A National Cancer Institute-designated Comprehensive Cancer Center

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Breast Cancer

Breast Cancer
As a dedicated team of breast cancer experts, we focus on compassionate, patient-centered, leading-edge care to save the lives of women.

A breast cancer diagnosis is life-altering. The Breast Cancer Program at City of Hope offers a unique approach for women diagnosed with breast cancer. Our expert team of doctors and researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact our patients today, and we focus on the patient as a whole, treating both the physical and emotional changes that a breast cancer diagnosis can bring, while also addressing the needs of partners and families.
Our multidisciplinary team of dedicated surgeons, medical and radiation oncologists, nurses, genetic counselors, and social workers provides compassionate, individualized care combined with access to state-of-the-art technologies and treatments.

We tailor treatment according to the individual patient’s cancer characteristics.
  • We recognize that breast cancer is different for every patient, and that each woman needs her own personalized treatment plan. We tailor our treatments to the patient according to patient age, genetics, psychosocial, and spiritual needs.
  • Doctors in our Cancer Genetics Program provide comprehensive consultations in cancer screening and prevention by assessing the cancer risk for individuals and families and providing recommendations to prevent as well as detect breast cancer at its earliest and most curable stage.
  • We use state of-the-art imaging modalities for accurate and rapid diagnosis as well as surgical planning, which facilitates minimally invasive techniques for the optimal staging and treatment of breast cancers.
  • We offer the latest modalities of breast preservation, skin-sparing surgeries, minimally invasive robotic surgery, oncoplastic surgery, and reconstructive surgery to provide optimal cancer surgery while achieving excellent cosmetic outcome.
  • We are constantly evaluating new drugs designed to treat pre-malignant conditions, as well as novel compounds that target advanced metastatic disease. We also study super-foods that help prevent cancer for women who are at high risk for developing breast cancer.
  • We assess the needs of cancer patients and family members using biopsychosocial screening that addresses the biological, psychological (thoughts, emotions, and behaviors), and social factors that all play a significant role in the lives of women battling cancer.
  • All breast cancer patients and their families can participate in the Partners Clinic, a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together.
  • All breast cancer patients can participate in the Survivorship Program: Our care does not end after completion of treatment. Our doctors and researchers are working to develop resources to help improve the quality of life for survivors, and all patients are able to participate in ongoing long-term research related to their life after cancer.

Combining the power of collaboration with a dedication to compassion, we seek to save the lives of women.
About Breast Cancer
Breast cancer can be classified in two broad categories: noninvasive and invasive.
  • Non-invasive or in situ breast cancers stay within the breast and do not spread into surrounding tissues.
  • Invasive or infiltrating breast cancers spread outside the breast into other parts of the body through  blood and lymph nodes.

Breast cancer is also classified based on where in the breast the disease started and how the disease grows.

Invasive ductal carcinoma
This is the most common type of breast cancer, beginning in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple).

Invasive lobular carcinoma
This cancer begins in the lobules (milk glands) of the breast. It is found in both breasts more often than other types of breast cancer.

Inflammatory breast cancer
In this uncommon type, the breast is red and swollen and may have thickening of the skin that resembles an orange peel.

Recurrent breast cancer
This is disease that returns after it has been treated. It may come back in the breast, in the chest wall or in other parts of the body.

Metastatic breast cancer
This is a breast cancer that has spread to sites and organs outside the breast and regional lymph nodes. One in 20 women are found to have metastatic cancer when they are first diagnosed with breast cancer. In others, spread is discovered after a previous diagnosis of early-stage breast cancer.
Breast Cancer Risk Factors
Breast cancer is the most common cancer among American women. Approximately one in eight women living in the U.S. will be diagnosed with breast cancer during their lifetime. More than 232,000 U.S. women and 2,200 men are expected to be diagnosed with breast cancer in 2013, according to the National Cancer Institute. Age is the strongest risk factor for breast cancer, but others are significant as well.
  • Age: Your risk of developing breast cancer increases as you get older, and half of all breast cancers are diagnosed in women older than 60.
  • Gender: A woman is 200 times more likely than a man to develop breast cancer.
  • Reproductive and menstrual history: Women who have never had a full-term pregnancy or who had their first after age 30 are at higher risk. Women who started menstruating before age 12 or who went through menopause after 55 are also at increased risk.
  • Obesity: Being overweight increases your risk of breast cancer, and obese women who are treated for breast cancer are cured less often than non-obese women.
  • Alcohol: Alcohol use is associated with a slightly higher risk of developing breast cancer.
  • Inactivity: Women with a long-term history of physical inactivity are at increased risk.
  • Family history: Having a close blood relative such as a mother or sister who has had breast or ovarian cancer can increase your risk.
  • Personal history: Women who have had breast cancer have a slightly greater chance of developing another breast cancer.
  • Inherited factors: In some families, genetic mutations may make some women more susceptible to developing breast cancer. The most comment inherited causes are mutations in the BRCA1 and BRCA2 genes.
Previous treatments
  • Radiation therapy: Women who have had radiation to the chest area, particularly before age 30, may be at a higher risk of developing breast cancer.
  • Hormone therapy: Menopause hormone therapy combining estrogen and progesterone for more than five years is associated with an increased risk.

