Breast Cancer Program at WCHN
When you’ve been diagnosed with breast cancer, it’s reassuring to know that outstanding care is available close to home. Here at Norwalk Hospital and our freestanding Breast Center, you have an entire team of highly skilled doctors—including breast imaging specialists, medical oncologists, breast surgeons, radiation oncologists, reconstructive surgeons, pathologist, lymphedema therapists, nurse navigators, and geneticists—who work together to design a breast cancer treatment plan tailored to your specific needs. In fact, we have the capabilities to determine biologic characteristics of your particular tumor, so we can pinpoint the most effective, targeted therapies for that specific cancer. In addition, every patient is reviewed multiple times throughout their course by our multidisciplinary Breast Tumor Board, so we ensure the patient is receiving the most appropriate treatment plan.
We treat every type of breast cancer and every type of breast cancer patient—including women and men of all ages. Notably, we have special expertise helping younger women preserve fertility after breast cancer treatment by addressing it at the start of the treatment planning. Our innovative approach to multimodal, perioperative pain management through techniques that prevent pain gets you back to your life quickly and comfortably. A certified oncology nurse navigator coordinates your care and provides guidance and support every step of the way. And we offer a range of other proven technologies and services designed to give you the best possible outcome in a compassionate, caring environment. It’s an approach to breast cancer care that’s earned us national accreditation for the quality and comprehensive nature of our program.
The sooner a diagnosis of breast cancer is made, the sooner treatment can begin—making timely, accurate diagnosis the critical first step in effective breast cancer care.
That’s why we offer a comprehensive array of today’s most advanced imaging and diagnostic testing techniques to evaluate breast issues and, when appropriate, determine if cancer has spread beyond the breast.
Once a concern is raised after imaging exams, your medical history and a clinical breast exam are performed, the next step is a biopsy to obtain a sample of the breast tissue of concern. There are several types of biopsies, and we offer an all-inclusive array—so you and your doctor can determine the approach that’s best for you:
- Core needle biopsy—In this procedure, a hollow needle is inserted into the suspicious area and withdraws a small tissue sample that’s viewed under a microscope. If the area cannot be felt (palpated) the biopsy is performed using imaging guidance (mammography, ultrasound or MRI)
- Fine needle biopsy/aspiration—In this procedure, a smaller needle is used to remove some of the fluid or cells from an area of concern so they can be examined for the presence of cancer
- Excisional/surgical biopsy—This open surgical procedure is performed under local anesthesia usually with IV sedation (twilight). It involves removing the abnormal area, sometimes along with some of the surrounding tissue. Because this approach is more invasive, it is only performed when a tissue sample can’t be obtained any other way.
Once a cancer diagnosis is made, if there is concern that breast cancer has spread (metastasized) beyond the breast, additional diagnostic tests may include:
- PET/CT Scan—With this form of 3D imaging, the CT scan shows detailed pictures of tissues and organs inside the body, while the PET scan shows abnormal cellular activity. Combined, the scans provide more information about the location and stage of cancer.
- High Resolution CT Scan
- Bone scan—This imaging test uses a small amount of radioactive material to determine the presence of cancer in the bones
Breast cancer is the most common cancer in women, but the good news is that it’s also one of the most curable cancers when detected early. A mammogram is still the most effective way to detect breast cancer in its early stages, although not the only way.
For women who are at average risk for breast cancer, we continue to support recommendations for annual mammograms starting at age 40-45. We encourage you to talk to your healthcare provider about your personal risk factors, and determine the screening timetable that works best for you. If your health care provider feels you are at above average risk for developing breast cancer, you could be recommended to see one of our breast specialists for a detailed and personalized risk assessment and prevention plan. This individualized plan may include advanced breast imaging, lifestyle modification counseling, medical risk reduction therapy, or even a discussion on select risk reduction surgery.
You’ll be glad to know that we offer the latest breast imaging technology for detecting breast cancer as early as possible, including:
- Digital mammography—An x-ray image of the breast viewed on a high-resolution computer monitor
- 3-D mammography—Also called tomosynthesis, this advanced technology takes multiple x-ray images of breast tissue to allow individual arrangement of different sections of the breast as well as to recreate a 3-dimensional picture of the breast
- Breast ultrasound—Imaging of the breast using sound waves; may be used in addition to mammography to supplement screening and aid in diagnosis
- Breast MRI—Imaging that uses powerful magnets to produce detailed images. Most commonly used in women known to be at high risk for breast cancer, or to help further evaluate breast tissue after a cancer diagnosis.
