The Cancer Institute at Good Samaritan - Breast Cancer
Each year, approximately 2,500 new cases of breast cancer are diagnosed on Long Island. Suffolk County has one of the highest breast cancer rates in the state, with 8% of cases occurring here. Most breast cancers occur in women over the age of 50. One in eight women will learn she has the disease at some point in her life. Thanks to advanced screening tools and new breakthroughs in treatment, breast cancer is often diagnosed at an earlier and more treatable stage resulting in fewer deaths from the disease.
Good Samaritan’s Breast Health Center opened in 1993 in response to community concerns and the hospital’s commitment to women’s health care needs. It was one of the first comprehensive, patient-focused programs on Long Island and offers a dynamic multidisciplinary approach to breast health. A team of expert oncologists, surgeons, nurses and support staff attends a multidisciplinary breast cancer weekly symposium that reviews and recommends treatment strategies prior to any surgery. This group works together to offer the highest level of breast cancer diagnosis and treatment.
Good Samaritan’s Breast Health Center is one of only a few in New York State to receive a three-year/full accreditation designation from the National Accreditation Program for Breast Centers—given to those facilities that have committed to provide the highest level of breast care and undergo rigorous evaluations.
Signs & Symptoms
In its early stages, breast cancer usually has no symptoms. As a tumor develops, a patient may note the following signs:
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
- A change in the size, shape, or contour of the breast
- A blood-stained or clear fluid discharge from the nipple
- A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed)
- An area that is distinctly different from any other area on either breast
These changes may be found during a breast self-exam, which should be part of a monthly routine. Visit a doctor if you experience breast changes. For those over 40 or at a high risk for the disease, an annual mammogram and physical exam by a physician should also be performed. The earlier breast cancer is found and diagnosed, the better the chances of achieving a cure.
Most experts agree that an annual mammogram is key in the early detection of and fight against breast cancer. A baseline mammogram is recommended at age 40 followed by yearly screenings for women of average risk for breast cancer. Women at elevated risk should speak with their physician about beginning screenings at an earlier age or using other tests such as ultrasound or breast MRI. Good Samaritan’s genetic counseling department provides full risk assessments to help pinpoint a woman’s genetic predisposition to breast cancer. Mammogram using advanced, digital equipment give physicians the greatest opportunity to detect breast cancer at an early, curable stage.
Accredited as a Breast Imaging Center of Excellence since 2007, Good Samaritan’s Women’s Imaging Center’s radiologists, nurses and board certified registered radiological technologists have special expertise in all aspects of breast imaging to provide the latest in screening and full-field, digital mammography services. In addition to 3-D digital tomosynthesis, computer-assisted detection, galactography, high-resolution breast ultrasound, ultrasound-guided fine needle and core biopsies, and stereotactic core biopsies are all available.
- 3-D Digital Tomosynthesis: Good Samaritan’s Women’s Imaging Center is the first facility in Suffolk County with this advanced diagnostic tool. This FDA-approved method detects abnormalities in dense breast tissue.
- Diagnostic Mammography: Comprehensive diagnostic procedures for patients with abnormal screening mammogram results or symptoms are offered. Patients are given their results by their physicians within 24 hours.
- Comprehensive Screening Mammogram: Routine screening mammograms using the latest digital technology helps ensure early detection.
- Diagnostic Ultrasound: Sonograms are being performed using the center’s new, fully digital ultrasound machines with 4-D imaging. This technology features a flat-screen display, voice recognition, intelligent automation and more, allowing staff to better assist patients in understanding their condition. It also produces clearer and more detailed images to identify suspicious breast lesions sooner and eliminate the need for more expensive and invasive tests. If a needle biopsy is needed, the high-tech system guides catheters and needles without radiation exposure and reduces the time required for many exams.
- Stereotactic Biopsy: The center is equipped with a stereotactic table with the most advanced vacuum-assisted biopsy technology. Using mammographic guidance, a technologist and nurse assist the doctor, who is able to biopsy microcalcifications (just millimeters in size) and suspicious lumps. This nonsurgical biopsy requires only local anesthesia and is less invasive than open-surgical biopsies, leaving little or no internal scar tissue.
- Needle Localizations: A lump that cannot be felt needs to be located and flagged prior to a biopsy for surgical removal. In such cases, a needle or wire may be used, along with either a mammogram or ultrasound, to mark the area for biopsy. The removed mass or calcifications are X-rayed immediately to confirm the procedure’s accuracy.
- Breast Magnetic Resonance Imaging (MRI): Breast MRI may be performed for newly diagnosed and high-risk breast cancer patients at Good Samaritan’s main campus.
