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Newly Diagnosed With Breast Cancer

Receiving a breast cancer diagnosis can be overwhelming. Here are some resources to help you get informed and organized so you can focus on getting the best treatment for your unique situation. It’s natural to have a lot of questions — not only about your diagnosis and treatment options, but also about things like health insurance, living expenses, and the impact on your professional and personal life. It may feel like you have to learn a huge amount of information in a short time, but you don’t have to do it on your own. We’re here to help you get informed and organized so you can focus on getting the best possible treatment for you. Here are some resources to help get you started.

Understanding Your Diagnosis

After processing the news, you and your doctors will decide on a treatment plan based on the type of breast cancer you’ve been diagnosed with, its stage, and other factors.

Type of Breast Cancer:

Determine if your cancer is hormone receptor-positive (estrogen and/or progesterone receptors), HER2-positive, or triple-negative. This will influence your treatment options.

Stage and Grade:

Early-stage breast cancer typically refers to stages I or II. The grade indicates how abnormal the cancer cells look under a microscope and how quickly the cancer might grow.

Genetic Testing:

The American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO) updated their germline genetic testing recommendations for people diagnosed with breast cancer, which now say that anyone newly diagnosed with breast cancer age 65 or younger should be offered BRCA1 and BRCA2 testing. The updated guidelines were published in the Jan. 4, 2024, issue of the Journal of Clinical Oncology. Read “Germline Testing in Patients With Breast Cancer: ASCO-Society of Surgical Oncology Guideline.”

Genetic Counselor:

Based on your personal and family health history, your healthcare provider might refer you for genetic counseling. Genetic counseling gives you information about how genetic conditions might affect you or your family. The genetic counselor or other healthcare professional will collect your personal and family health history. They can use this information to determine how likely it is that you or your family member has a genetic condition. Based on this information, the genetic counselor can help you decide whether a genetic test might be right for you.
and for more information on how to find a genetic counselor. Please make sure to check with your health insurance to make sure they are in-network.

Your pathology report

After you have a biopsy or surgery to remove the breast cancer, a doctor called a pathologist will examine the removed tissue and run additional tests. The results of all these tests make up your pathology report. Your pathology report is the key to understanding your diagnosis. By providing a clearer picture of how the breast cancer looks and behaves, the test results in the pathology report will help you and your doctor make appropriate treatment choices for your particular diagnosis.

There are two main types of pathology reports:

The biopsy pathology report describes what is found in the small sample of tissue removed during the biopsy. If the biopsy pathology report finds breast cancer, in most cases you will have surgery to remove the entire cancer, which doctors call an excision.

The synoptic summary in an excision pathology report describes all the characteristics of the whole cancer.

Questions for your Breast Surgeon and Medical Oncologist:

Planning your treatment

Based on your pathology report and other factors, you and your doctors will work together to make a treatment plan specific to your diagnosis. Generally, breast cancer treatment plans have two main purposes: destroy the cancer cells reduce the risk of the breast cancer coming back in the future (called recurrence) Depending on your specific diagnosis, your treatment plan may include one or more treatments, including surgery, radiation therapy, chemotherapy, hormonal therapy, or other therapies.

Treatments you may have in addition to surgery:

Depending on your particular diagnosis, the following treatments may be recommended in addition to surgery: radiation therapy, chemotherapy, hormonal therapy (also called endocrine therapy or anti-estrogen therapy), targeted therapy, and immunotherapy. These treatments are usually given after surgery (called adjuvant treatment) to reduce your risk of the cancer coming back. But some of these treatments may be given before surgery to shrink the tumor before it is removed (called neoadjuvant treatment).

Fertility issues

If you wish to have children in the future, it’s important to talk with your doctor about fertility issues as you’re planning your treatment. Some treatments for breast cancer can make pregnancy difficult or not possible after treatment ends. A fertility specialist or counselor can talk to you about your options. Ask your cancer center for references and/or call your health insurance for fertility specialists.

Surgery or chemotherapy first?

Ask Questions: Don’t hesitate to ask your healthcare team about your diagnosis, treatment options, potential side effects, and expected outcomes.