Breast cancer treatment today is highly personalized, based on the type and stage of your cancer, its unique molecular profile, and your general health and treatment goals.
With our multidisciplinary approach to breast cancer care, an entire team of breast cancer experts works together to tailor an optimal treatment plan for you, based on the latest scientific evidence and the unique features of your particular tumor. Your personalized treatment plan can include one or a combination of today’s most effective therapies, all in one convenient location.
Treatment options include:
- Surgery, including state-of-the-art, less invasive breast-conserving surgery to advanced “oncoplastic” techniques such as Goldilocks mastectomy and/or nipple-sparing mastectomy with reconstruction
- Systemic therapy, which can include chemotherapy, targeted therapy, and endocrine (hormonal) therapy
- Radiation therapy
- Novel treatments available through clinical trials
Surgery to remove the tumor is often the first step in treating breast cancer. Our fellowship-trained breast surgeons have exceptional expertise in all aspects of surgical breast care, including in breast-conserving surgery and nipple-sparing mastectomy techniques to help preserve the appearance of the breast, as well as minimally invasive lymph node assessment which help to decrease the risk of lymphedema.
What’s more, we have adopted a multimodal approach to pain management working with our fellowship trained anesthesiologists that results in low or no narcotic use—and high on patient satisfaction—because patients are able to recover and get back to their regular activities quickly and comfortably.
There are several procedures used to remove breast tumors. Your breast surgeon will review them with you and, together, you’ll decide on what’s best for you:
- Lumpectomy or partial mastectomy: In this procedure—also known as breast-conserving surgery—your surgeon removes the tumor along with a margin of surrounding normal tissue. This surgery, together with radiation, has been shown to have equal or better survival outcomes when compared to mastectomy.
- Radioactive (breast) seed localization (RSL) may be used in conjunction with lumpectomy or a benign breast surgical biopsy. Under mammography or ultrasound guidance, the radiologist places a tiny radioactive seed the size of a rice grain in your breast. This helps your surgeon pinpoint the location of a tumor that appears on a breast imaging study but cannot be felt. The seed may be placed a day or more before your procedure so you spend less time in the hospital on the day of surgery. Your surgeon locates the seed—and tissue to be removed—with a hand-held detection device.
- Wire localization is an alternative when RSL isn’t feasible. The radiologist uses imaging guidance to insert a thin, flexible wire into the tumor site. During surgery, your surgeon uses the wire to locate and remove the targeted area.
- Mastectomy: In this procedure, your surgeon removes the breast tissue, leaving behind skin and fat. For women who plan to undergo reconstructive surgery, our surgeons can perform skin-sparing, areola-sparing, or nipple-sparing mastectomy, in which the remaining skin envelope is used to help maintain the breast’s natural shape for reconstruction. The decision as to which technique is individualized to the patient’s breast cancer and anatomy.
- Lymph node assessment: Some lymph nodes in the underarm (axillary nodes) may be removed to measure the extent of breast cancer in order to plan treatment effectively.
- Sentinel node biopsy: This procedure involves injecting a small amount of radioactive dye with or without blue dye near the breast tumor, which helps locate the lymph node to which tumor cells would first spread. That node is removed and examined by a pathologist to determine if cancer is present. If it is negative, no further axillary node surgery is performed.
- Axillary lymph node dissection: If a tumor is identified in the lymph nodes, removal of most lymph nodes found in the axilla region may be considered.
- Reconstruction: Reconstructive surgery can rebuild the size and shape of your breast after mastectomy. There are many different options and types of breast reconstruction procedures available to you, using your own tissue or implants. Some procedures are done (or started) at the same time as mastectomy, while others are performed later. Your surgeon will explain these options to you and refer you to a reconstructive specialist.