How We Diagnose Breast Cancer

An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. Early detection and ongoing management of your treatment are our priority. Your highly skilled team will use the most advanced and powerful breast imaging technologies and laboratory techniques to plan your personalized treatment.

Breast Imaging

Imaging studies give your breast cancer team important information about changes that may be occurring in your breast tissue. Breast imaging is an important part of a woman’s health care, so that problems can be detected when they are most treatable.
A mammogram is a safe and reliable low-dose X-ray exam that provides a view inside breast tissue. Mammography is appropriate for women who have a current symptom or women with a history of previous breast cancer.
Screening mammography: A specially licensed radiologic technologist will administer the mammogram. First, a compression paddle is lowered slowly onto the breast. This prevents any movement and allows the maximum amount of tissue to be examined. There may be some brief discomfort from the compression. A series of images is taken and checked for quality.

Diagnostic mammography: During a diagnostic mammogram, a number of X-rays are taken to obtain views of the breast from several angles. Areas may be magnified to produce a detailed picture that can help the doctor make an accurate diagnosis. A diagnostic mammogram takes longer than screening mammogram because more X-rays are needed to obtain varying views of the breast.

Digital mammography: This specialized form of mammography uses digital receptors and computers instead of X-ray film to help examine breast tissue for cancer. The electrical signals can be read on computer screens, permitting more manipulation of images to allow your doctor to more clearly view the results.
Breast MRI
Women who are at extremely high risk for developing breast cancer because of family history, genetics or prior treatment may require closer screening with a breast MRI (magnetic resonance imaging). MRI technology combines magnetic fields, radio waves and a computer system to obtain cross-sectional three-dimensional images. Breast MRI is especially useful for women with breast implants, as well as women with dense breast tissue that can be difficult to image with regular mammography. It can also detect small lesions that may not be visualized with mammography. The test does not use radiation.

Diagnostic ultrasound: An ultrasound uses high-frequency sound waves to create an image of the breast tissue on a viewing screen. An ultrasound may be used to distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

A biopsy is a test in which a sample of breast tissue is obtained through a needle or by removing a piece of tumor, which is then examined using a microscope. The examination can answer questions about the specific composition of a breast lump or other abnormality.

Fine needle aspiration biopsy: In this minor surgical procedure, a thin, hollow needle is inserted into a breast lump to take a small sample of cells that are examined under a microscope.

Needle-localized open surgical biopsy: This type of biopsy is performed when you have an abnormality that cannot be felt but is visible on a mammogram. After a local anesthetic is administered, a small needle is inserted into the breast to mark the 
area to be sampled, and then mammogram images are taken to confirm the needle is correctly positioned. A guide wire is then inserted through the needle to show the surgeon exactly where to take the biopsy. The tissue biopsy is obtained in the operating room and the wire removed.
Stereotactic biopsy: This type of biopsy uses a computer and X-rays to locate the abnormal breast tissue. A sample of tissue is then removed using a fine needle aspiration biopsy.

MRI-guided biopsy: MRI (magnetic resonance imaging) uses magnetic fields and radio waves, and a computer system to generate three-dimensional cross- sectional images of the body. MRI-guided biopsy is used when an abnormal area cannot be visualized well by mammogram or ultrasound. Sometimes, an MRI-guided biopsy is used when an abnormality can only be visualized on an MRI scan.

Ultrasound-guided biopsy: During ultrasound-guided biopsy, your doctor will use ultrasound to guide the needle to the appropriate area. The sample of tissue or fluid then is evaluated in the laboratory.

