There are more treatment options today than ever before to control breast cancer or put it into remission, even if you have metastatic disease (cancer that has spread to another part of the body).
Our breast cancer specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for breast cancer and offer you access to the latest innovations through clinical trials.
People with breast cancer are living longer, healthier lives.
The Breast Cancer Specialty Clinic is a multidisciplinary center for people with non-metastatic invasive breast cancer. At the BCSC, your team will include a nurse navigator, breast surgeon, medical oncologist and radiation oncologist. These experts will work together, listening to your needs and preferences, to make a treatment plan that is right for you.
A BCSC visit takes about half a day. A nurse navigator will meet with you first to go over the plan for the day, give you educational and support materials and answer your questions. A resident or fellow (a physician who is doing extra training to specialize in cancer) will examine you and talk with you about your medical history. Then, while you take a break, Fred Hutch’s full team of breast cancer specialists will meet to talk about your treatment options.
Next, your physicians will come to see you in an exam room. Often, they will examine you together to make sure they agree about the best therapies to treat your disease. Then each physician will meet with you one-on-one. They will explain the specific treatment they recommend and what will happen next. This is also a time for you to ask any questions you may have.
The Breast Health Clinic is for people who have a breast health concern, are higher-risk for breast cancer or are having breast cancer surgery.
The team at the Breast Health Clinic diagnoses and treats a full range of breast concerns. We look at patients who have a breast lump or other symptom or an abnormal screening mammogram. We also do imaging tests, clinical breast exams and biopsies.
If you have a higher risk of breast cancer, our team can make a screening and follow-up plan just for you. We will design your plan to give you and your health care team the best chance of finding breast cancer early, when it is easier to treat. We will also help you reduce your risk and connect you with other Fred Hutch services.
UW Medicine surgeons who do breast cancer surgery see patients at the Breast Health Clinic. Our team also provides care before and after breast surgery. If you have already been diagnosed with breast cancer and you need surgery, you will come to the Breast Health Clinic for the care you need in order to get ready for surgery and recover afterward.
This clinic focuses on medicine-based treatments, like chemotherapy, endocrine therapy, targeted therapy and immunotherapy. Most people with breast cancer will get one or more of these. If you have metastatic breast cancer, it is likely that all your treatment will be medicine-based.
The NOW Clinic is for people with newly diagnosed breast cancer. At the NOW Clinic, advanced practice providers (APPs) who specialize in breast cancer usually see you just a few days after you request an appointment. They will give you information and support, prepare you for what comes next and answer your questions.
Your APP will also find out if you need any tests or scans before you come to see your team of physicians. They will help you set up these tests and scans so your physicians will have as many details as possible when you see them.
If cancer has spread from your breast to distant parts of your body, you have options. New treatments at Fred Hutch may put your cancer into remission and give you a good quality of life for decades.
Many people who started treatment somewhere else come to Fred Hutch if their breast cancer comes back or spreads. They come here because of our experts and our focus on research to improve outcomes.
Our ASSIST Program helps people with metastatic breast cancer. ASSIST stands for Advanced Stage Support Information Symptoms Trials.
A nurse from ASSIST will contact you before your first appointment with your Fred Hutch medical oncologist. The nurse will talk with you about supportive care services that might help you, like nutrition counseling and physical therapy.
If you feel overwhelmed, or if you need help understanding how care works at Fred Hutch, ASSIST can help with this, too. We can connect you with a social worker or a patient navigator.
As part of ASSIST, our clinical trials team will look at your medical history to see if you can join a clinical trial. If you can, your medical oncologist will talk with you about your options.
People with advanced breast cancer often get treatment in clinical trials. These studies can give you access to new options that are not available any other way. If standard treatments are not working for you, a clinical trial at Fred Hutch may provide you with another choice.
Before we recommend trials or any type of therapy, we will test your cancer for features that affect how well various treatments work. These features — like your hormone-receptor status, HER-2 status and genomics — can be very complex. They can also change over time. By doing tests after cancer comes back or spreads, we can plan the best treatment for you.
At Fred Hutch, we have a monthly advanced molecular tumor board. This is a meeting where our experts talk about the best ways to treat people who have the most challenging metastatic breast cancers.
Call 206.606.6487 to learn more about ASSIST.
