Breast Cancer

Breast cancer is the most common non-skin cancer among women in the United States. It is the second leading cause of cancer death in women. Approximately 200,000 new invasive breast cancers will be diagnosed this year. The chance of a woman developing breast cancer some time during her life is approximately one in eight.

Breast cancer can present as either non-invasive (in situ) or invasive forms. Another name for non-invasive breast cancer is ductal carcinoma in situ (DCIS). DCIS is confined to the milk ducts. While it is a type of cancer, it rarely spreads to other parts of the body. Treatment for this type of cancer is almost always successful. Lobular Carcinoma in Situ (LCIS) refers to a condition which is a marker of increased risk for developing breast cancer but itself is not considered malignant.

 Invasive breast cancer refers to cancer that has already invaded or spread beyond the milk ducts or breast lobules of the breast and therefore has the potential to spread to lymph nodes or other parts of the body. Invasive breast cancer typically comes in one of two forms: invasive ductal cancer and invasive lobular cancer. The more common type of invasive breast cancer is the ductal type. Both of these are typically treated by surgery, possibly in combination with radiation therapy, chemotherapy, and/or hormone therapy.

Other types of breast cancer such as inflammatory breast cancer require special considerations in planning treatment. In addition, conditions that increase the risk of developing invasive breast cancer such as LCIS should be managed by those who have expertise in advising risk reduction strategies.

Men can also develop breast cancer, though this is quite rare and occurs approximately 1% as often as in women. Approximately 2,000 new cases of invasive male breast cancer will be diagnosed each year in the United States. Overall, the lifetime risk of developing breast cancer for a man is approximately 1 in 1,000.

Symptoms of Breast Cancer

Symptoms or signs which may indicate there is an underlying cancer include:

  • New breast mass
  • Swelling in part or all of the breast
  • Skin dimpling
  • Nipple discharge that may be clear or bloody
  • Bleeding/crusting of the nipple
  • Localized breast pain
  • Skin changes of the breast including thickening, scaling, redness or ulceration
  • Swollen lymph nodes under the arm

Even for women without symptoms, it is recommended that all women have mammograms on a regular basis since breast cancer is often detected by mammography before any symptoms develop. Screening guidelines are the subject of much discussion currently and vary among organizations however annual mammographic screening for women over the age of 40 has been advised by some for women of average risk. Screening for women at increased risk of breast cancer should be discussed with a physician as it often starts at an earlier age and may include the use of MRI.

Risk Factors for Breast Cancer

Breast cancer, like many other cancers, increases in frequency with age. A majority, approximately 85% of cases, occur in women age 50 or older.

Other risk factors are listed below:

  • Personal history of breast cancer. Individuals who have experienced breast cancer once are at increased risk of developing a second breast cancer. The risk of developing a second breast cancer is about ½% to 1% per year for patients who have had breast cancer once.
  • Individuals with a family history of breast or ovarian cancer are at a higher risk of developing breast cancer themselves. Women with an especially strong history (i.e. two or more first degree relatives with breast or ovarian cancer) may have a greater than 50% chance of developing breast cancer and are commonly referred for genetic consultation and testing.
  • There are heritable risk factors that may involve a genetic mutation in genes such as BRCA1 or BRCA2 or other genes such as p53 or PTEN. Genetic testing is available for BRCA and other mutations and may be obtained, if warranted, after careful discussion with your physician.

Other risk factors are as follows:

  • Women who have taken hormone replacement therapy, especially those women taking a combination of an estrogen and progestagen for more than 2-3 years.
  • Women who have had radiation to the chest, particularly during teenage years and early adulthood are at increased risk of developing breast cancer.
  • Women with a history of increased breast density on mammography appear to be at an increased risk of developing breast cancer.
  • Women who have undergone breast biopsy, primarily those women with a finding of atypical hyperplasia on a biopsy may have an increased risk of developing breast cancer. Common breast conditions such as fibrocystic change or fibroadenoma do not appear to increase a woman’s risk of developing breast cancer.
  • Prolonged estrogen exposure - such as earlier age at onset of menses or later age at onset of menopause - both result in longer lifetime exposure to estrogen and may increase a woman’s risk of developing breast cancer.
  • Similarly, women who have never given birth and women who have their first child after the age of 30 have an increased risk of breast cancer as compared to women with multiple births or women who give birth before the age of 30. Breast-feeding may reduce a woman’s risk of breast cancer.
  • The use of hormone replacement therapy, specifically the combination of estrogen and progestin, for five or more years, has been associated with an increased risk of breast cancer in women.
  • Alcohol consumption has been associated with an increased risk of breast cancer. The consumption of certain alcoholic beverages has been associated with some protective effects in other diseases and thus, the overall risk and benefits of consuming alcohol containing beverages should be discussed with a physician.
  • There are other factors that have been associated with the risk of developing breast cancer although the reasons remain unclear. Women of higher socioeconomic status may be more likely to develop breast cancer. In addition, smoking appears to increase a woman’s lifetime risk of breast cancer.