Breast Cancer Treatment Approaches

City of Hope is at the forefront of breast cancer treatment. For women needing medical intervention, we take a comprehensive and aggressive approach to treatment offering state-of-the-art surgical, medical and radiation therapies, including many that are not yet available to the general public, and our supportive care and long-term follow-up programs help women and their families manage the process of treatment and recovery.
City of Hope offers the latest advances in the surgical management of breast cancer provided by specialty-trained breast surgeons. The scope of surgery is determined by the size and extent of the breast cancer.
  • For patients with small tumors and early-stage breast cancer, breast-conserving surgery is a treatment option providing optimal cancer surgery while achieving excellent cosmetic outcomes. Our surgeons specialize in nipple-sparing mastectomies, in which the entire appearance of the breast is preserved. This technique can be used for appropriate patients with breast cancer or as “risk reduction” surgery in patients who are at very high risk for developing breast cancer.
  • For patients with larger tumors, chemotherapy can sometimes be given before surgery to shrink the tumor, which can help make breast conservation an option.
  • Patients who are not candidates for breast conservation or who elect to undergo a total mastectomy with removal of all breast tissue may still have reconstructive surgery, either immediately or at a later time.
Reconstruction can be performed either using implants or the patient’s own tissue during reconstructive procedures to create the most natural breast possible. Our surgeons also specialize in secondary reconstructive surgery when initial procedures prove unsatisfactory. A new method developed by the Breast Cancer Program at City of Hope to recreate the nipple and areola is providing better cosmetic results with minimal scarring.
Medical Oncology
Medicines that slow or stop the growth of cancer cells are often included in a patient’s treatment plan because these drugs travel through the bloodstream, and are able to kill any small cancer cells that have leaked into the blood that may eventually take root in other parts of the body. We offer the best treatments available and are constantly investigating promising new treatments, including novel chemotherapies, endocrine therapies, and immunotherapies to help save the lives of our patients.
  • Patients with small tumors or early-stage breast cancer may receive chemotherapy alone, neoadjuvant chemotherapy, which is treatment given before surgery to help shrink the tumor, adjuvant chemotherapy, which is additional treatment given after surgery to “mop up” microscopic disease, or hormonal therapies (medication given after surgery).
  • Patients with large primary tumors may be considered for neoadjuvant treatment. Patients with more advanced disease may also be candidates for new strategies developed to slow the spread of cancer. These may include combinations of standard drugs, investigational and targeted therapies or other options.
Radiation Oncology
Radiation therapy is often used in treating breast cancer. It may be employed as a stand-alone treatment for early stage cancer, or in combination with surgery and other treatments in more advanced cases, to help reduce the chance of the cancer recurring.
Radiation therapies available at City of Hope include advanced partial breast irradiation techniques. These focus radiation only on the affected area, rather than the entire breast. Radiation therapy is a standard part of treatment for patients who have a lumpectomy for small invasive breast cancers and non-invasive cancers. Some mastectomy patients may also receive radiation therapy. We also offer new investigational treatments for appropriately selected breast cancer patients.
  • External Beam Radiation Therapy
    External Beam Radiation Therapy is the most common form of radiation therapy, where radiation is directed at the tumor from outside the body.
  • Intensity Modulated Radiation Therapy (IMRT)
    IMRT targets tumors with pencil-thin “beamlets” of radiation. By sculpting the radiation to precisely match the tumor’s contours, a higher dose can be delivered to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.
  • Intra-operative Radiotherapy (IORT)
    At City of Hope, we also offer appropriately selected breast cancer patients radiation therapy delivered in the operating room. We are one of a select number of cancer centers to provide IORT .  This advance enables many women to receive their entire course of radiation on the same day as their surgery, rather than stretching out radiation treatment over six to eight weeks. Learn more about IORT.

Breast Self-Exam

What Every Woman Needs to Know

As a woman, you are at risk for breast cancer. In fact, American Cancer Society statistics show that one out of every eight women in the U.S. will develop breast cancer in her lifetime. Even men can get breast cancer. But thanks to better, more advanced treatments, many of those diagnosed with breast cancer will go on to live full, active lives.

Early detection is important, because when a cancer is detected in the early stages, treatments can be more effective. You may have heard about different ways to test for breast cancer. One of the easiest is the Breast Self-exam (BSE), a physical examination of your own breast tissue. The BSE is something you can do by yourself, in private, on your own schedule. By getting to know how your breasts normally look and feel, the BSE can be an added defense against dying of breast cancer. In fact, eight of 10 breast lumps are found by women themselves. The Breast Center at City of Hope follows the Breast Screening Guidelines recommended by the National Comprehensive Cancer Network ( NCCN ).

How Often Should I Perform my Breast Self-exam?