Depending on several factors, including the stage of your cancer, your overall health, if and how much the cancer has spread, and the specific characteristics (biology) of your tumor, your doctor may suggest any of the following treatment options, or a combination of multiple:

Second Opinions: Always remember that it is your patient right to seek a second opinion if you have any doubts about your diagnosis or treatment plan. While a second opinion may confirm your original doctor’s diagnosis, another doctor may also be able to provide more details about the type and stage of the breast cancer, raise additional treatment options you hadn’t considered, or recommend a different course of action.

Types of Breast Cancer - Non-invasive or Invasive

Many people are surprised to learn that breast cancer is not a singular disease. In fact, there are many different types of breast cancer—each with its own unique molecular features, prognosis, treatments, and origins in the breast. There are two broad types of breast cancer: non-invasive breast cancers and invasive breast cancers. Under these umbrellas, there are breast cancers that are more aggressive than others, breast cancers that have different molecular features, breast cancers that originate in certain areas of the breast, and much more.

Non-invasive breast cancers (stage 0)

Non-invasive breast cancers are also known as stage 0 breast cancers or carcinomas in situ. Essentially, non-invasive breast cancers are abnormal cells that stay in the area of the breast where they are first formed. These non-invasive breast cancers are not generally life-threatening, but they can become invasive breast cancers if left untreated.

Ductal Carcinoma in Situ (DCIS) means the cells that line the milk ducts of the breast have become cancer, but they have not spread into surrounding breast tissue. DCIS is considered non-invasive or pre-invasive breast cancer. DCIS can’t spread outside the breast, but it is often treated because if left alone, some DCIS cells can continue to undergo abnormal changes that cause it to become invasive breast cancer (which can spread).

In most cases, a woman with DCIS can choose between breast-conserving surgery (BCS) and simple mastectomy. But sometimes, if DCIS is throughout the breast, a mastectomy might be a better option. There are clinical studies being done to see if observation instead of surgery might be an option for some women.

Lobular Carcinoma in Situ (LCIS), a much rarer non-invasive breast cancer, starts in the cells lining the breast lobules, the glands that make milk. Unlike DCIS, LCIS is not thought to generally progress to invasive breast cancer, but instead they are believed to increase a person’s risk of breast cancer in the future. Some refer to LCIS as lobular neoplasia instead, as neoplasia refers generally to an abnormal growth of cells that can be benign or malignant.

Invasive Breast Cancers

Unlike non-invasive breast cancers, invasive breast cancers do not stay put; these breast cancers leave their original sites in the ducts or breast lobules and invade nearby breast tissue and lymph nodes.
Originating in the ducts of the breast, invasive ductal carcinoma (IDC) is by far the most common type of breast cancer with 70 to 80 percent of women being diagnosed with this form each year. Typically, IDC tumors form a hard mass or lump in the breast.
Originates in the milk-producing glands of the breast called lobules. It is the second most common histological type of breast cancer diagnosed, accounting for about 10-15% of all breast cancers. One of the most unique features of most ILC tumors is the fact that they do not form a lump, making ILC much harder to detect with screening, advanced imaging, and self-exams. Despite a generally good prognosis, some studies suggest an increased risk of late recurrence (after 5 years).
HR-positive breast cancer is when a patient is diagnosed with breast cancer that is classified as estrogen receptor (ER)–positive and/or progesterone receptor (PR or PgR)–positive—based on the presence of estrogen and progesterone receptors in the tumor cell—this is also called hormone receptor (HR)–positive breast cancer.

HR-positive breast cancer is the most common form of invasive breast cancer and has the best outcome when diagnosed early. It can be treated in several ways, including with hormone therapies that either suppress estrogen levels in the body or prevent estrogen from attaching to receptors. In both cases, HR-positive breast cancers are cut off from hormones needed to grow.

HER2-positive breast cancer (human epidermal growth factor receptor 2) breast tumors are routinely tested for an overexpression of the HER2 protein, and, if found, they are then classified as HER2-positive breast cancers. An estimated 25 to 30 percent of diagnoses are HER2-positive breast cancer. For a long time, HER2-positive breast cancer, which tends to be aggressive, had a poor prognosis. Today, HER2-positive breast cancer has one of the best outcomes overall and a multitude of treatment options.

