Breast Cancer

The Breast Center at Smilow Cancer Hospital provides coordinated, state-of-the-art care for patients with benign and malignant diseases of the breast. For patients diagnosed with breast cancer, we offer dedicated care, innovative treatment options, and cutting edge research, coupled with the recognized excellence of a National Cancer Institute designated Comprehensive Cancer Center. A great deal of progress in the detection and treatment of breast cancer has been made in recent years, and our physicians are on the leading edge of finding even better solutions.

Our Center is accredited by the National Accreditation Program for Breast Centers, and was the first National Cancer Institute Comprehensive Cancer Center in the Northeast to hold this designation.  Women with a diagnosis of breast cancer are cared for by a multidisciplinary team of physician specialists, including radiologists, breast surgeons, medical oncologists, radiation oncologists, pathologists, and plastic surgeons.

From the tranquility of the building and the range of services offered by complementary therapy and the boutique, to the most sophisticated personalized therapies and equipment offered in every discipline, Yale offers the perfect blend of art and science to help you through your journey.   We are committed to tailoring treatment to you.  At different points in time, you may need different resources – at Smilow, we are pleased to provide you with coordinated appointments with all of the appropriate specialties at the right time, accommodating your personal values and schedule.

Genetic counseling and testing is an important tool in guiding management and surveillance for patients with breast cancer and their family members.  Breast cancer patients with early-onset (<50 years) cancer, a triple-negative breast cancer before age 60 years, or of Jewish ancestry are candidates, as are all patients with a family history of a genetic mutation, or of breast, male breast, ovarian, gastric or pancreatic cancer. Our team of graduate-trained and board certified genetic counselors are here to navigate insurance pre-authorization, pre- and post-test counseling and ensure that the correct test is ordered and that it is interpreted accurately.  In addition, our genetic counselors work closely with a team of specialized breast and gynecologic oncologists, who can provide options for patients at high-risk.

The breast imaging center performs well over 20,000 breast examinations each year. These consist of screening and diagnostic mammograms, breast ultrasounds, digital tomosynthesis, and MRI examinations. The newest technology, digital tomosynthesis, creates a three-dimensional picture using breast x-rays for review. This allows our radiologists to look very closely at the breast tissue, often minimizing the need for repeat mammograms. In addition, we offer radiologist-performed ultrasound, and 3-Tesla breast MRI. The radiologists at Smilow Cancer Hospital are recognized as leaders in their field and are involved in teaching, both on a local and a national level.

At our breast imaging center, a screening mammogram is done on a woman who has no breast problems or symptoms. A diagnostic mammogram is used when there is a breast complaint or symptom, or when an abnormality has been discovered on a routine screening mammogram. Approximately 20,000 breast screening and diagnostic mammograms are performed at our breast imaging center.

Many patients with breast cancer also need drug therapy, such as chemotherapy and/or hormonal therapy.  Our team of nationally renowned experts in breast medical oncology utilizes both standard approaches and new ‘biological’ or ‘targeted’ therapies to attack the cancer specifically while avoiding harm to normal tissues.

Breast cancer is the most common cancer diagnosed in women. In the United States alone, an estimated 246,000 people will be diagnosed with breast cancer in 2016, and 61,000 people will be diagnosed with the earliest form of breast cancer (ACS, 2016). In Connecticut, the most commonly diagnosed cancer in women was breast cancer, accounting for more than three out of every ten cancers diagnosed during the period 2006-2010 (CT, 2014). At SCH, the number of breast cancers diagnosed and or treated has increased in the last years. In part, this is attributed to the expansion of cancer care across the region of Connecticut throughout the Smilow Cancer Centers. In 2015, a total of 1,210 breast cancer cases were newly diagnosed and/or received all or part of the first course treatment at SCH (analytic cases), and 146 cases received their initial cancer treatment at another facility.

Investigators at Yale are famous throughout the world for elucidating the biology of a cellular receptor called HER2.  Our medical oncologists have been particularly successful in developing treatment strategies for HER2 positive breast cancer and have extended this expertise to provide effective therapies for triple negative/basal like and ER positive breast cancer.  They continue to study innovative new treatments, and patients at Smilow Cancer Hospital have the opportunity to receive such novel therapies through exciting clinical trials not available elsewhere in Connecticut. 

Our medical oncologists are known for their unique expertise in breast cancer, and all new cases are discussed weekly by the breast cancer medical oncologists so that every patient benefits from the combined expertise of the entire group.  In addition, our medical oncologists are happy to see patients for a second opinion.  While many patients will opt to have their care at Smilow Cancer Hospital, we work closely with our colleagues at Smilow Care Centers, located throughout Connecticut, to ensure that patients can receive the same high quality care in the most convenient setting for them.