According to the NCCN guidelines, you should perform a BSE each month. By becoming more familiar with your normal breast tissue and appearance, it may make it easier for you to notice changes if and when they occur. When Should I Perform my Self-exam? The ideal time for a BSE is seven to 10 days after the first day of your menstrual period. Your breasts are naturally less lumpy and tender at this time. The same is true if you have breast implants. If you are pregnant, or no longer have menstrual cycles, you can perform your BSE at any time, but make it the same time each month. If you are breast feeding, you should also perform your monthly BSE at the same time each month. Be sure to do it after you have fed the baby, not before. Any time of the day is okay.

How do I Perform my Self-exam?

Your BSE will only take a few minutes, but it is best to choose a time when you have some privacy and will not be disturbed.
  1. Stand undressed from the waist up in front of a full length mirror with your arms relaxed at your sides. If you cannot stand comfortably, you can do this part sitting down. Get to know how your breasts look. Even a small visual change may be a significant early sign of a problem. Notify your health care provider immediately if you notice any changes.
  2. Compare your breasts while turning from side to side. Look for any changes in breast size, shape, skin texture or color including redness, dimpling, puckering or retraction (pulling back of your skin).
  3. Notice any nipple changes, such as scaliness, a pulling to one side, or a change in direction.
  4. Place your hands on your waist and press inward, then turn from side to side to note any changes. If you cannot place your hands on your waist, try clasping your hands together in front of you, to tighten the chest muscles.
  5. Tightening the chest muscles beneath the breasts in other ways can also help you notice changes. Try different positions, such as putting your hands above your head and turning side to side as you look.
  6. Place your hands at your waist and bow toward the mirror, letting your breasts fall forward. Note any changes in breast shape.
  7. Nipple discharge can be a sign of a problem. Look for any discharge in your bra or clothing, but do not squeeze the nipple or try to expel any secretions. Notify your health care provider if you notice any discharge.
  8. Feel above and below your collarbone for pea- and bean-sized lumps or thickening. Applying skin cream or lotion can make this easier.
  9. Check for lumps or thickening under your arm while relaxing your arm at your side. Reach across with your other hand to feel the area. Check deeply up and down the inside of the armpit, and up and forward toward your chest. Note any changes from previous self-exams. For the next steps, lie down. The bed is okay.
  10. Place a pillow or folded towel under your left shoulder. This helps your breast tissue spread evenly across your chest wall. Bend your left arm behind your head and reach across with your right hand to your left breast. A little skin cream or lotion on your fingers will make them more sensitive.
  11. Begin the exam at the armpit. Move your three middle fingers together using light, medium and deep pressures.
  12. Your hand should move in straight rows to cover all the breast tissue from the line where your blouse seam would fall (midaxillary line) to the bra line, the breastbone (sternum) and collarbone (clavicle). Then, repeat on the other side.
What if I Find Something?

Most commonly, lumps such as cysts, are benign and are usually not a serious health problem. However, always report any changes in your breasts to your health care provider. Remember, breast tissue can vary in density naturally. Your breasts may change during different times of the month if you are still menstruating. Breast tissue also changes with age.

Your Best Defense

Early detection is important, because treatments are more effective when cancers are small.

Take Your Time

Try to avoid being rushed during your BSE, so that you can pay careful attention to your body.

Breast Cancer Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center , which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.