Some forms of cancer treatment may affect fertility. If you would like to know about options for preserving your fertility, talk with your care team and ask about our Oncoreproduction Clinic.
We also offer a support group for young adults, aged 18–40, who are in active treatment at Fred Hutch. The group gives you a place to talk with people who understand what you are going through. You can share your experiences and connect with others who are living with a cancer diagnosis.
Fred Hutch uses a special risk-assessment tool to help plan care for older patients with breast cancer. If you are 65 or older with non-metastatic disease, your team may give you this tool to fill out. We may ask you to do this before you visit the Breast Cancer Specialty Clinic. This way, your care team can use your answers to understand your exact needs and personalize your care.
After cancer treatment, we are still here for you. In fact, it is important to keep getting care from experts who can guide your full recovery. Fred Hutch has teams to support you.
At Fred Hutch, breast cancer specialists — including surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and researchers — work together to make a custom treatment plan for each patient.
Twice a week, our breast cancer experts gather in a meeting called a tumor board to get ready for the Breast Cancer Specialty Clinic. Together, team members from different areas of breast cancer care discuss their patients’ treatment plans. This approach gives you the benefit of everyone’s knowledge and experience.
We also have a monthly advanced molecular tumor board. This is a meeting where Fred Hutch physicians review advanced genomic testing on breast cancer to figure out the best ways to treat people who have the most challenging metastatic breast cancers.
The Fred Hutch experts at these meetings, including your physicians, will:
At your first appointment, your breast cancer physician will walk you and your caregiver through the treatment plan we recommend for you. It is important to us to learn about each patient’s goals, needs and concerns to make the best treatment plan. You will have a chance to share your personal preferences, and you will decide together what happens next.
The treatment plan we design for you depends on many things, including:
Because breast cancers have different features, there is no one way to treat everyone. However, the standard therapy for most patients with early-stage breast cancer is surgery to remove the tumor, which is often followed by radiation therapy and medicine-based treatments. These include chemotherapy, endocrine therapy, targeted therapy and sometimes immunotherapy. Physicians can use these one at a time or combine them.
But standard therapy can be different for different people. People with early-stage cancer may need only surgery. Often, people with advanced or metastatic cancer are best treated with systemic, medicine-based therapies. When you come to see us, we will explain the standard therapy for your situation.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.
Our patients can also choose to receive promising new breast cancer therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.
Nearly everyone with non-metastatic disease has their tumor removed. For metastatic disease, surgery is sometimes done to help with symptoms.
Breast surgery is very personal, and we want to help you make decisions you feel comfortable with. We will take the time to talk with you about your options, what to expect and any questions you have.
You may be able to have surgery to remove your cancer and keep your healthy breast tissue (lumpectomy), or you may need surgery to remove the entire breast, including the cancer (mastectomy). This will depend mainly on the size of the cancer, where it is and if you have one tumor or several tumors in the breast.
If you have metastatic disease, meaning the cancer has spread to other places in your body, your cancer cannot be fully removed by surgery. So your care team will probably not recommend this form of treatment. However, we may suggest surgery to help with symptoms.
Your first step toward reconstruction, if you are interested, is to meet with one of our breast reconstructive plastic surgeons.
The surgeon will go over a range of options with you and explain the timeline for reconstruction so you have all the information to make a decision that meets your goals.
Typically, this visit about reconstruction will happen after your cancer care team makes your treatment plan. This gives you a chance to think about the plan and then decide the next step. We will schedule your reconstruction visit to meet your needs.
It is normal for your first consultation to be just the start. Patients often have more than one visit with their surgeon to talk about and think through all their choices.
Our plastic surgeons are all UW Medicine physicians. They are highly skilled in both ways to restore your breast — with either implants or natural tissue. Implants use synthetic materials (like saline or silicone) to reconstruct the breast. Natural-tissue methods restore your breast using tissue from your own body.
Having radiation therapy after surgery can help reduce the chances of non-metastatic cancer coming back.
Radiation therapy uses high-energy rays to kill cancer cells. Often, it is done to clear cancer cells that may be left behind in your breast, chest wall or nearby lymph nodes after surgery. A radiation oncologist decides on the type, dose and schedule of your treatment.
