Breast cancer treatment
Advanced, comprehensive breast cancer care
If you are diagnosed with breast cancer, getting the most effective treatment from the very beginning is essential. VCU Massey Cancer Center provides the highest-quality treatment, including innovative clinical trials, a full range of support services and compassionate patient care.
Treatment for breast cancer may involve surgery, radiation therapy and drugs such as chemotherapy, hormonal therapy and targeted therapies. Many women get more than one type of treatment for their breast cancer. They may undergo surgery to remove the tumor and may also receive chemotherapy and/or radiation before and/or after surgery.
or call: 877-4MASSEY
Specific treatment plans will be recommended by a team of physicians based on the patient’s age, overall health and medical history; the extent of disease; tolerance for specific medications, procedures or therapies; expectations for the course of the disease; and the patient’s preferences. Massey’s cancer care team will guide you and your family on the best course of treatment.
Our patient-centered, multidisciplinary approach is what sets the VCU Massey Cancer Center breast team apart. Our cancer care team consists of specialists from a variety of disciplines with expertise in breast cancer who combine their insights to diagnose patients, recommend treatment plans and coordinate care. Our Breast Cancer Collaborative Care Clinic takes the multidisciplinary approach one step further by bringing together these specialists to see patients on the same day in the same clinic. This efficient, coordinated care helps reduce treatment delays, lessens anxiety and leads to the best possible outcomes for our patients. Learn more about Massey’s Breast Cancer Collaborative Care Clinic.
Speak with a breast nurse navigator
Call Donna Wilson at (804 217-2415) or Joany Flynn at (804) 512-2804
Breast cancer treatments may include any of the following:
For some patients, surgery may be required to remove the tumor, a portion of the breast or the entire breast (a mastectomy). Surgery may also be required to understand how far the cancer has spread, such as to the lymph nodes under the arm. Physicians will determine the best surgery and treatment type based on the breast cancer diagnosis, spread and personal medical history. Surgery may not be an option for some patients.
Massey offers sophisticated and less-invasive surgical procedures, such as breast-sparing or breast-conserving surgery, sentinel node mapping to see if the cancer has spread to the lymph nodes, and oncoplastic techniques, which combine the latest plastic surgery techniques with breast surgical oncology for a better cosmetic result.
Additionally, Massey was the first in the region to use a new, FDA-approved device that guides surgeons in locating and removing breast tumors. Named Magseed™, the device is a simpler, more effective alternative to traditional wire localization methods.
VCU Massey offers cutting-edge radiation therapies for the treatment of breast cancer. These options include such advanced techniques as accelerated radiotherapy for both partial and whole breast to decrease the number of radiation treatments, prone positioning to reduce toxicity and dose-limiting techniques to protect the heart.
Radiation therapy uses precisely aimed radiant energy to shrink tumors and kill breast cancer cells that cannot be seen or removed during surgery. Research has shown that radiation therapy greatly decreases the risk that breast cancer will recur. Radiation therapy may be used alone or in combination with chemotherapy. Radiation therapy may not be an option for some patients.
Radiation therapy usually begins with these steps:
- Consultation – You will meet with your radiation oncologist who will carefully review your medical history and imaging and perform a physical exam. The radiation oncologist will explain the benefits of radiation treatment specific to your case, as well as the supporting research. The doctor will also discuss any potential side effects and take time to answer your questions.
- Simulation – During simulation, the radiation therapy team determines the best position for your body to limit the side effects of treatment. Cushions and other devices are used to help you rest comfortably in place. A CT scan is performed to help the radiation oncologist target precisely where the radiation will be aimed on the body.
- Treatment plan – After simulation, the radiation oncologist designs a treatment plan that uses the latest technology to target the cancer cells while directing radiation away from normal tissues. Radiation treatment typically starts one to two weeks after simulation.
There are two ways that radiation therapy is delivered to treat breast cancer:
- External beam radiation – A precise beam of radiation is directed at the cancer cells from outside of the body using a machine called a linear accelerator. In order to protect the surrounding healthy tissue, special shields may be used. Radiation treatments usually last a few minutes.
- Brachytherapy – Brachytherapy is a type of radiation treatment wherein a material that gives off radiation is temporarily placed in the breast surgical cavity through a narrow tube called a catheter. During treatment, the radiation travels throughout the surgical cavity, but only a short distance beyond the surgical cavity. Because only part of the breast receives radiation, the risk of certain side effects is lower. Brachytherapy allows a higher radiation dose to be given over a shorter time period so the overall treatment course is shorter for the patient.
At VCU Massey Cancer Center, we are using the newest technology and the latest techniques to reduce the side effects of radiation treatment and make treatment more efficient for patients.