Certain factors can increase your risk for breast cancer, including:
- Family history of breast and/or ovarian cancer
- Prior radiation treatment to the breast or chest
- Personal history of breast cancer or non-cancerous breast disease such as atypical hyperplasia
- Long-term hormone replacement therapy
- Dense breasts
- Regular alcohol consumption
When a personal or family history suggests the possibility of an inherited cancer, we refer patients to the Hereditary Cancer Program for further evaluation and possible genetic testing. It’s important to know, however, that only a small percentage of breast cancers involve inherited gene mutations. The majority of breast cancers are due to unknown changes that occur in breast tissue spontaneously —which is why regular screening is so important.
At Norwalk Hospital, you’re never alone in your cancer journey. We offer a range of supportive services to help address the questions and concerns you and your loved ones may have not only during breast cancer treatment, but also beyond—in your life as a breast cancer survivor.
Cancer treatment can be complex, and we’re here to help make it less so. We’ll connect you to a special team of navigators focused on helping you through your treatment experience. While you can turn to any member of our staff whenever you have a question, these dedicated navigators have specific areas of specialization:
- Oncology Nurse Navigator: These compassionate professionals will meet with you to provide information and emotional support, help you understand your treatment options, and assist with scheduling and coordination of your medical tests and appointments. They are oncology-certified, which means they have special training and expertise in cancer care. They get it.
- Oncology Financial Navigators: Financial counseling is available to all patients, whether or not you have health insurance. The financial navigator can provide information on treatment costs and insurance benefits, and connect you to resources that may help pay for cancer treatment and medications.
We offer a wide array of complementary programs to promote healing and relaxation, help reduce unpleasant side effects from treatment, and contribute to your overall well-being. We believe in holistic cancer treatment, using complementary therapies such as aromatherapy, acupuncture, massage, and reflexology.
Good nutrition is essential for healing. Our dedicated oncology dietitian can provide support and guidance about nutrition during cancer treatment, and how to manage changes in taste, appetite and other side effects that can alter your nutritional intake.
We offer an ongoing schedule of community support groups and educational programs for you and family members, with sessions for people who are newly diagnosed, in treatment, and living as survivors of cancer. Danbury Hospital works collaboratively with Ann’s Place, a cancer community support center that offers support groups, classes, and social support services.
With sensitivity to every patient’s beliefs, needs and desires, our specially trained oncology chaplains are available for supportive listening, advocacy on your behalf, and counseling for you and your family members.
The Western Connecticut Health Network was the first in the state to offer a Joint Commission-accredited palliative care program at Danbury Hospital. Pain and other symptoms are not only uncomfortable, but also can present a barrier to treatment and healing. That’s why symptom management is a key part of our palliative care program, and we have many therapies and treatments to offer.
Our physical and occupational therapists have expertise in treating lymphedema and other complications from breast cancer surgery. With the goal of helping you achieve as normal a level of function as possible, we offer the full array of physical and occupational rehabilitation services.
Our care doesn’t end when your treatment does. People who survive cancer face a unique set of issues including managing the risk of recurrence, understanding the long-term effects of treatment, and addressing social, physical or emotional concerns. That’s why we have a team of survivorship experts--doctors, nurses and psychologists, and social workers—who’ll work with you and your primary care physician to create a plan to help you live well beyond cancer.
Systemic therapies are drugs given intravenously (through a vein) or by mouth. From there, they travel throughout the body to control, slow or even cure your cancer. They include chemotherapy, targeted therapies and endocrine therapies. Systemic therapy may be used alone or in combination with surgery or radiation.
The decision to use systemic therapy is based on many factors such as the stage of your breast cancer, how sensitive it is to hormones, whether a protein called Her2/neu plays a role in your cancer, and your overall health.
A genomic test of the tumor called OncoType DX® is sometimes used to determine the benefit of using chemotherapy in addition to hormone therapy for some estrogen receptor-positive breast cancers. Your medical oncologist will discuss all your options with you.
- Chemotherapy: Chemotherapy (chemo) drugs are used to kill cancer cells and prevent them from multiplying. Chemotherapy can be used in several ways:
- To decrease the risk of spread of cancer
- Prior to surgery, to shrink a tumor so it’s easier to remove
- After surgery, to ensure that no cancer cells remain after the tumor has been removed
- As maintenance therapy, to keep the cancer in check after initial therapy
- As palliative therapy, to reduce pain and other symptoms of advanced cancer
Chemotherapy may be given by intravenous infusion or taken orally as a pill. Most patients have a series of treatments over several weeks or months, often including drug-free periods to allow their body to recover.