Until recently, HER2-targeted therapies could only work for patients who had a certain level of HER2 overexpression (3+ values on HER2 testing). Trastuzumab deruxtecan (T-DXd/Enhertu®)—a new drug in an emerging class of targeted treatments called antibody-drug conjugates—was shown to target cells that were previously classified as HER2-negative but actually have lower levels of HER2 protein (values of 1+ or 2+ on HER2 testing, or FISH-). This led to the new classification of breast cancers as HER2-low and opened an exciting avenue for more research breakthroughs.

Patients who don’t have any HER2 overexpression—those that are called HER2-0 in testing—are classified as HER2-negative; they may be HR-positive or triple-negative (see triple-negative breast cancer below). Patients who have HR-positive and HER2-positive breast cancer are sometimes referred to as having triple-positive breast cancer.

Triple-negative breast cancer (TNBC) is characterized by the fact that it’s “negative” for the three main receptors in breast cancer mentioned above (estrogen, progesterone, and HER2). These markers inform prognosis and treatment strategies for breast cancer, as we have many targeted therapies for these types.

TNBC accounts for approximately 15 percent of breast cancer diagnoses and is more commonly diagnosed than other forms in younger women, Black and Hispanic women, as well as women with inherited BRCA1 gene mutations. These breast cancers tend to be more aggressive than those that are HR-positive, and they also tend to be diagnosed at later stages. TNBC is sometimes referred to as basal-like breast cancer, but not all basal tumors are triple-negative.

Because TNBCs lack the common targets for treatment, they have fewer treatment options than other breast cancers. Research is beginning to identify subsets or subtypes of TNBC—and investigating targeted therapies. TNBC is typically treated with surgery, chemotherapy, and radiation, as well as drugs including PARP inhibitors, immunotherapy agents, and antibody-drug conjugates. BCRF investigators are urgently researching potential treatment targets and probing the underlying biology of TNBC to give these patients more options.

Other Rare Types of Breast Cancer

Inflammatory breast cancer (IBC) is a rare (about 1 to 5 percent of diagnoses) and aggressive breast cancer that is characterized by its unusual symptoms. Instead of a typical lump, patients usually experience breast swelling, skin dimpling, and/or discoloration on the breast that looks like a pink or red rash. IBC is more common in younger women and Black women.
Metaplastic breast cancer is another very rare (less than 1 percent of diagnoses) and aggressive form. These tumors are very fast-growing and are more likely to metastasize. Metaplastic breast cancer’s biology has been understudied. Tumors appear to resemble invasive breast cancer tumors but under a microscope they show multiple types of cancer cells.
Though male breast cancer is not a specific type of breast cancer (most men are diagnosed with HR-positive breast cancer like women are), the disease will impact approximately 2,800 men in the U.S. in 2023 (about 1 percent of diagnoses). Men tend to be diagnosed with breast cancer at later stages and have potentially worse outcomes, likely due in large part to a lack of awareness and stigma about a diagnosis.

What is Biomarker Testing?

Biomarker testing is used to find out whether breast cancer cells have certain receptors.

Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormones estrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.

Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.

What Biomarker Testing Includes

If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive (HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ and HER2/neu breast cancers are more likely to grow and divide faster than HER2- breast cancer.
Sometimes the breast cancer cells will be described as triple negative or triple positive.
If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive. It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.

Mental Health Support

Emotional turmoil in response to a diagnosis of breast cancer can affect a person’s physical health as well as psychological well-being. Some cancer centers also offer various patient support groups for those who prefer to talk with others going through similar experiences. There are also cancer centers that offer psycho-oncology services.

When to Seek Mental Health Support

Anyone diagnosed with breast cancer can benefit from mental health support. Talking to a mental health professional may help if you are:

How Mental Health Support Can Help In Survivorship

If you are newly diagnosed, receiving treatment, or have completed treatment, getting mental health support can help you:

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