Prone Breast Treatment –The patient is treated lying on their stomach rather than their back. This technique allows the breast to fall away from the chest wall so radiation can be given to the breast while avoiding the heart and lungs. A special type of positioning board is used that allows only the treated breast to fall away from the body; the other breast stays close to the body so only the affected breast is treated. This technique can decrease radiation exposure to the heart and lungs and thereby reduce the risk of side effects to these tissues.
Active Breathing Coordination/Breath Hold – The patient holds their breath for 20 seconds at a time during treatment. A machine measures the amount of air in the patient’s lungs and makes it more comfortable for them to hold their breath. When the breath is held, the lungs expand and the heart moves away from the breast. This movement of the organs creates space for the radiation beam to target the breast while avoiding the heart. The radiation beam is activated only during the breath hold. This technique markedly reduces radiation exposure to the heart. Research has shown that active breathing coordination reduces the risk of long-term side effects to the heart.
Hypofractionated Whole Breast Irradiation – Radiation is given over a shorter period of time to make treatment more time-efficient for the patient. Standard whole breast irradiation typically lasts five to seven weeks, while hypofractionated whole breast irradiation lasts only three to four weeks. Research has shown that for patients who are age 50 or older, the shorter course of treatment is equally as effective as the longer course.
Accelerated Partial Breast Irradiation – VCU Massey is a national leader in accelerated partial breast irradiation. This technique treats only part of the breast rather than the whole breast. Partial breast irradiation can be completed in a week or less, while whole breast irradiation lasts several weeks. The area treated is typically the surgical cavity plus 1 to 2 cm around the cavity, which is the area at greatest risk for cancer recurrence. By treating only part of the breast, much of the normal breast and other nearby tissues are spared radiation. This technique decreases radiation exposure to the breast, heart and lungs. At VCU Massey, partial breast irradiation is performed using brachytherapy. Sometimes the radiation is given through small tubes placed in the breast; other times it is given through a balloon placed in the surgical cavity. In all cases, the radiation field is shaped and targeted only to the area of greatest risk for cancer recurrence.
AccuBoost – VCU Massey was the fifth site in the world and the first in Virginia to offer AccuBoost, an advanced, image-guided and noninvasive treatment for breast cancer. The process uses digital mammography (imaging) for localization and surface applications for the delivery of radiation. The treatment is as easy for the patient as getting a mammogram, giving patients a “boost” of radiation to the surgical site following whole-breast radiation treatment. The assistance of imaging improves dose delivery to confirm that each “boost dose” is accurate and successful. Patients receive treatment each day for five to eight days, and for each treatment, the beam targets different angles so that the entire surface is radiated. Learn more about AccuBoost
Potential side effects of radiation
Receiving radiation is painless, but normal cells are sometimes damaged in the process of killing cancer cells. Damaged normal cells can lead to side effects, which are monitored and treated by the radiation oncologist. Because each patient’s medical history and biology are unique, so too is their reaction to radiation.
The most common side effects of breast radiation:
- Fatigue (especially during the later weeks of treatment)
- Skin changes in the treatment area, including sensitivity, redness similar to a sunburn, darker skin color, itching, and/or skin peeling; in most cases, the skin effects of radiation are temporary, and the skin heals shortly after treatment is completed
- Increased scar tissue near the surgical cavity
- Potential swelling of the arm if the regional lymph nodes are treated
Other less likely side effects can occur and will depend on the patient’s medical history and treatment plan. The radiation therapy team carefully monitors each radiation treatment, and the radiation oncologist will meet with the patient regularly to discuss and treat any side effects that may occur.
Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body. Systemic therapies are prescribed by medical oncologists. VCU Massey Cancer Center offers the latest medical oncology options for the treatment of breast cancer. These options include chemotherapy, hormone therapy, targeted therapy and neo-adjuvant therapy (chemotherapy before surgery) as well as clinical trials.
Systemic therapy is often recommended as part of the treatment plan for cancer even if the cancer has been surgically removed completely in order to kills cancer cells that could not be seen during surgery or to decrease the risk of the cancer recurring. There are three types of systemic therapy for breast cancer: hormonal therapy, chemotherapy and biological therapy. The choice of therapy is based on the characteristics of the cancer, including hormone receptor status, HER-2 status (which tells whether or not the human epidermal growth factor receptor 2 gene is playing a role in the cancer) and the involvement of lymph nodes. Other factors that are taken into account for treatment options include age, menopausal status, extent of disease if metastatic and the presence of other medical problems. Several tests have been developed that may help you and your oncologist determine if you need chemotherapy. Oncotype and Mammaprint are two commercially available tests that provide information about the risk of recurrence for hormone receptor-positive cancers. Your oncologist will discuss with you the best treatment options for your situation. Treatment may last a few months to several years.