How Breast Cancer is diagnosed

A suspicious breast abnormality is often first identified by mammography. An ultrasound or a magnetic resonance image (MRI) may be obtained to further characterize the abnormality.

In order to make the diagnosis, a piece of tissue must be obtained – called a breast biopsy. This is often done by the surgeon in the office, using either a fine needle or core needle and with local anesthesia. Increasingly, more and more breast biopsies are done by the radiologist following an abnormal mammogram or ultrasound. A suspicious breast mass or cluster of calcifications is seen by the radiologist, and either a stereotactic core biopsy (for an abnormal mammogram) or an ultrasound-guided core biopsy (for an abnormal ultrasound) is recommended.

Occasionally, patients may still need an open surgical biopsy to establish the diagnosis of cancer. Once the biopsy is completed, the tissue is then sent to the pathology lab to be examined under the microscope. The tissue is evaluated to determine if it is malignant, and special stains may be ordered to determine the exact type and options for treatment.

The role of breast self examination is detecting early stage breast cancer is controversial and its value should be discussed with a physician. One should not rely on breast self examination alone to screen for breast cancer.

Treatment Options for Breast Cancer at Tufts Medical Center

The treatment for breast cancer is individualized for each woman and is primarily based upon stage and the age of the patient. The stages range from Stage 0 (non invasive) to Stage IV with the lower numbers corresponding to less advanced disease. Options for treatment include surgery, radiation, and chemotherapy and hormone therapy. These options can be combined in a variety of ways to best treat each individual. For patients with hormone sensitive breast cancer, hormone therapy, such as tamoxifen and aromatase inhibitors, may frequently be used for prolonged periods of time to help reduce the risk of cancer from coming back.

Programs + Services


Cancer Center

Cancer Center at Tufts Medical Center
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Breast Health Center

Discover the Breast Health Center at Tufts Medical Center in Boston and learn about treatment for patients with a breast cancer diagnosis and other breast diseases.
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Doctors + Care Team

Rachel J. Buchsbaum, MD

Rachel J. Buchsbaum, MD

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Accepting New Patients

Virtual Appointments Available

Title(s): Director of the Cancer Center; Chief, Division of Hematology/Oncology; Hematologist/Oncologist, Breast Health Center; Fellowship Program Director, Tufts Medical Center; Dr. Jane F. Desforges, MD, Chair in Hematology/Oncology and Professor of Medicine, Tufts University School of Medicine; Professor of Genetics, Graduate School of Biomedical Sciences, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-5757
Fax #: 617-636-2342

Breast cancer therapy, risk assessment and prevention

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David E. Wazer, MD

David E. Wazer, MD

Virtual Appointments Available

Title(s): Radiation Oncologist-in-Chief and Chair, Department of Radiation Oncology, Tufts Medical Center; Chair and Professor, Department of Radiation Oncology, Tufts University School of Medicine
Department(s): Radiation Oncology
Appt. Phone: 617-636-6161
Fax #: 617-636-4513

Oncologic consultation for general radiotherapy, breast cancer, including postlumpectomy radiotherapy for breast preservation, melanomas, including ocular melanoma, gastrointestinal carcinoma, brachytherapy, stereotactic radiotherapy and radiosurgery

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Abhishek  Chatterjee, MD, MBA

Abhishek Chatterjee, MD, MBA

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Accepting New Patients

Virtual Appointments Available

Title(s): Chief, Division of Plastic Surgery; Breast Surgical Oncologist; Plastic Surgeon; Breast Surgeon; Oncoplastic Specialist; Associate Professor, TUSM
Department(s): Surgery, General Surgery, Plastic Surgery
Appt. Phone: 617-636-5600
Fax #: 617-636-9095

Breast surgical oncology, plastic surgery, surgical oncology, breast surgery, oncoplastic surgery

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Danielle DeMarco, MHS, PA-C

Danielle DeMarco, MHS, PA-C

Title(s): Physician Assistant
Department(s): Surgery, Plastic Surgery
Appt. Phone: 617-636-5600
Fax #: 617-636-9095

Plastic surgery and breast cancer reconstruction

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Daniel N. Driscoll, MD, FACS

Daniel N. Driscoll, MD, FACS

Accepting New Patients

Virtual Appointments Available

Title(s): Plastic Surgeon; Adjunct Assistant Professor, Tufts University School of Medicine
Department(s): Surgery, Plastic Surgery
Appt. Phone: 617-636-5600
Fax #: 617-636-9095

Cosmetic surgery of the face and body, breast reconstruction, body contouring after massive weight loss, pediatric plastic surgery, posttraumatic and post-oncologic reconstruction, burn reconstruction

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Shital S. Makim, MD

Shital S. Makim, MD

Title(s): Chief of Breast Imaging; Radiologist; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Breast imaging, general radiology

