Breast Cancer

Risk Factors

No one knows the exact causes of breast cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for breast cancer include the following:

• Older age
• Menstruating at an early age
• Older age at first birth or never having given birth
• A personal history of breast cancer or benign (non-cancer) breast disease
• A mother or sister with breast cancer
• Treatment with radiation therapy to the breast/chest
• Breast tissue that is dense on a mammogram
• Taking hormones such as estrogen and progesterone
• Drinking alcoholic beverages
• Being white

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Signs and Symptoms

Early breast cancer usually doesn't cause symptoms. But as the tumor grows, it can change how the breast looks or feels. The common changes include:

• A lump or thickening in or near the breast or in the underarm area
• A change in the size or shape of the breast
• Dimpling or puckering in the skin of the breast
• A nipple turned inward into the breast
• Discharge (fluid) from the nipple, especially if it's bloody
• Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin at the center of the breast). The skin may have ridges or pitting so that it looks like the skin of an orange.

If you have any of these symptoms, you should tell your doctor so that the problems can be diagnosed and treated.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Diagnosis

UC Davis Comprehensive Cancer Center recommends that women have regular clinical breast exams and mammograms to help find breast cancer early. Treatment is more likely to work well when breast cancer is detected early.

Clinical Breast Exam

During a clinical breast exam, your doctor looks for differences in size or shape between your breasts and checks for rashes, dimpling, or other abnormal signs. Using the pads of the fingers to feel for lumps, your doctor will check your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your doctor will also check the lymph nodes near the breast to see if they are enlarged.

If you have a lump, your doctor will feel its size, shape, and texture and check to see if the lump moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests are needed to diagnose the problem.

Mammogram

A mammogram is an x-ray picture of tissues inside the breast. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

Before they have symptoms, women should get regular screening mammograms to detect breast cancer early:

• Women in their 40s and older should have mammograms every 1 or 2 years. 
• Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

If the mammogram shows an abnormal area of the breast, your doctor may order clearer, more detailed images of that area.

Other Imaging Tests

If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other imaging tests, including:

• Ultrasound: An ultrasound device sends out sound waves that bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst ), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer. 
• MRI: MRI (Magnetic Resonance Imaging) uses a powerful magnet linked to a computer to make detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.

Biopsy

A biopsy is the removal of tissue to look for cancer cells. You may need to have a biopsy if an abnormal area is found. Your doctor or a surgeon will remove fluid or tissue from your breast in one of several ways:

• Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump. 
• Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue. 
• Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin. 
• Surgical biopsy: Your surgeon removes a sample of tissue.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Treatment

The close collaboration between our doctors and our research scientists means that new drugs and treatments developed in the laboratory can quickly move to the clinic, offering our patients immediate access to the latest therapies.

For example, our surgeons were among the first in the country to pioneer a treatment known as non-surgical lumpectomy, or radiofrequency ablation. This investigational treatment employs heat to destroy small, early stage breast cancers. Our scientists are also developing a new CT breast-imaging machine that could become an alternative to standard mammography.

Clinical Trials
UC Davis Comprehensive Cancer Center has a large clinical trials network, allowing our patients access to the newest drugs and therapies before they become widely available. During all stages of your treatment you should talk to your medical specialist about what clinical trials may be available for you.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Your Team

Hematology/Oncology

Helen Chew, M.D.
Director, Clinical Breast Cancer Program
Associate Professor of Medicine

Scott Christensen, M.D.
Professor of Medicine
Medical Director, Cancer Care Network
Medical Director, Yolo Hospice

Tianhong Li, M.D., Ph.D.
Co-Director, Phase I Program
Co-Director, Breast Cancer Research Program
Assistant Professor of Medicine

Surgery

Richard Bold, M.D.
Chief of Surgical Oncology
Professor of Surgery

Vijay Khatri, M.D.
Professor of Surgery
Director, Faculty Development and Mentoring

Steve Martinez, M.D.
Associate Professor of Surgery

Anthony Yang, M.D.
Assistant Professor of Surgery

Diagnostic Radiology

Terry L. Coates, M.D.
Professor of Radiology

Karen K. Lindfors, M.D.
Chief of Breast Imaging
Professor of Clinical Radiology

Pathology

Alexander Borowsky, M.D.
Associate Professor of Medical Pathology

Lydia P. Howell, M.D.
Interim Chair and Director, Anatomic Pathology
Professor of Medical Pathology

Plastic and Reconstructive Surgery

Thomas R. Stevenson, M.D.
Chief of Plastic Surgery
Professor of Surgery

Granger Wong, M.D., D.M.D.
Associate Professor of Surgery

Michael S. Wong, M.D.
Assistant Professor of Surgery

Radiation Oncology

Jyoti Mayadev, M.D. 
Assistant Professor

Allen M. Chen, M.D.
Associate Professor
Director, Residency and Fellowship Training Program

Support

The UC Davis Breast Cancer Program is dedicated to caring for the whole patient. We offer:

• New patient support specifically for breast cancer patients 
  (WeCARE Peer Navigator Program)
• "Look Good... Feel Better," an American Cancer Society workshop
• Psychosocial counseling
• Patient education classes, lectures and newsletter
• A cancer resource center