Additional Resources
Breast Health and Breast Cancer Information
  • American Cancer Society (ACS)
    ACS has 3,400 offices across the country. The ACS website offers an online community and contains abundant information about breast
    cancer and the affected areas of one’s life. ACS also connects patients with clinical trials.
  • BreastCancer.org
    A physician-reviewed website, BreastCancer.org helps you to identify important questions to ask your physician. BreastCancer.org also hosts Ask-the-Expert online conferences and offers information on breast cancer. Discussion groups are available to connect with others, as well.
  • Breast Cancer Network of Strength
    800-221-2141 (English and non-Spanish languages)
    800-986-9505 (Spanish)
    Network of Strength offers a wealth of information on breast cancer in several different languages, while maintaining a focus on emotional support through the YourShoes peer counselor hotline. Peer support is available 24-hours a day, 7 days a week and is available in over 150 languages. Informational brochures are available and  low-income women can apply for a free wig, prostheses, or mastectomy bra.
  • Breast Cancer Support
    Breast Cancer Support offers online discussion boards for women diagnosed with breast cancer, as well as their family, friends, and caregiver(s). Links to the latest research news in breast cancer
    are posted daily.
  • Busted Foundation
    Offers financial support to women, especially those in Southern California, who are experiencing financial hardship due to their medical treatment. Educational support including information on insurance, how to access grants, and other charity organizations is also offered by contacting them through their website.
  • CancerCare
    CancerCare offers financial assistance for copays, prescriptions, transportation, childcare, and homecare. Professional oncology social workers offer free one-on-one counseling. Support groups, workshops, and a telephone helpline are available. The website has information topics for a variety of cancer diagnoses.
  • Gilda’s Club
    (Affiliate of the Cancer Support Community)
    gcdcinfo@dc.rr.com (Coachella Valley region)
    www.thewellnesscommunity.org (National)
    Based predominantly on the east coast, Gilda’s Club serves the Coachella Valley region in Riverside County. Free psychosocial cancer support is offered to those affected by cancer. Gilda’s Club also provides programs like Tai-Chi, pilates, knitting, socials, various support groups for individuals and families, and etcetera.
  • The Inflammatory Breast Cancer Foundation
    Designed specifically for women struggling with inflammatory breast cancer (IBC). A variety of information is available in various formats, including brochures that can be ordered through their website.
  • Living Beyond Breast Cancer
    Lbbc.org offers free brochures in English and Spanish on various types of breast cancer
    issues like financial and emotional support. A discussion board and educational webcasts are also on the website.
  • Los Angeles Breast Cancer Alliance
    LABCA offers a variety of programs, including financial assistance for transportation. LABCA also offers non-clinical support to women diagnosed with breast cancer, including a special program specifically for young women.
  • Men Against Breast Cancer
    www.menagainstbreastcancer.org info@menagainstbreastcancer.org
    An organization designed by men to offer support to empower men when a female they love is diagnosed with breast cancer. The organization provides support and information for men on how to appropriately be a caregiver to their loved one. Men are encouraged to join advocacy efforts to find a cure for breast cancer.
  • Metastatic Breast Cancer Information and Support
    These two sites offer women with metastatic breast cancer a safe place to connect with one another via an email list group. Information is available on the website regarding breast cancer and treatment.
  • Mothers Supporting Daughters with Breast Cancer
    Offers one-on-one peer support for mothers who have a daughter diagnosed with breast cancer.  Also available are free educational materials for mothers and daughters with information on how to support each other.
  • National Breast Cancer Foundation
    The National Breast Cancer Foundation (NBCF) provides funding for women who cannot afford mammograms to receive them for free. Their website has an online message board, as well as information on risks, diagnosis, and treatment options.
  • National Cancer Institute (NCI)
    NCI offers a wealth of information and educational materials for patients and families. Also offers information on various treatment options and clinical trials.
  • National Coalition for Cancer Survivorship
    Offer a survivor-led advocacy group with the goal of empowering cancer survivors and advocating for equality cancer care. Their website also has their free, award-winning "Cancer Survivor’s Toolbox."
  • National Lymphedema Network
    Provides free information and guidance to patient’s experiencing lymphedema, including prevention and management techniques. Their website also provides information on support groups and clinical trials.
  • Pink-Link
    Search for other women with breast cancer through Pink-Link’s Breast Cancer Support Network. You can also subscribe to their Pink-Link Newsletter.
  • SHARE: Self-help for Women with Breast or Ovarian Cancer
    SHARE has a telephone support program in 12 different languages. SHARE also hosts support groups, educational programs, and encourages advocacy. They also offer a monthly newsletter for  updates.
  • Sharsheret
    Offers resources for young Jewish women confronted with breast cancer. A peer support service is provided to connect young women with others who have experienced a similar diagnosis.
  • Sisters Breast Cancer Survivors Network
    A support network aimed to assist African American women with breast cancer. They have a support group that meets once a month in Los Angeles.
  • Susan G. Komen for the Cure
    Susan G. Komen for the Cure is one of the most popular breast cancer support organizations. The website includes educational materials, information on organizations that patients can contact for financial assistance, and a message board. There is also a national breast care helpline for support.
  • Triple Negative Breast Cancer Foundation
    Offers a toll-free hotline for women diagnosed with breast cancer and their loved ones. Also provides support to researchers to learn more about triple negative breast cancer.
  • The Wellness Community (Affiliate of the Cancer Support Community)
    www.twcfoothills.org (Pasadena)
    www.twc-wla.org (West LA)
    www.thewellnesscommunity.org (National)
    The Wellness Community offers a variety of programs, including online and face-to-face support groups, short-term therapy for cancer related issues, yoga and other mind-body classes, educational classes, social events, and etcetera. All programs and services are free to participants.
  • WeSpark Cancer Support Center
    818-906-3022 (Sherman Oaks)
    661-288-2322 (Santa Clarita)
    WeSpark offers free supportive services to individuals diagnosed with cancer and their families. Services offered include a variety of support groups, yoga, Thai-Chi and other mind and body classes, acupuncture, and workshops.
  • Young Survival Coalition
    Dedicated to addressing the unique issues faced by women under the age of 40 diagnosed with breast cancer. Their website also has an online bulletin board. Women can call the number listed to be connected with a peer who has experienced a similar diagnosis and treatment who can offer peer support.