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Sarah M.  Persing, MD, MPH

Sarah M. Persing, MD, MPH

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Accepting New Patients

Title(s): Surgeon
Department(s): Surgery, Plastic Surgery
Appt. Phone: 617-636-5600
Fax #: 617-636-9095

Breast cancer, plastic surgery, oncoplastic surgery, reconstructive surgery, microsurgery

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Carolyn A. Rooney, MS, APRN, OCN, NP-C

Carolyn A. Rooney, MS, APRN, OCN, NP-C

Virtual Appointments Available

Title(s): Nurse Practitioner
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-5757
Fax #:

Breast health, women’s health, hematology, oncology

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Ilana M.  Schlam, MD

Ilana M. Schlam, MD

Accepting New Patients

Title(s): Hematologist/Oncologist
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Breast medical oncology

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Research + Clinical Trials


evaLuation of variations pharmacokinEtics and phArmacogeNOmics of Ribociclib in rAce-based Cohorts: The LEANORA study

This is a research study to test the combination therapy with the study drug ribociclib (Kisqali) and approved breast cancer drug letrozole or fulvestrant, in the treatment of subjects with hormone receptor positive metastatic breast cancer from different racial groups.

The study aims to determine the pharmacological and biochemical association between ribociclib exposure and CYP3A variants in African American/Blacks and Non-Hispanic White patients.

The findings should allow clinicians to tailor treatments to maintain therapeutic doses while limiting toxicities.


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Randomized Prospective Trial of Breast Cancer Locator Guided vs. Wire Localized Partial Mastectomy for Breast Cancer 

Approximately 230,000 women are diagnosed with invasive breast cancer and 60,000 women are diagnosed with ductal carcinoma in situ (DCIS) (breast cancer in the breast milk ducts) annually in the US. Most women choose to be treated with breast conserving surgery (BCS). The goal of BCS is to resect the tumor with a surrounding margin of tissue free of cancer, and to minimize the volume of tissue removed, thereby preserving the overall shape and appearance of the breast. The Standard of Care (SoC) technique for such patients is wire localization, in which a wire is pre-operatively placed near the tumor under mammographic, ultrasonic, or MRI guidance.  Wire localization suffers from several limitations. It adds another procedure prior to surgery, complicating and lengthening the process and complicating scheduling. It can be uncomfortable for the patient. Its biggest limitation is inaccuracy. Wire localization requires the surgeon to estimate the three-dimensional (3D) position of the cancer from two-dimensional (2D) mammography images. As a result, positive margins are common after partial mastectomy for non-palpable cancer and DCIS.  The aim of this study is to assess whether a device called the Breast Cancer Locator (BCL) can be used during the time of breast cancer removal surgery, and to assess its efficacy, when compared to the SoC group, as defined by the amount of cancer cells remaining in tissue, while assessing the safety of BCL over a period of 6 weeks post-operation.  
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A Study of Dato-DXd Versus Investigator's Choice Chemotherapy in Patients With Locally Recurrent Inoperable or Metastatic Triple-negative Breast Cancer, Who Are Not Candidates for PD-1/PD-L1 Inhibitor Therapy (TROPION-Breast02)

This is a Phase III, randomised, open-label, 2 arm, multicentre, international study assessing the efficacy and safety of Dato-DXd compared with ICC in participants with locally recurrent inoperable or metastatic TNBC who are not candidates for PD-1/PD-L1 inhibitor therapy.
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Phase 2 Trial of Fulvestrant and Binimetinib in Patients With Hormone Receptor-Positive Metastatic Breast Cancer With a Frameshift or Nonsense Mutation or Genomic Deletion in NF1: A ComboMATCH Treatment Trial

This ComboMATCH phase II trial compares the usual treatment alone (fulvestrant) to using binimetinib plus the usual treatment in patients with hormone receptor positive breast cancer that has spread from where it first started to other places in the body (metastatic) and has an NF1 genetic change. The addition of binimetinib to fulvestrant in breast cancers with an NF1 genetic change could increase the percentage of tumors that shrink as well as lengthen the time that the tumors remain stable (without progression) as compared to fulvestrant alone.
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A011801: The CompassHER2 Trials (COMprehensive Use of Pathologic Response ASSessment to Optimize Therapy in HER2-Positive Breast Cancer): CompassHER2 Residual Disease (RD), A Double-Blinded, Phase III Randomized Trial of T-DM1 and Placebo Compared with T-DM1 and Tucatinib

This study is being done to answer the following question: Is the combination of T-DM1 and a newer drug tucatinib, better than usual treatment with T-DM1 alone at preventing human epidermal growth factor receptor 2 (HER2)-positive breast cancer from returning?

This study aims to find out if this approach is better or worse than the usual approach for human epidermal growth factor receptor 2 (HER2)-positive breast cancer.


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