Female breast cancer is most common in middle-aged and older women. Approximately 80% of the individuals diagnosed with breast cancer in the United States are over the age of 50 (ACS, 2015). At SCH, a significant number of women are diagnosed between the ages of 50 and 69, representing about 53% of the breast cancer.

One of the most important elements of modern breast cancer treatment is the pathologic evaluation of tumors, and increasingly, the ability to profile tumors allows patients access to novel treatments that may be most effective for treating their particular tumor.  Yale is fortunate to have one of the finest pathology departments in the country, complete with a high-level tumor profiling service.  And, because it operates “behind the scenes,” patients are frequently not aware of its importance.  Today, breast cancer is divided into an increasingly complex number of categories based on a whole host of sophisticated molecular markers that were not identified a few years ago. Pathologists therefore play a crucial role in our Tumor Board conferences.  They carefully review the characteristics of each patient’s tumor, and help the clinical team to define optimal treatment strategies best suited to the individual patient. 

At Smilow Cancer Hospital, approximately two thirds (64%) of patients with breast cancer are diagnosed with early stage 0 or I, the tumor is located in the breast and has not spread to lymph nodes. Stage II breast cancer disease accounts for 25% of the cases (e.g. tumor size <2 cm and/or spread to lymph nodes). Breast cancer diagnosed in advance Stage III or Stage IV comprised of 7% and 4% respectively.

The Breast Center at Smilow Cancer Hospital places great emphasis on taking care of all of our patients’ needs, with the best medical care available and a network of supportive care services.  Our intake specialists will ensure that you have everything you need for your first visit with our team, and our clinical secretaries and schedulers will work with you to coordinate your appointments to fit your busy schedule.  Physicians at the Breast Center work closely with our patient care associates, nurses, advance practice providers, and nurse coordinators to ensure that you feel well-informed and supported every step of the way.  In addition, our team extends to a myriad of essential services including social work, pastoral support, dietary and nutritional aid, physical therapy, complementary therapy, pain management, and psychosocial support.  In addition, Smilow offers a state-of-the-art Survivorship Clinic that employs a multidisciplinary team approach designed to optimally address patients’ needs after treatment ends.  We work closely with collaborators at the Yale School of Public Health, so that women have the opportunity to participate in studies designed to promote health and wellness before, during and after treatment through interventions like healthy eating, physical activity, and mindfulness.
Treatment with radiation is an integral part of therapy for many breast cancer patients today.  Smilow Cancer Hospital’s Radiation Therapy Center has state-of-the-art radiation therapy facilities in the lower level of the hospital.  Yale radiation oncologists were some of the first to begin treating breast cancer patients with lumpectomy and radiation therapy, and have been leaders in the field in research and clinical care of patients who receive radiation. The radiation oncologists at Yale consistently seek out the best methods for the delivery of radiation therapy to our patients, including the use of accelerated partial breast irradiation – a faster, more convenient treatment for women who are appropriate candidates.

Since prior to 2011, Yale has been offering a new way treating breast cancer to its patients: hypofractionated breast radiation.  This treatment involves 3-4 weeks of radiation rather than the traditional 5-6 weeks of radiation.  This treatment has been proven to be just as effective- and with less side effects- than the standard six weeks of radiation.  Yale's prone breast board program also allows delivery of hypofractionated treatment for those women who may derive additional benefit from its use.  Hypofractionated breast radiation has been identified by the American Society for Radiation Oncology's (ASTRO) Choosing Wisely Campaign as an intervention that all physicians should consider strongly for the breast cancer patients.  This treatment has been proven to be highly effective for women after lumpectomy, when lymph node areas do not need to be targeted. At Yale, we can offer this treatment to women who have undergone chemotherapy, as well.
Although many general surgeons perform breast surgery, there is no question that dedicated breast surgeons have the experience and knowledge to handle difficult or unusual cases and generally are more likely to understand the complexities of breast diagnosis and treatment.  The surgeons at the Breast Center at Smilow Cancer Hospital perform breast surgery exclusively, and are nationally known as being leaders in the field.  Historically, Yale surgeons were among the first to perform a lumpectomy instead of a mastectomy and were instrumental in the development of non-invasive procedures like sentinel lymph node biopsy, intraoperative guidance by ultrasound, and advanced oncoplastic procedures.  Our surgeons are experienced in cutting-edge modern techniques such as skin-sparing and nipple-sparing mastectomy, and often work hand-in-hand with our plastic surgeons to offer a variety of options for breast reconstruction. 

Reconstructions vary from placement of a simple implant to elaborate reconstructions using natural tissue from the abdomen or back, such as TRAM or DIEP flap reconstruction. Careful attention is given to achieve the highest chance for cure while achieving the best possible cosmetic result and quality of life for women with breast cancer.  In each case, the approach is customized to best fit the goals and lifestyle of the patient.