Chemotherapy – Chemotherapy (chemo) is treatment with cancer-killing drugs to either treat or prevent recurrence of cancer. Chemo may be taken as pills or into a vein as an injection over a few minutes or by IV infusion over a longer period of time. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. At Massey, when chemotherapy is given intravenously it is delivered by oncology-trained nurses. The oncologist will determine the right combination of chemotherapy and the best schedule. Chemotherapy is usually given in cycles with treatment one day, then a recovery period and then a repeat treatment. The doctor and the other medical team members will design the treatment plan, give you educational material about the medications and discuss with you the potential side effects.
Many patients are scared of chemotherapy side effects. Fortunately, great strides have been made over the past 20 years that have made patients more comfortable during treatment. Many patients are able to keep working, take care of their families and contribute to their communities while undergoing treatment. The new nausea medications have made a big difference. Other possible side effects include hair loss, constipation, cognitive dysfunction (“chemo brain”), increased risk of infection, neuropathy (nerve damage) and decreased endurance. There may be other drug-specific side effects that the oncologist will discuss with you and your caregiver. Not everyone gets every side effect, and most side effects disappear when treatment is completed.
There are many drugs approved for treating breast cancer, and the list continues to grow. Many are used in combination, and many are approved for treating metastatic or recurrent breast cancer. If the cancer has spread to other parts of the body, your oncologist will discuss with you the best choices for treatment.
Hormone therapy – Hormonal therapy is one of the oldest systemic cancer therapies used for women with hormone receptor-positive cancers. Cancers that are hormone receptor-positive are cancers that are stimulated by estrogen and progesterone: Their cells have receptors (proteins) that attach to the hormones estrogen (ER-positive cancers) and/or progesterone (PR-positive cancers). For these cancers, high estrogen levels help the cancer cells grow and spread. Approximately two-thirds of breast cancers are affected by hormones in the blood.
There are several types of hormone therapy, which use drugs (and, in some cases, surgery) to either lower estrogen levels or stop estrogen from acting on breast cancer cells.
- Tamoxifen has been available for more than 30 years; it interferes with estrogen influencing the growth of the cancer cells. The pill is taken once a day for a minimum of five years and up to 10 years. It can be used for any age group but is the preferred treatment for premenopausal women. It can be used with any stage of the disease. Side effects can include hot flashes, a rare risk of blood clots and a very rare risk of uterine cancer. It is inexpensive and widely available. Tamoxifen is also approved as a risk reduction medication for women who have not been diagnosed with breast cancer but have an increased risk of developing breast cancer.
- Aromatase inhibitors are a newer group of hormonal therapies. These drugs are also pills taken once a day for five to 10 years. They block estrogen production outside of the ovaries. They are only effective in women who are post-menopausal or who have had their ovaries removed or suppressed with drugs. Side effects include joint stiffness and pain, osteopenia (thinning of the bones) and dry skin. They are widely available but are more expensive than tamoxifen. Recent studies suggest that ovarian suppression or removal of the ovaries plus an aromatase inhibitor to shut down estrogen production from other tissues may be better than tamoxifen for some premenopausal women.
- There are other hormonal therapy drugs that are used for recurrent breast cancer. Fulvestrant is a monthly shot that interferes with the hormonal receptors. Megestrol acetate is an older medication that previously was used for breast cancer but is now predominantly used to boost appetite in patients undergoing cancer treatment.
