ProHealth Care offers the most advanced technology available to women. It was the first health care system in Wisconsin to make digital breast tomosynthesis, often called 3D mammography, available. All sites offer 3D mammograms for screening and diagnostic testing.
We offer individualized treatment through a multidisciplinary approach. Patients most often consult with a surgeon, medical oncologist and radiation oncologist at some point during their care.
All patients have the opportunity to work with an oncology nurse navigator. Other key supportive team members include cancer rehabilitation specialists, dietitians, genetic counselors, researchers and social workers. Many of these team members meet weekly to review each breast cancer case to ensure treatment is individualized and communicated to the rest of the team.
Three types of mammograms:
- The screening mammogram is an X-ray exam of the breasts done routinely for women who have no breast symptoms or changes in their breast exam. The goal of a screening mammogram is to detect breast cancer as early as possible. Routine screening mammography can lower the risk of dying of breast cancer by 40 percent. ProHealth Care uses digital breast tomosynthesis, or 3D mammography, for all screening mammograms.
- A diagnostic mammogram is performed when a woman has a breast problem such as a lump, breast pain, nipple discharge or an abnormal area found on a routine screening mammogram. Diagnostic mammograms also are done in women who need short interval follow-up, or who were previously treated for breast cancer. ProHealth Care uses digital breast tomosynthesis, or 3D mammography, for all diagnostic mammograms.
- Digital breast tomosynthesis is advanced technology that allows the radiologist to review the breast tissue through a series of thin, detailed images, or “slices.” The use of 3D imaging detects 41 percent more breast cancers than 2D imaging alone.
Other types of breast imaging:
- A breast ultrasound uses sound waves to make a picture of the tissues inside the breast. A breast ultrasound is used to see whether a breast lump is filled with fluid or if it is a solid lump. An ultrasound does not replace the need for a mammogram in most women, but it is often used to check abnormal results from a mammogram.
- Breast magnetic resonance imaging (MRI) uses a magnetic field and pulses of radio waves to make pictures of the breast. MRI of the breast does not replace mammography or ultrasound imaging, but is a tool with many important uses. MRI can be used for screening in women at high risk for breast cancer. It is also used to provide additional information in women who have been diagnosed with breast cancer.
Three types of biopsies:
- Stereotactic core biopsy is a minimally invasive technique that uses low-dose X-rays to target an area of concern. The method ensures precise sampling of the abnormality. Samples are reviewed by a pathologist and the patient is notified of the results, usually in 1 to 2 days.
- Ultrasound-guided core biopsies use ultrasound images to locate the area of concern and to help guide the biopsy needle to a precise location. This technique helps ensure that the area that is biopsied is the exact area where the abnormality was seen on the ultrasound. Samples are reviewed by a pathologist and the patient is notified of the results, usually in 1 to 2 days.
- MRI-guided core biopsies use magnetic resonance imaging to locate the area of concern and to help guide the biopsy needle to a precise location. This technique helps ensure that the area that is biopsied is the exact area where the abnormality was seen on the MRI. Samples are reviewed by a pathologist and the patient is notified of the results, usually in 1 to 2 days.
Cyst aspiration: Cyst aspiration is an ultrasound-guided procedure to withdraw fluid from a cyst within the breast. This is done to relieve breast pain when a cyst is present.
Galactogram: Galactography is performed to identify the possible cause of suspicious types of nipple discharge. Contrasting material is injected into the duct producing the discharge and digital imaging is performed. Then imaging-guided biopsies of abnormalities detected by this method are analyzed to diagnose the cause of discharge.
Surgery: Surgical treatments are individualized based on factors such as tumor size, location and focality, lymph node involvement, family history or genetic predisposition, cosmetic outcome and personal preference after informed decision making.
Surgical options for treating breast cancer include:
- Partial mastectomy (or lumpectomy) is the removal of the area of the breast with cancer assuring there is a clear or cancer-free margin of breast tissue. The rest of the breast remains. Often radiation is required as an adjunct treatment after this surgery.
- Mastectomy is removal of the whole breast. This can be combined with immediate reconstruction if appropriate. The nipple may or may not be spared.
- Immediate or delayed reconstruction is the re-creation of a breast mound and is done either at the time of initial breast cancer surgery or in the future. Various types of reconstruction are available, including placing a tissue expander with implant or using the patient’s own tissue from various locations to recreate a breast. Reconstruction is available after previous breast cancer surgeries or treatments.
- Oncoplastic breast surgery uses plastic surgery techniques in combination with partial mastectomy for the best cosmetic result in realigning the nipple and areola.
- Radiative seed and wire localization is the placement of a small radiative marker or special wire directed for removal of the cancer during partial mastectomy. These procedures are typically performed in the Breast Imaging Department under guidance of mammogram, ultrasound or MRI. The seed or wire is then removed from the breast at time of surgery.
- Sentinel node biopsy is the removal of lymph nodes during surgery after the physician injects a blue dye or radioactive tracer that indicates where to test for cancer cells that may have left the breast. Testing the lymph nodes will determine if the cancer has spread outside of the breast as well as if additional treatment needed. Removal of only a few lymph nodes lowers the chance of lymphedema or swelling to the breast or arm of the cancer side.
- Axillary node dissection is the removal of a grouping of lymph nodes under the armpit after needle or sentinel node biopsy has determined that cancer has spread from the breast. A greater number of lymph nodes removed and/or amount of radiation directed to the lymph node area increases future chance of lymphedema or swelling to the breast or arm of the cancer side.
Medical therapy: There are several types of medical therapies for treating breast cancer:
- Neoadjuvant therapy is given before breast cancer surgery. This can make cancer easier to remove and keep cancer from coming back. This is done with the intent to eliminate any cancer cells in the breast or the rest of the body.
- Adjuvant therapy is given after breast cancer surgery to kill any remaining cancer cells and to keep cancer from coming back.
- Palliative therapy is given to slow cancer that has spread to other parts of the body. This is used if a cancer comes back or is found in other parts of the body (also known as metastatic or Stage IV cancer).
Individualized treatment for each patient is based on a variety of factors, including tumor characteristics such as size, grade, and molecular genetics. In certain patients medical oncologists are able to perform a tumor gene profiling test (such as Oncotype Dx®), which analyzes 21 genes to help determine the patient's risk for cancer recurrence and whether they would benefit from chemotherapy.
The type of medical therapies offered at ProHealth Care include:
- Chemotherapies, which are drugs that kill fast-growing cells, including cancer cells.
- Endocrine therapies, which block or lower estrogen levels.
- HER2-targeted therapies for breast cancer in patients who test positive for the human epidermal growth factor receptor 2 gene, which promotes the growth of cancer cells.
External beam radiation therapy: Both conventional and intensity modulated radiation therapy use a computer to aim radiation at tumors from outside of the body, killing cancer cells over time. Radiation is administered based on tumor size, shape and location. The intensity of the beams can be adjusted as needed to match the exact geometric shape of the tumor, minimizing damage to surrounding tissue. Generally, five treatments are required per week for a period of four to six weeks. Treatments cause no pain and only last a few minutes each.