Breast cancer is often a lifelong concern for many women and men, affecting millions of Americans every year. At Penn Medicine, our world-class breast cancer care team of nationally renowned oncologists, breast surgeons, and nurses provides an unparalleled level of expertise, addressing every facet of a patient's journey with precision and empathy.
Understanding breast cancer
Breast cancer is a disease in which the breast cells of the lobules, ducts, or surrounding connective tissue begin to grow abnormally. Rapid division of these breast cells causes the formation of a breast lump or mass that grows and, in certain cases, metastasizes (spreads) to blood vessels, lymph nodes, or other areas of the body.
Breast cancer behavior, progression, and characteristics vary by type, with each requiring a specific approach to treatment and management. Our specialized breast pathologists use their in-depth understanding of tumor characteristics to recognize all types of breast cancer.
Breast cancer type is determined by two factors—where the cancer began and whether it has spread. Most breast cancers start in the breast ducts, which carry milk to the nipples (ductal cancers). Breast cancer may also begin in the breast lobules, the glands that produce milk (lobular cancers).
Breast cancer may also be non-invasive or invasive. Breast cancer is non-invasive if it has not spread to nearby breast tissue, whereas invasive (or infiltrating) breast cancers spread to surrounding connective tissue.
No matter where breast cancer originates in the breast, it can spread to other areas of breast tissue, lymph nodes under the armpit, or even to other parts of the body. When breast cancer has metastasized, it is considered in stage 4.
We test the cancer cells for hormone receptors and genetic expression. Depending on the results of those tests, we may use specialized therapies to further personalize your treatment.
- Hormone receptor status: Some breast cancers use the hormones estrogen and progesterone to grow. Those cancer cells have receptors that “feed” on the hormones. These tumors are considered hormone receptor-positive (HR+), or hormone-positive. About 80 percent of all breast cancers are HR+. Breast cancer may test positive for estrogen (ER+), progesterone (PR+), or both (ER/PR+).
- HER2 status: We typically test invasive breast cancer tissue for HER2, or human epidermal growth factor receptor 2. Normal breast tissue has HER2 receptors (produced by the HER2 gene) on each cell. These receptors control breast tissue growth and repair. In some cases, an excess of HER2 receptors causes cells to grow too rapidly, leading to a tumor.
Types of breast cancer
Breast cancer signs and symptoms
Recognizing the symptoms of breast cancer can be challenging. The signs may look different for each person and may depend on your breast cancer stage of progression (0 to IV). Small, early-stage breast cancer rarely has symptoms. In those cases, breast cancer screening is vital to early detection.
Breast cancer symptoms to look for include:
- A hard, typically painless lump in the breast or underarm
- Swelling, skin dimpling, or puckering
- Red, flaky, or thickened breast/nipple skin
- Persistent breast pain or heaviness
- Nipple retraction or non-milk discharge
- Noticeable changes in breast size or shape
In some cases, breast pain or lumps may be caused by a benign (non-cancerous) issue. Our specialized nurse practitioners work to determine the cause of your symptoms.
Diagnosing and treating breast cancer
We believe successful cancer treatment begins with an accurate diagnosis made by a skilled pathologist, who will perform a breast biopsy to evaluate the breast tissue. Your breast cancer diagnosis will identify the type of cancer you have, the stage of your breast cancer, your cancer’s HER2 status, and your cancer’s hormone receptor status.
After we make a diagnosis and determine which breast cancer type you have, our breast cancer oncology team works with you to develop a personalized breast cancer treatment plan. Along with standard care, we offer unique access to novel therapies and the newest treatments through our breast cancer research.
Comprehensive breast cancer care at Penn Medicine
As an active member of the National Accreditation Program for Breast Centers (NAPBC), our Breast Cancer Program delivers comprehensive, patient-centered care based on innovative research. When you trust us with your breast cancer care, you can expect:
- Complete multidisciplinary care and expertise: We deliver high-level care for every stage of breast cancer. Our fellowship-trained physicians and surgeons specialize in breast cancer and sit on committees within the National Comprehensive Cancer Network (NCCN) to help create guidelines for all breast cancer care nationwide.