- Dual-Energy X-Ray Absorptiometry (DEXA) Bone Densitometry: The “gold standard” of bone assessment methods, this noninvasive test is a baseline assessment for osteoporosis and can be completed in a matter of minutes. Test results provide important information to assess the next steps in care to help prevent future bone loss and minimize the risk of a devastating injury. When an appointment is made for a mammogram, a DEXA test can be scheduled as well.
- Genetic Counseling: Screening for hereditary cancer risk performed by board certified genetic counselors with expertise in cancer risk assessment is available at both the Women's Imaging Center and the main hospital campus.
Surgery is usually the first line of attack against breast cancer. Decisions about surgery depend on many factors. Good Samaritan’s cancer team will help determine the kind of surgery that’s most appropriate based on the stage of the cancer, the type of the cancer and the patient’s wishes.
Good Samaritan’s board certified surgeons will discuss a range of options including:
- Lumpectomy - also known as breast-conserving surgery, is the removal of only the tumor and a small amount of surrounding tissue
- Mastectomy - is the removal of all of the breast tissue.
- Lymph node removal (or axillary lymph node dissection) - can take place during lumpectomy and mastectomy. Most people qualify for the less-invasive sentinel lymph node dissection, which is the removal of the first lymph nodes the cancer may spread to. If these nodes are clear, then there is no need to remove more.
- Breast reconstruction - the rebuilding of the breast after mastectomy and sometimes lumpectomy. Reconstruction may take place at the same time as cancer-removing surgery, or months to years later.
- Prophylactic mastectomy – the preventive removal of the breast to lower the risk of developing breast cancer in high-risk people.
Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and those that have spread to another part of the body. There are quite a few chemotherapy medicines. In many cases, a combination of two or more medicines will be used as chemotherapy treatment for breast cancer.
Good Samaritan’s experienced oncologists offer chemotherapy options to treat:
- Early-stage invasive breast cancer, eliminating any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back
- Advanced-stage breast cancer to destroy or damage the cancer cells that have traveled beyond the breast
In some cases, chemotherapy is given before surgery to shrink the cancer.
The Department of Radiation Oncology uses high-energy rays to treat cancer and other diseases. When radiation is used in high doses and aimed at targeted areas of the body, the rays can destroy the cancer cells and prevent them from reproducing. When used by professionals with special expertise and training, it is very safe and a highly effective treatment for cancer.
With Intensity-Modulated Radiation Therapy (IMRT), individual radiation beams are further broken down into tiny segments. They are carefully controlled so that the intensity of the beam can change in each little section. Therefore, even irregularly shaped tumors can be irradiated at a high dose, while at the same time protecting healthy, normal tissue that surrounds or is surrounded by the tumor. A newer technique allows for optimal treatment with fewer visits.
Partial breast irradiation is a new modality being developed. MammoSite places the radiation source inside the space left after a tumor is removed. This delivers radiation to the area where cancer is most likely to recur. Other methods include external beam irradiation, brachytherapy and non-operative treatment.
Good Samaritan’s Radiation Oncology Department is one of only a few centers in New York State to be accredited by the American College of Radiology. Here patients are treated with compassion, dignity and respect by board certified radiation oncologists. With this experience and technology available locally, patient’s don’t have to go far to get the most far-reaching cancer treatment available.
The Radiation Oncology Department has received a three-year accreditation by the American College of Radiology (ACR)-American Society for Radiation Oncology (ASTRO). Accreditation by ACR-ASTRO demonstrates that Good Samaritan has undergone a comprehensive review process and meets nationally accepted standards of care. The ACR-ASTRO accreditation process signifies that Good Samaritan’s radiation oncology professionals, equipment, quality assurance and radiation safety meet the highest standards.
Hormonal therapy medicines treat breast cancers in two ways:
- By lowering the amount of the hormone estrogen in the body
- By blocking the action of estrogen on breast cancer cells
Most of the estrogen in premenopausal women's bodies is made by the ovaries. Estrogen makes hormone-receptor-positive breast cancers grow. Reducing the amount of estrogen or blocking its action can reduce the risk of early-stage hormone-receptor-positive breast cancers from coming back after surgery. Hormonal therapy medicines can also be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers. Also, the medications can be used to decrease the risk of developing a new breast cancer in high risk women (nophylaxis).
There are several types of hormonal therapy medicines, including aromatase inhibitors, selective estrogen receptor modulators and estrogen receptor down regulators.
In some cases, the ovaries may be surgically removed to treat hormone-receptor-positive breast cancer or as a preventive measure for women at very high risk of breast cancer. The ovaries also may be shut down temporarily using medication.