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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 Program

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

John K. Erban, MD

John K. Erban, MD

Title(s): Clinical Director, Tufts Cancer Center; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-5757
Fax #: 617-636-7060

Breast cancer, clinical trials

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Roger Graham, MD

Roger Graham, MD

Title(s): Chief, Division of General Surgery; Chief, Surgical Oncology; Director, Breast Health Center; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-8270
Fax #: 617-636-9095

General surgery, surgical oncology, thyroid surgery, breast cancer

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

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

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

Breast health, women’s health, hematology, oncology

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Daniel N. Driscoll, MD, FACS

Daniel N. Driscoll, MD, FACS

Title(s): Chief, Plastic Surgery; 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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David E. Wazer, MD

David E. Wazer, MD

Title(s): Radiation Oncologist-in-Chief; Chairman, Department of Radiation Oncology; Chairman and Professor, 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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Judith F. Katz, MD

Judith F. Katz, MD

Title(s): Chief of Ultrasound; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-7818
Fax #: 617-636-1499

Ultrasound, nuclear medicine, body CT, mammography, general radiology

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Kellie A. Sprague, MD

Kellie A. Sprague, MD

Title(s): Director, Bone Marrow and Stem Cell Transplant Program; Director, Adult Leukemia Program; Assistant Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Bone marrow transplantation, acute and chronic leukemia, myelodysplastic syndromes, lymphoma, myeloma, myeloproliferative disorders

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Rachel J. Buchsbaum, MD

Rachel J. Buchsbaum, MD

Title(s): Director, GME; Designated Institutional Official for the ACGME; Chair, GME Committee; Physician, Breast Health Center; Director, Hematology/Oncology Fellowship Program; Associate Professor, Tufts University School of Medicine; Principal Investigator, Molecular Oncology Research Institute
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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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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Stephen P. Naber, MD, PhD

Stephen P. Naber, MD, PhD

Title(s): Chief, Anatomic Pathology; Associate Professor, Tufts University School of Medicine
Department(s): Pathology and Laboratory Medicine
Appt. Phone: 617-636-5829
Fax #: 617-636-8849

General surgical pathology, breast pathology, oncologic pathology

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Research + Clinical Trials


Breast Cancer - Determining Effect of MGAH22 in Breast Cancer Patients

To determine if MGAH22 has sufficient activity in the population of breast cancer participants whose tumors exhibit 2+ HER2 oncoprotein expression and lacks HER2 gene amplification.
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A phase III, randomized, open label, multicenter, controlled trial of niraparib versus physician’s choice in previously-treated, HER2 negative, germline BRCA mutation-positive breast cancer patients.

The purpose of this study is to compare the effects, both good and/or bad, of giving participants either niraparib or the standard chemotherapy for HER2-negative , BRCA mutation positive breast cancer to find out which is better
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A Phase 3, Randomized Study of Margetuximab Plus Chemotherapy vs Trastuzumab Plus Chemotherapy in the Treatment of Patients with HER2+ Metastatic Breast Cancer Who Have Received Prior Anti-HER2 Therapies and Require Systemic Treatment

The purpose of this study is to determine whether patients treated with margetuximab plus chemotherapy have longer progression free survival and overall survival than patients treated with trastuzumab plus chemotherapy.
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A Phase II Randomized Controlled Trial of Genomically Directed Therapy After Preoperative Chemotherapy in Patients with Triple Negative Breast Cancer

The purpose of this study is to test the theory that therapy designed for each individual’s tumor will improve outcomes over standard of care in a population that needs a better standard. Using tumor tissue samples from a prior surgery, treatment reccomendations will be made based on DNA sequencing of the tumor cells by a Cancer Genomics Tumor Board facilitated by the Hoosier Cancer Research Network. Subjects will be randomized to one of several treatment options based on their specific tumor genetic make-up, prior treatment history and tolerance, and medical history.
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A Cohort Study to Evaluate Genetic Predictors of Aromatase Inhibitor Musculoskeletal Symptoms (AIMSS)

This research is being done to find out what effects, good and/or bad, that anastrozole has on women and whether their genes can help explain how anastrozole affects them. Specifically, many women who take anastrozole, or one of the other aromatase inhibitors (letrozole or exemestane) during treatment for breast cancer report muscle and joint aches; however, the reasons that lead to these symptoms are not known. These symptoms have been called “aromatase inhibitor-associated musculoskeletal syndrome” (or AIMSS). Small studies have suggested that a person’s genetic information may help us to develop a way to predict who will develop side effects and how best to treat them, and we hope to collect information in this study to look at this more closely. In addition, we hope to look at how the side effects from hormone therapy influence quality of life and a patient’s willingness to continue hormonal treatment.
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Palbociclib Collaborative Adjuvant Study: A randomized phase III trial of Palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for hormone receptor positive (HR+) / human epidermal growth factor receptor 2 (HER2)-negative early breast cancer

The purpose of this study is to compare any good and bad effects of using 2 years of Palbociclib in combination with standard anti-hormone therapy to using standard anti-hormone therapy alone and to evaluate the likelihood that invasive breast cancer returns.
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A Randomized Phase III Trial of Adjuvant Therapy Comparing Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel with or without Carboplatin for Node-Positive or High-Risk Node-Negative Triple-Negative Invasive Breast Cancer

This study is looking to determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel will improve invasive disease-free survival compared to treatment without carboplatin.
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