Targeted therapies work differently from standard chemotherapy. They are typically intravenous medications that work by “targeting” specific DNA abnormalities within the cancer cells. The targeted therapy is chosen after a thorough analysis of a patient’s tumor specimen. Herceptin, which targets the Her2/neu protein found in some breast cancers, was one of the first targeted therapies. These are truly personalized cancer medicines.
Some breast cancers are fueled by the hormones estrogen and/or progesterone. Oral or injectable medications may be used to block these hormones that could contribute to cancer growth.
Radiation therapy is the precise and controlled use of radiation to kill cancer cells, and it’s almost always recommended following a lumpectomy. The types of radiation therapy we offer for treating breast cancer include:
- External beam radiation: External beam radiation delivers a beam of high-energy x-rays from a machine called a linear accelerator to your tumor site. It’s the most common treatment used after lumpectomy. The whole breast is irradiated, typically in sessions scheduled 5 days a week over 4 to 6 weeks.
- Accelerated partial breast irradiation (APBI): This form of breast radiation therapy delivers focused radiation specifically to the part of the breast where the tumor was removed. It also allows the treatment to be given in a shorter, faster schedule. You may be a candidate for APBI if your breast cancer is small and early stage.
APBI can be performed in one of two ways:
- Brachytherapy, in which a radioactive pellet is inserted via catheter into the cavity where your tumor used to be. This treatment is performed twice daily for 5 days at our New Milford Hospital campus.
- External beam APBI, also called tomotherapy, which also is typically given in 10 treatments over 5 days.
It’s important to know that our skilled radiation oncologists use advanced technology to perform what’s called respiratory gating during external beam radiation therapy. This technique times the delivery of radiation doses to specific points in your breathing cycle to ensure accuracy, and to protect healthy tissues when they move into the beam field during different times in the breathing cycle.
In western Connecticut, you don’t have to travel far to get exceptional breast cancer care. At WCHN, we offer a comprehensive program with you’d find at other major cancer centers—but right here at home.
Each year, hundreds of women and men of all ages, with all types of breast cancer, turn to WCHN for their care. Here are some of the top reasons why:
- Our physicians have advanced subspecialty training in breast cancer care— giving you a superior depth of expertise
- Our staff includes medical oncologists, radiation oncologists, fellowship-trained breast surgeons, reconstructive surgeons, fellowship-trained and/or specialized breast radiologists, pathologists, genetic counselors and lymphedema therapists—giving you a remarkable breadth of breast cancer-specific expertise, all in one place
- Treatment recommendations are made on every breast cancer patient seen with input from this multidisciplinary team—giving the benefit of their collective knowledge
- Our surgeons are adept at today’s most advanced procedures, including minimally invasive to advanced “oncoplastic” techniques such as nipple-sparing mastectomy—giving you options for preserving the appearance of your breast(s)
- We have invested in today’s most sophisticated technology for diagnosing and treating breast disease—giving you access to the most accurate and effective resources
- Our compassionate, oncology-certified nurse navigators are here to guide you through every step of diagnosis and treatment—so you’re never alone in your cancer journey
- With capabilities to determine each breast cancer tumor’s specific biologic profile, treatments can be targeted for your particular cancer—so your treatment is truly personalized
- We are the only program in the state to offer breast radioactive seed localization, a “no wire” technique that helps your surgeon find the abnormal tissue when it’s too small to be seen or felt on exam—ensuring the most targeted surgical therapy
- We offer special expertise in helping younger women preserve their fertility after breast cancer treatment
- Our distinctive approach to pain management around the time of surgery speeds recovery and gets you back to your regular activities more quickly with less need for pain medications
- We have a robust clinical research program—giving you opportunities to participate in trials investigating novel targeted therapies
- Our team of support specialists is here to ensure that all your physical, emotional and spiritual needs are met
- We offer a survivorship program that continues to educate, support and care for you, even after treatment is completed
- We are accredited by numerous national organizations—a testament of our ongoing commitment to high quality and comprehensive care of the breast patient