Your Fred Hutch radiation oncology team specializes in treating breast cancer. We have extensive experience with every type, grade and stage of the disease. To give you the best outcome, we use our expertise along with state-of-the art equipment and technology to carefully plan and deliver your treatment.
Proton therapy is an advanced radiation treatment that targets the cancer while reducing the amount of radiation exposure for healthy tissues and organs.
Proton therapy is like conventional external-beam radiation therapy (EBRT), but it uses beams of protons instead of photons.
Using protons instead of photons helps because physicians can aim radiation at the target with less radiation exposure for nearby healthy tissues. This has to do with the way protons deliver radiation to your body. A high dose can be sent to the right area, but the radiation does not keep going to other parts of your body. The goal is to kill cancer cells while reducing the risk of side effects.
We have many chemotherapy options for both early-stage and advanced breast cancers.
Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). Your breast medical oncologist prescribes your chemotherapy and other medicine-based treatments. They also set your treatment schedule.
Chemotherapy can be given by infusion or by mouth. For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Cancer nurses who are experts in infusions give you these treatments. They will also watch over you during the treatment. They will help with any medical issues that come up and will keep you comfortable.
Some types of chemotherapy are given as a pill that you take at home.
For some cancer subtypes, you may get targeted therapies. These are more exact than chemotherapy, which affects all fast-growing cells throughout the body.
This treatment is important if your cancer cells have receptors for estrogen or progesterone.
Most people with breast cancer have hormone receptor-positive (HR+) disease. This means the breast cancer cells have receptors where the hormones estrogen or progesterone can attach. These hormones help the cancer cells multiply quickly.
Endocrine therapy helps control HR+ breast cancer in two ways. One is that it reduces or blocks the body’s production of hormones. The other is that it reduces or blocks the effects of the hormones. This form of treatment is also called hormonal therapy.
For some cancer subtypes, you may get targeted therapies. These are more exact than chemotherapy, which affects all fast-growing cells throughout the body.
Targeted therapies work in one of these ways:
Sometimes, targeted therapies are a pill that you take at home. Or they can be given by infusion in repeating cycles. They can be used alone or with other treatments. Some can improve the effects of endocrine therapy and are only used along with endocrine therapy.
There are many options for both early-stage and advanced or metastatic breast cancer.
Immunotherapies use the power of your immune system to find and fight breast cancer cells.
A healthy immune system attacks bacteria, viruses and sometimes harmful cells, like cancer cells. It leaves harmless cells alone. Sometimes, cancer cells survive by sending false signals that make them look harmless, which tricks the immune system.
Medicines called immune checkpoint inhibitors block these false signals. This allows your natural defenses to work better. Immune checkpoint inhibitors are now approved for some patients with triple-negative breast cancer (and many other types of solid tumors).
Fred Hutch has been a leader in developing cellular immunotherapy. With this treatment, a patient’s own immune cells (lymphocytes) are genetically changed in a laboratory to attack certain proteins on cancer cells. Examples of cellular immunotherapy include chimeric antigen receptor T cells (CAR T-cell therapy) and T-cell receptor (TCR) therapy. These therapies, while promising, have not been approved for breast cancer yet. Patients may choose to join clinical trials testing these new approaches.
While you’re in active treatment, your breast cancer care team will see you regularly for exams and tests to check:
We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.
Along with treating your breast cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.
From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.
Learn more about Supportive Care
As a caregiver, you can give your loved one both emotional and practical support around the time of health care appointments. Ask them if you can help with things like these:
When your breast cancer is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see Fred Hutch breast health experts. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).
Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).
After breast cancer treatment, you are on a lifelong journey as a survivor. Many people have the sense of moving into a new stage of life and slowly adjusting to a “new normal.”
When it is time to shift your focus to recovery, we encourage you to come to the Fred Hutch Women’s Wellness Clinic. This clinic offers wellness-focused follow-up. It is for patients who are at least five years out from breast or gynecologic cancer treatment. The clinic is a place for you to get care and services you need under the medical supervision of oncologists you know and trust.
At the Women’s Wellness Clinic, you can get:
The clinic also sees people who have been to Fred Hutch’s Breast and Ovarian Cancer Prevention Program (BOCPP). BOCPP is for people at high risk.
Call 206.606.1422 or 206.606.7222 for an appointment. The Women’s Wellness Clinic is in the Fred Hutch Wellness Center.