- Access to innovate research and clinical trials: O We are leaders in breast cancer research, addressing the most pressing needs in breast cancer care. Our 2-PREVENT Breast Cancer Translational Center of Excellence is a national leader in research dedicated to breast cancer recurrence. Through this program, patients will also have access to industry-leading breast cancer clinical trials.
- Wide-ranging support and expert guidance: Our support services include access to a social worker, nutritionist, and counselor. Experienced nurse navigators work closely with you to coordinate appointments, offer guidance and support, and facilitate communication with your providers.
- Care close to home: We offer expert evaluation and treatment at all Penn Medicine breast cancer care locations. Our specialists and staff collaborate across the network to ensure you receive the best care possible, no matter where you live.
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.
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Patient stories
From survivor to inspiring others to exercise
Doris Piccinin uses her own firsthand experience as a breast cancer survivors to help other survivors. “I’m excited to see a lightbulb go on for people when they realize that not all physical activity is the same, and to see them recognize and understand the questions to ask when they’re having limitations. That’s where I gain my inspiration.”
A mom-inspired clinical trial journey to help others
“I wanted to participate in a clinical trial because I was inspired by my mom,” Kate Korson said. “I saw how brave she was and the success she had on a clinical trial. I felt like I received the best possible care by taking part in a clinical trial, and it feels good to know that I’m helping others by contributing to cancer research.”
Coming home to ‘Team Penn’: Kate’s Story
From the moment Kate Korson showed up at her first appointment wearing a Penn sweatshirt to symbolize she was on “Team Penn,” every one of her caregivers let her know they were on “Team Kate.” “Penn has now saved all three members of my family,” she said, after participating in a clinical trial.
Creating beauty out of a breast cancer journey
“Cancer isn’t just physically grueling. It mentally and emotionally tears you down,” Ginger Mimmo Rohlfing said of her experience navigating HER2-positive breast cancer, chemotherapy, mastectomy, and breast reconstruction surgery. Her paintings of leaf and petal patterns “were a metaphor for putting pieces of myself back together.”
A diagnosis that ripples through the family
“It’s harder to find out your sister has cancer and a BRCA mutation than to find out for yourself,” said Laura Temple. Testing and treatment have made all the difference for the three BRCA-positive sisters who are now breast cancer survivors. They are grateful for Susan Domchek, MD, answering questions about research that could benefit their children.
From patient to advocate, battling breast cancer and disparities
With her metastatic breast cancer under control, Jamil Rivers is looking out for other Black women. “We’re trying to help them understand what to anticipate, what questions to ask, and how to be advocates for themselves.”
Mother and daughter recover from surgery with home care
“I loved that I was able to do this right from the house, because otherwise we’d have to drive 40 minutes and then wait in a doctor’s office,” said Lauren Magaziner, who went first. Lauren and her mother, Robin, had preventive mastectomies a few weeks apart after learning they both carried a BRCA mutation.
Helping to stop cancer from coming back
“I often say Dr. DeMichele saved my life twice,” said Illeana Casiano-Vazquez. “Without this trial, I don’t know if I’d still be here. She really put herself at the center of what it is to be a breast cancer patient without any options, and I’m so thankful she didn’t give up.”
Volunteering to intercept cancer for future generations
“I'm convinced that I would have had breast cancer in my 40s as my mother, my grandmother, and my grandmother’s sister all did,” said Maggie Gaines. She is now part of an innovative clinical trial aiming to intercept hereditary cancers before they start.
A woman's unique path to a lung cancer diagnosis
I was completely shocked. I had no symptoms, I never smoked or spent time around smokers, and there is no history of lung cancer in my family.