Partners Clinic

Breast cancer affects the whole family, causing stress in relationships, among family members, and in your work and home life. A united team can help effectively manage these disruptions. The Partners Clinic is a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together.
Designed specifically for newly diagnosed breast cancer patients and their partners or families, the clinic offers communication training and gender-based problem-solving led by board-certified counseling experts. This session, which occurs  at the initial surgical visit, provides patients and their families with the necessary tools to communicate honestly and directly with each. It actively encourages the sharing of emotional concerns and fears in a way that helps everyone manage their unique situations.

Breast Cancer Clinical Trials/Research

There is extensive collaboration between medical doctors and laboratory scientists within the Breast Cancer Program to develop and evaluate new therapies designed to treat breast cancer and improve the likelihood of cure. Many of these new treatment approaches are only available at City of Hope. As a patient at City of Hope, you may qualify to participate in a clinical trial of one of these new therapies.

We offer access to a wide variety of clinical trials ranging from new chemotherapy and targeted therapies, hormone therapies to surgical approaches focused on developing novel and personalized treatment for breast cancer.

We are also deeply invested in research to better understand breast cancer, the well-being of patients and the needs of patients and their family members.

Some of the research questions we strive to answer include:
  • What are the potential long-term side effects for cancer survivors  and how can we prevent or minimize them?
  • What is the impact of surgery choices in underserved communities ?
  • Why are some cancers resistant to chemotherapy?
  • How can the use of psychotherapeutic interventions play a larger role in helping women cope emotionally both during and after treatment?

Some of our most exciting current research projects include:
  • Evaluating expression patterns of genes and potential protein targets from individual patient’s cancer stem cells
  • Characterizing circulating tumor cells in patients with locally advanced and metastatic disease
  • Decoding mechanisms of resistance to anti-estrogen and other therapeutic agents
  • Identifying and interfering with unfavorable activations of genes and transcriptional and signal transduction pathways by studying microRNAs and a host of epigenetic modulatory components
  • Focusing on novel therapeutic developments to treat metastasis
  • Studying the role of STAT3, a protein highly activated in cancer cells, and developing drugs that block the tumor-regulating protein
  • Examining the role of PARP inhibitors, a class of drugs that block a cancer cell’s ability to repair DNA damage caused by chemotherapy and radiation therapies; these drugs could make those treatments more effective. 
  • Investigating health and risk factors among more than 100,000 female educators in the California public school system
  • Studying the role of aromatase inhibitors
  • Improving counseling and other support services for women at high risk of development cancer who make the difficult decision to undergo prophylactic mastectomies, hysterectomies and oophorectomies
  • Studying survivorship  with a focus on quality-of-life issues, the prevention of secondary cancers, and other survivorship issues
To learn more about our clinical trials program and specifically about trials for breast cancer, click here.
Low-dose Tamoxifen for Radiation-Induced Breast Cancer Risk Reduction Trial
A clinical research study is currently underway to see if low-dose tamoxifen can reduce the risk of breast cancer in childhood, adolescent , and young adulthood cancer survivors. 

Why childhood, adolescent , and young adulthood cancer survivors?
Women who received radiation therapy for childhood, adolescent, and young adulthood cancer that included the chest or axilla before age 40 have increased risk for developing breast cancer. Careful breast cancer screening is recommended for childhood, adolescent , and young adulthood cancer survivors, but there is currently no risk reduction options designed just for them.
Why Tamoxifen?
Tamoxifen is a drug that has been proven to reduce the risk of breast cancer by 50% in other women at high risk for developing breast cancer. More recently, data has shown that a lower dose may be better tolerated and just as effective.

What would I be asked to do?
  • Screening for eligibility:
    Medical history, breast exam, and lab tests.
  • If you are eligible:
  • You will be given pills containing either placebo or 5mg of tamoxifen to take daily for two years.
  • You will come back to the clinic every six months for a breast exam. Blood and urine will be collected annually. Breast imaging will be performed as standard of care for your level of breast cancer risk.
  • Breast tissue sampling will be performed at the beginning at the end of the study. 
Is it risky?
Common side effects reported with standard-dose tamoxifen include hot flashes and vaginal discharge, These have not been reported with low-dose tamoxifen.  Other potential side effects will be discussed at your initial meeting.

