Recognizing the Signs of Breast Cancer
- A decade after her diagnosis, Melissa Christensen recalls initially dismissing the lump as a cyst she found in her mid-40s, later learning it was early-stage breast cancer—typically defined as smaller tumors confined to the breast and nearby tissue.
- Dr. Jesse Tao of Johns Hopkins explains that pathology is the first step in evaluating tumors in early-stage breast cancer, focusing on markers like estrogen receptor, progesterone receptor, and HER2, as well as features such as lymphovascular invasion (LVI), which can indicate a higher risk of spread.
- Dr. Tao adds that pathology testing provides critical insight into the biology of breast cancer, helping clinicians determine subtype and aggressiveness, while molecular profiling is less relevant at the early-stage diagnosis phase.
- Christensen’s choice of a bilateral mastectomy allowed her to avoid chemotherapy and radiation—an outcome she acknowledges is not universal, as timing and tumor characteristics play a major role in treatment options.
- Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai, notes that a double mastectomy typically takes about two hours for tissue removal, with overall surgery length depending on whether and what type of reconstruction is performed.
Christensen was in her mid-40s in 2015 when she discovered the lump. Reflecting on that moment, she said, “I just knew my body, and I knew something was different.”
Read More“With regards to early-stage breast cancer, molecular profiling at this juncture is probably less relevant, but there is pathologic testing on a tumor that helps us understand what specific type of tumor you have and what the features are, and what we call the biology of the tumor,” Dr. Tao said.
“So, this would be things such as immunohistochemistry for estrogen receptor, progesterone receptor, and HER2, the three major markers that define the subtype of a particular breast cancer, and other pathologic testing, such as lymphovascular invasion, or LVI. Lymphovascular invasion is essentially looking at the tumor under a microscope to see whether cancer cells are invading the nearby vasculature. It gives a sense that this tumor may be more aggressive or have a higher likelihood of spreading,” Dr. Tao continued.
WATCH: Testing In Early-Stage Breast Cancer
For treatment, Christensen and her care team decided on a bilateral mastectomy (also called a double mastectomy), which is a procedure that removes both breasts. Some women choose to get a double mastectomy to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.
WATCH: Dr. Elisa Port explains what happens during a double mastectomy.
Deciding to undergo a mastectomy can be an emotional experience for many women facing breast cancer. While the surgery itself may only take a few hours, the changes can be difficult to adjust to mentally.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
Christensen explains that by choosing a double mastectomy, she was able to avoid chemotherapy and radiation.
“Not all women are that lucky—it really is the luck of the draw. It depends on when you find it,” she reflected.
Now, more than a decade into survivorship, she dedicates part of her time to advocating for other women facing breast cancer.
Expert Resources on Breast Cancer Treatment
- ‘A Real Milestone’: FDA Approves New After Surgery Treatment for High-Risk Early Breast Cancer
- For Breast Reconstruction After Mastectomy, Women May Choose ‘Now,’ ‘Later,’ or ‘Never’
- Is a Preventative Mastectomy Right for Me?
- Implant Reconstruction After a Mastectomy: The Options
- Should I Have a Lumpectomy or Mastectomy?
What to Expect from a Mastectomy
When you’re faced with possibly getting a mastectomy, many factors go into the decision-making process, such as the size and features of the tumor and your family history. Some patients may opt for a lumpectomy instead, which is when doctors remove just the cancer and an area of healthy tissue around it rather than the entire breast or breasts.
Some women decide to have their breasts reconstructed after undergoing a mastectomy and have implants put in right away, while others don’t have reconstruction at all.
Dr. Port added that most women opt to have some reconstruction. The length of these surgeries can vary greatly. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area during reconstruction.
WATCH: Regaining your sense of self after reconstruction.
Coping With Your New Body After Cancer Treatment
After breast cancer surgery, patients often struggle with the changes to their bodies that others can see, whether those changes are temporary or permanent, like hair loss and weight gain. However, survivors also struggle with changes that may not be as obvious — such as infertility — and these can create body image issues and make survivors feel vulnerable.