Biological therapy – Biological therapy involves the use of living organisms, substances derived from living organisms or laboratory-produced versions of such substances to treat breast cancer. Biological therapies may be used to treat the cancer itself or the side effects of other cancer treatments. There are generally two types of biological therapies for cancer:
- Targeted therapy – Also known as precision oncology (precision medicine), new drugs are being developed that target specific genetic mutations known to cause cancer. Massey was the first cancer care provider in Virginia to perform DNA sequencing for the treatment of cancer, and we continue to stay at the forefront of targeted therapies. All targeted therapies work best with chemotherapy. There are several different regimens available. Patients with early stage disease may receive therapy for up to one year. Patients with advanced disease may receive the medications for many years. The most serious side effect is heart damage, and heart function is monitored regularly during treatment. Learn more about precision cancer treatment
- Immunotherapy – Immunotherapies harness the patient’s own immune system to fight cancer. Exciting advancements in immunotherapies are bringing new hope to difficult-to-treat breast cancers, and Massey is making important research contributions in the field. Learn more about immunotherapy
Adjuvant and neoadjuvant therapy
Adjuvant therapy refers to chemotherapy or radiation therapy given after surgery. It’s used to kill any cancer cells that may be left over in the breast or in the rest of the body. Neoadjuvant therapy incorporates chemotherapy or radiation therapy prior to surgery in order to reduce the size of the tumor. Neoadjuvant therapy may improve surgical outcomes, or allow patients who were not candidates for surgery to become eligible. Massey is currently conducting clinical trials to optimize neoadjuvant therapy in order to improve surgical outcomes. VCU Massey surgeons and medical oncologists have been pioneers in the use of neo-adjuvant therapy and involved in clinical trials of this approach since the 1980’s. Learn more about the advances in neoadjuvant therapy that Massey is leading
Massey has one of the largest selections of cancer clinical trials in Virginia, giving patients expanded treatment options. Our trials offer new hope every day to both newly diagnosed and relapsed patients, including studies that are not found elsewhere in the region. Our trials test new anti-cancer therapies and ways to minimize common cancer-related symptoms. These trials provide access to investigational agents and new, innovative therapies that may help increase the chance for successful treatment. Learn more about our breast cancer clinical trials
Breast reconstruction can help restore the look and feel of the breast after a mastectomy. Massey’s internationally recognized and board-certified plastic and reconstructive surgeons combine skill with artistry to achieve naturally beautiful results. We offer many options for replacing the lost breast tissue during reconstruction, including using an implant and transferring tissues from elsewhere in the body, known as microsurgery. Because of the high level of skill and advanced equipment required to perform microsurgery, this form of breast reconstruction is typically offered only at specialized medical centers such as Massey.
Patients may choose to have immediate reconstruction, in which we start the process of rebuilding the breast during the surgery to remove the tumor or the breast (mastectomy). Some patients opt to begin reconstruction after the initial surgery and other treatments are complete. Once our plastic surgeons finish creating the new breast, the other breast may be altered to achieve symmetry so that breasts look similar in size and shape. In the final step, we can build a new nipple-areola complex, which we can then tattoo with a color similar to the other side. Learn more about breast reconstruction
If reconstruction isn’t right for you, artificial prostheses are available. Learn more about breast prostheses
Cancer and its treatment may have an effect on your daily performance, including physical, cognitive, emotional and social functioning. Breast cancer rehabilitation can minimize the impact of treatment and improve quality of life. Massey offers one of the nation’s longest-running cancer rehabilitation programs, with therapists who work exclusively with the unique needs of cancer patients. In addition to your doctor and nurse, your care team may include a physical therapist, occupational therapist, lymphedema specialist and/or others. Learn more about Massey’s cancer rehabilitation services
At Massey, we define cancer survivorship from the day of diagnosis. The term refers to those actively being treated for cancer, those who have completed cancer treatment and those living with incurable cancer.
Supporting a cancer survivor during and after treatment involves the whole medical team. Massey offers comprehensive cancer support services [link to the Breast Cancer Resources page] to help minimize symptoms and side effects and to help you cope with the emotional and psychological effects of cancer. For the management of pain and symptoms, Massey provides palliative care by an international award-winning team, including an outpatient Supportive Care Clinic. Palliative care is not only for people who are dying. Palliative care can help you live for as long as possible in the best way you can, within the limits of your illness.
For patients with incurable cancer (because it has spread to other parts of the body, and/or grown to be too big for treatment to work, and/or has come back after treatment), the cancer may be controlled but not cured. For some patients, the cancer can be kept under control for months or years, and they continue to live their normal daily life for some time.
For patients who have finished cancer treatment, they may still need our help long after. Our breast health team will develop treatment plan summaries and work with their primary care physician to help manage the long-term consequences.
Most breast cancer survivors return to full and active lives, but surviving cancer is a lifelong effort. We are committed to supporting you in every way we can—physically, emotionally, spiritually and otherwise—for as long as you need us.
High-quality imaging is an integral part of Massey’s multidisciplinary approach, and VCU Health Breast Imaging offers both screening mammography (including 3-D mammograms/tomosynthesis), for routine annual evaluations to detect early breast cancer, and diagnostic mammography, recommended for women who are experiencing symptoms that may be related to breast cancer. Breast ultrasound may also be done for patients with breast symptoms or abnormal mammograms. Breast MRI is available for those with a higher lifetime risk and for those with a new diagnosis of breast cancer.
All studies are interpreted by fellowship-trained physicians (radiologists) who specialize in breast imaging, and results of diagnostic evaluations are personally discussed with the patient by the doctor during your appointment. If a biopsy is needed, you may be able to have it done the same day, with results usually available the next business day. by
VCU Health Breast Imaging was Richmond’s first team to have earned the American College of Radiology’s Breast Imaging Center of Excellence designation. Learn more about VCU Health Breast Imaging