Who can get involved?
Participants must be women at least 25 years old with childhood, adolescent , and young adulthood cancer survivors  at least 2 years ago.  They must have received radiation to the chest or axilla prior to the age of 40 and remained recurrence-free for at least 2 years.  Breast implants or hormone use is not allowed.

This study is only being conducted at select cancer centers in North America.  To see if you qualify, please contact the coordinating center at City of Hope:
(800) 250-8430
This study is supported by a grant from the National Cancer Institute (R01 CA140245-01A1).

Breast Cancer Team

Breast Cancer FAQs

How do I conduct a Breast Self-Exam (BSE)?

The key to doing a BSE is knowing your own breast. Please review our Breast Self-exam page and ask Breast Center staff if you need additional instruction.

Should I get a screening mammogram every year?

Mammography is the most beneficial and reliable screening test of all cancer screening. Although not the perfect test, a mammogram can detect cancer growing long before any type of physical examination allows a growth to be felt. City of Hope follows the American Cancer Society guidelines and the National Cancer Center Network (NCCN) in believing that yearly mammograms are necessary for women over 40.

What should I do if my mammogram is abnormal?

Your doctor will receive a report outlining the concerns and conditions noted on the abnormal mammogram. Included in the report will be recommendations for further diagnostic evaluation and studies. You should follow the recommendations as closely and quickly as possible. Upon additional reviews and a more comprehensive evaluation, most suspicious areas are found to be benign.

Can I get additional imaging at City of Hope?

At City of Hope, we have the ability to do additional mammographic film views of the breast, as well as ultrasound and MRI scanning, should there be any concern with initial findings.

Can I get a biopsy at City of Hope?

All types of minimally invasive biopsies are available and can be performed at City of Hope. By offering on-site services such as these, we let you have the biopsy scheduled and learn the results more quickly.

Do you offer pap smears or gynecologic exams?

City of Hope does not offer routine pap smears. However, a referral can be made to our gynecology department if you are: already a patient, at high risk, taking Tamoxifen with irregular bleeding, or having abnormal side effects from other hormonal therapy.

Is digital mammography better than regular mammography?

A recently completed study concludes that digital mammography is more effective for detecting cancer in younger women and those with dense breast tissue. For other women, there was no significant difference between digital and conventional mammography. This large multi-institution study, sponsored by the American College of Radiology, was the first to show superiority of digital mammography. Prior smaller studies had shown the two methods to be equally effective in finding cancer.

Should I only have my mammograms performed at a facility that offers digital mammography?

The majority of hospitals and breast imaging centers do not yet offer digital mammography, so your provider options will be more limited. If you are in one of the groups for which digital mammography may be more effective (under age 50, have dense breasts, or are pre-menopausal), you may want to consider having your mammogram at a facility that offers digital mammography. Otherwise, there is no reason for you to choose digital over conventional mammography.

Does City of Hope offer digital mammography?

Yes, City of Hope offers digital mammography and also computer-assisted detection software to further aid radiologists in detecting cancerous changes on mammography. We hope this information helps you to make an informed decision about mammography that is right for you. If you have any other questions, please feel free to speak to one of our imaging technologists at the Women's Health Center.

Breast Cancer Survival

For women who have been diagnosed with breast cancer, we’re ahead of the curve in providing better options that can lead to higher survival rates.  These options include surgical, medical and radiation therapies.
City of Hope is one of the few hospitals providing the latest advances in radiation therapy for breast cancer patients — intraoperative radiation therapy, or IORT. During surgery, patients receive a concentrated dose of precise radiation, rather than the normal follow up plan of six to eight weeks of daily radiation treatments.  IORT allows one day as opposed to six to eight weeks of daily radiation, with the exact same excellent results.
In addition, we have an extensive research program for women with breast cancer with more than 20 clinical trials, to help women find the right treatment for them.
A national database of cancer outcomes is maintained jointly by the American Cancer Society and the American College of Surgeons’ Commission on Cancer.  Each year, the National Cancer Database (NCDB) provides data to hospitals to allow each institution to compare its results with those obtained nationally.
The chart below compares survivorship over a five year period for City of Hope patients, who have had breast cancer and were treated by surgery, with patients nationally who have had the same treatment for the same stages of their disease.
At City of Hope, our survivorship exceeds the survival rates for patients treated at other cancer programs that report to the Commission on Cancer (CoC). 
Data include both patients diagnosed at City of Hope and those who visit post-diagnosis as well as initial treatment elsewhere.   Higher curves for City of Hope indicate better survival results, reflecting excellent care at City of Hope.  Although some variation between the curves may also be due to timing of referral to City of Hope, and other details of the patients’ situations.

Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

Breast Cancer Videos
Low-dose Tamoxifen for Radiation-Induced Breast Cancer Risk Reduction Trial
A clinical research study is currently underway to see if low-dose tamoxifen can reduce the risk of breast cancer in childhood, adolescent, and young adulthood cancer survivors.
The Positive Image Center is where licensed cosmetologists support and assist patients with building and maintaining self-confidence in their appearance. Services are free and provide a forum in which patients can access wig fittings and stylings and discuss cosmetic techniques.
Cooper Finkel Women’s Health Center
Many gynecological cancer and breast cancer  services at City of Hope are provided at the Rita Cooper Finkel and J. William Finkel Women's Health Center. Here, women receive the highest quality care, whether seeking prevention and screening services or coping with a cancer diagnosis.
As an leader in cancer research, our goal is to bring the latest scientific findings into medical practice as quickly as possible.
  • Christine Crews isn’t only a fitness enthusiast, she’s also a personal trainer and fitness instructor. Being active defines her life. So when she was diagnosed with bladder cancer at age 30, she decided she absolutely couldn’t let the disease interfere with that lifestyle. And it didn’t. For t...
  • Cancer treatment and the cancer itself can cause changes in your sense of taste or smell. These side effects typically subside after treatment ends, but there are ways to help alleviate those bitter and metallic tastes in your mouth. Here are tips from the National Cancer Institute to help keeps tastes and food...
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  • Thanks to the California Institute for Regenerative Medicine (CIRM), high school students across the state gained valuable hands-on experience with stem cell research this summer. City of Hope hosted eight of those students. As part of the CIRM Creativity Awards program, the young scholars worked full time as m...
  • Radiation therapy can help cure many children facing Hodgkin lymphoma and other cancers. When the radiation is delivered to a girl’s chest, however, it can lead to a marked increase in breast cancer risk later in life. A recent multi-institutional study that included City of Hope’s Smita Bhatia, M.D., M.P.H., t...
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  • Appetite loss may be common during cancer treatment, lasting throughout your therapy or only occasionally, but it can be managed. Below are tips from the National Cancer Institute (NCI) that can help you keep your weight up and, in doing so, keep your body well-nourished. (See the end of this article for a deli...
  • Myelodysplasia, sometimes referred to as myelodysplastic syndrome or MDS, is a rare group of blood disorders caused by disrupted development of blood cells within the bone marrow, resulting in a decreased number of healthy blood cells. People diagnosed with the condition, considered a precancer, may be at great...
  • Twenty years ago, scientists discovered that a mutation in a gene now widely known as BRCA1 was linked to a sharply increased risk of breast cancer, paving the way for a new chapter in identifying women at risk of the disease and giving them options to potentially avoid an aggressive cancer. But experts have al...
  • The Eugene and Ruth Roberts Summer Student Academy at City of Hope turned 54 this year. Marking the occasion, the academy announced a new scholarship in honor of longtime director Paul Salvaterra, Ph.D. Salvaterra, a professor in City of Hope’s Department of Neurosciences, has led the summer student acade...
  • Stevee Rowe has a very personal connection to the research she’s conducting on neural stem cells: Her late father participated in a City of Hope clinical trial involving neural stem cells. Rowe — her full name is Alissa Stevee Rowe, but she prefers to use her middle name — will enter her senior year at the [...
  • Although multiple myeloma is classified as a blood cancer, patients with this disease often experience bone-related symptoms, too. This includes bone pain, frequent fractures and spots of low bone density or bone damage that show up during a skeletal scan. Here, Amrita Krishnan, M.D., director of City of Hope&#...
  • Women using some birth control pills, specifically those with high doses of estrogen and a few other formulations, may be at an increased risk of breast cancer, a new study has found. At first glance, the findings seem alarming, but a City of Hope breast cancer surgeon is warning against overreaction. The study...
  • Cancer is hard enough on the immune system, and chemotherapy takes an additional toll. This double blow to the immune system means cancer patients are more likely to develop infections than people not fighting cancer. The federal Centers for Disease Control and Prevention reports that one out of every 10 cancer...