One way to prepare yourself for possible body changes during cancer treatment is to understand that changes are possible but also, frequently, temporary. This can also help build up your self-confidence. Your support group, filled with loved ones, can help you during this stage of your journey as well.
Psychologist Dr. Marianna Strongin shares with SurvivorNet some additional tips cancer warriors can explore to help manage the emotional toll body changes can have during treatment.
Dr. Strongin encourages survivors to take ownership of the part (or parts) of their body impacted mainly by cancer treatment. She says that although they may represent “fear and pain,” they also represent “strength and courage.”
“Research has found that when looking in the mirror, we are more likely to focus on the parts of our body we are dissatisfied with, which causes us to have a negative self-view and lower self-esteem. Therefore, I would like you first to spend time gazing at the parts of your body you love, give them time, honor them, and then thank them,” Dr. Strongin said.
Dr. Strongin then suggests focusing on the part or parts of your body affected by the cancer or its treatment. She recommends creating a regular practice of accepting your body image because it helps you accept your cancer journey emotionally and physically.
“As you allow yourself to spend more time looking at all of you, you will begin having a new relationship with your body. It may not happen immediately, but with time, you can begin honoring and thanking your new body,” Dr. Strongin added.
What If You Have the BRCA Gene Mutation?
We briefly discussed that some women choose to get a preventative mastectomy if they are at higher risk of breast and ovarian cancer. One way to know if you’re at higher risk is if genetic testing reveals you have the BRCA gene mutation.
Discovering a genetic mutation can be unsettling, but there are several options available to manage cancer risk effectively. These include enhanced screenings for early detection, prophylactic (risk-reducing) surgery to remove high-risk tissue, and chemoprevention—the use of medications designed to lower the chances of developing cancer.
Interestingly, for individuals diagnosed with ovarian cancer, carrying a BRCA mutation may provide a treatment advantage when paired with a class of drugs known as PARP inhibitors. Approved by the FDA starting in 2014, these targeted therapies have transformed the landscape of ovarian cancer treatment.
WATCH: Understanding the BRCA Gene Mutation
PARP inhibitors function by blocking the protein PARP, which normally repairs damaged DNA. By preventing this repair process, the inhibitors selectively destroy cancerous cells while sparing healthy ones, making them a powerful treatment tool.
“The PARP inhibitor prevents the repair of the [damaged] single-strand DNA break, and your BRCA mutation prevents the repair of the double-strand DNA break,” explains Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham, in an interview with SurvivorNet.
This combination of genetic insight and advanced medical therapies highlights how precision medicine continues to evolve, offering more effective, tailored approaches to cancer prevention and treatment.
What to Consider When Weighing Preventive Mastectomy?
A prophylactic, or preventative, mastectomy is an operation where the breast tissue is removed to prevent cancer from developing in the future.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer, for genetic mutation carriers, who are the ones at the highest risk; there’s unfortunately only one way to actually prevent breast cancer,” Dr. Port tells SurvivorNet.
WATCH: What to Consider When Thinking About a Mastectomy
“Women who are found to test positive for a genetic mutation really have two options,” Dr. Port explains. “One is what’s called high-risk surveillance, which means we check them every six months or so, mammograms, MRIs, with the hope that if God forbid, they develop breast cancer, we pick it up early. But that’s not prevention; it’s early detection.
“Early detection is a goal; it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say, reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
The benefits of a prophylactic or preventative surgery are:
- Significant reduction in cancer risk (from 80-90% to 1-2%)
- Nipples can often be spared
- Women can get reconstruction at the same time
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
- What can I do to prepare for a double mastectomy?
- What happens before and after the procedure?
- For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
- What should I know about implants? Should I opt for preventative surgery?
- What will recovery look like after the procedure?
- What are the benefits of a watch & wait approach vs. preventative surgery?
- What kind of surveillance is required after the surgery?
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