
• Chemotherapy: can begin before or after surgery, depending on size and location of the tumor.
• Hormone Therapy: can begin before or after surgery and may be given if premenopausal.
• Immunotherapy: is given when there is a lack of hormone receptors.
• Targeted Therapy: may be given at different times in your treatment and may also be used if surgery is not recommended.

Many factors can help determine your treatment plan which include hormonal exposure, menopause, pregnancy, age and preference. It is important to discuss options for treatment with your provider.

If you or someone you love are facing breast cancer, please know that you are not alone. As a surgeon, I have the privilege of walking alongside patients during some of the most difficult moments of their lives, and I am continually inspired by their resilience and strength. There is no one-size-fits-all path, and you deserve care that is thoughtful, compassionate and tailored to your needs. If you have questions, I am here for you—ready to help you navigate the road ahead with compassion and hope. Call 360.293.5142 to schedule an appointment.