Breast cancer is the leading cancer among women in the United States, the second most common cause of cancer death in women, and the main cause of death in women aged 40 to 59 years.1 Treatment is not straightforward or based on simple decision-making. A number of factors influence a provider’s treatment decision and which path the patient ultimately chooses. This article explores the complexity of diagnosing early-stage breast cancer and the importance of understanding how this condition is defined to help make sense of the available therapeutic options. The goal is to describe the process from diagnosis to treatment planning in a clear, concise, and understandable way.
Most breast abnormalities are detected by mammogram.2 However; an abnormal mammogram alone is not diagnostic. After an abnormality is found, the patient is referred for additional views and/or ultrasound-guided core-needle biopsy (CNB). The CNB is the preferred method over fine-needle aspiration (FNA), as it has several advantages, including histologic diagnosis.2 Knowing the histologic characteristics (type: ductal, lobular; grade: high, intermediate, low) is essential to the planning of surgery and treatment. In addition, the status of estrogen receptors in samples obtained via CNB can easily be ascertained.3
Early-stage breast cancer is defined as a tumor measuring <2 cm with negative axillary lymph nodes.2 The diagnosis is further broken down based on its pathology: Is it invasive (spread from the duct or lobule into surrounding, healthy tissue) or in situ (the cancer cells have begun to multiply but are confined inside the breast)? Is the cancer ductal or lobular? Ductal carcinoma is the most common breast cancer, accounting for approximately 75% of all cases.4
Once the type of breast cancer has been identified, testing for hormone receptor status is conducted on either the CNB specimen or tissue from the surgical excision of the tumor. This immunohistochemical assay will reveal the hormone status of the tumor: estrogen receptor (ER), negative or positive; and progesterone receptor (PR), negative or positive. Women with early-stage ER-positive breast cancer who receive no systemic therapy (hormone-blocking therapy or chemotherapy) after surgery have a 5%-10% lower risk of recurrence at five years than those who are ER-negative.5
The Cancer Center at Harrington, as in many cancer centers throughout the United States, becomes involved early on once a patient has been diagnosed with breast cancer. The patient’s first encounter with our breast cancer nurse navigator is when she reaches out to them pre/post breast biopsy. At Harrington, our nurse navigator is an experienced oncology nurse certified in Breast Cancer Navigation. The navigator plays a key role in helping patients access the care they require across the oncology specialty areas – they assist the patients, their families and caregivers to help overcome barriers to care through the healthcare system; they also guide patients through the complicated steps in managing a cancer diagnosis during active treatment and in survivorship.
Donna Kentley, PA-C, works at The Cancer Center at Harrington in Southbridge. She completed her Physician Assistant program at Northeastern University Bouve’ College of Pharmacy and Health Sciences in Boston.