Breast Cancer

What is Invasive Carcinoma?

Invasive Ductal Carcinoma, the most common type of invasive breast cancer, makes up about 80 percent of all breast cancers. It is a cancer that starts in the milk ducts and spreads to the surrounding breast tissues. Invasion means the cancer has broken through the normal milk duct structure. It can spread further to the lymph nodes and potentially other areas of the body (metastatic disease).

Ductal carcinoma on histology.

What is Metastatic Breast Cancer?

Metastatic breast cancer, or stage 4 breast cancer, is breast cancer that has spread to other organs of the body beyond the breast.

Carcinoma of the breast that has metastasized to the lymph nodes.

“I wouldn't be able to know my diagnosis or how my cancer should be treated without pathologists and laboratory professionals.”

Sui's Story

When Sui was younger, her doctor informed her that she had dense breast tissue, meaning that there is a lot fibrous and glandular tissue and not as much fat tissue present. Breast density can increase the risk of breast cancer and it also makes it harder to see cancer on mammograms because both dense breast tissue and breast masses look white on a mammogram. So Sui received regular ultrasound scans of her breasts instead. During one of these scans, the doctors noticed an abnormal growth. They performed a biopsy on the mass by removing a small piece of tissue from the growth. The tissue sample was sent to a laboratory, where a specialist called a histotechnologist sliced it thinly and placed it on glass slides. A pathologist examined these slides and diagnosed Sui with breast cancer.

Sui is also a pathologist, so when she received her pathology report, she understood exactly what it meant, and she had a good understanding of her treatment options. Her main concerns were about her recovery, because she worried that recovery would be more challenging for her as she uses a wheelchair and relies on her arms for many activities. During the recovery from her double mastectomy (surgical removal of both breasts), she was unable to use her arms and had to rely on her friends and family to help her navigate her everyday tasks.

Sui's doctors had also requested HER2 testing, which determines whether the cancer has extra copies of the HER2 gene and excess amounts of the protein that it produces (HER2-positive). While HER2-positive tumors can be more aggressive, they are susceptible to treatment that specifically targets HER2. People with HER2-postive tumors respond well to these drugs and have a good prognosis. About 20%-30% of breast cancers are HER2-positive. Sui’s lab results showed that her tumors were HER2-positive, so she received HER2+ treatment after her surgery. Sui's treatment was successful, and she has been cancer free for over eight years.

“Without the lab, accurate and appropriate treatment cannot be done.”

“You are not alone. Search for communities with other patients that share their stories about their cancer journey and what helped them to make better decisions for their care”

Larisa's Story

In 2018, when I was 45 years old, I scheduled a routine check-up with my doctor. This turned out to be the very beginning of my cancer journey. During my visit, my doctor found a lump in my breast unexpectedly. They performed an ultrasound scan, which showed a lump that looked normal on a mammogram. During my first surgery the suspected fibroadenoma, a solid, noncancerous breast lump, was removed. Fibroadenoma occurs in most women between the ages of 15 and 35. Although fibroadenomas usually do not increase breast cancer risk by much, inside that breast lump the laboratory found abnormal cells after doing a biopsy and diagnosed me with Ductal Carcinoma in Situ. This is a non-invasive breast cancer, but it can increase the risk of developing an invasive breast cancer later on.

When I was first diagnosed, I felt overwhelmed. It was not easy to digest the amount of medical information and all the decisions that I needed to make. Although overwhelming and scary, my diagnosis was a wakeup call that brought me back to life. It put things in perspective and allowed me to see all the things that were truly important to me and my family. After spending some time understanding my diagnosis, I opted to treat it by having a mastectomy with immediate reconstruction, where my care team removed one of my breasts and then reconstructed the breast in one operation. Since then, I have been cancer free and live my life more consciously. I do not delay my decisions or save trips for in a few years, I live in the here and now!

I have learned and accomplished a lot since my diagnosis and am grateful that my breast cancer was caught early. Early detection gives us quality of life and would not be possible without laboratory testing, pathologists, and lab professionals. I think it’s important for patients and caregivers to understand pathology reports, as they are one of the most important documents that you can have. My advice would be to ask for a copy of your lab results and understanding those reports can help you when making decisions about your treatment.

Today, I live in Bern, Switzerland with my two daughters who are 12 and 14 years-old. I work as an innovator and entrepreneur in various associations that advocate for women’s health. With 20 years’ experience in the healthcare industry and as a breast cancer survivor, I have a better understanding of what patients need. I am now the co-founder of a digital healthcare startup that helps patients understand their medical information and scientific publications in a better way, as understanding such information was challenging for me when I was first diagnosed. I am passionate about amplifying the patient voice across various platforms and am honored to be a part of this community that helps others in their healthcare journeys.

“My career is based on data and technology. So being a woman of science, lab results are very important to me. I use it to validate the information that my doctors give me. Read all your lab results. It might be difficult to understand but it will be worth it.”

ANNE'S STORY

Anne was born and raised in the slums of the Philippines and immigrated to the United States with only $200 in her pocket for an amazing job opportunity. Throughout her whole life, Anne has shown what it means to be resilient and purposeful.

In January 2019, she found a lump in her right breast. She immediately made an appointment with her doctor and what was supposed to be a one-hour appointment turned into a 4-hour ordeal. During that appointment, she underwent a mammogram, an ultrasound, and a biopsy. A biopsy is a laboratory procedure where tissue is removed from the body for pathologists and laboratory staff to examine and determine if disease is present or the extent of a disease. Her doctor called the next day with the results, but unfortunately, Anne missed the call. She woke up the next morning to find a notification on her phone that her test results were available. This was the start of Anne's battle with Stage 3 invasive ductal carcinoma breast cancer.

Working in a retail pharmacy, Anne had an understanding of the lab and its role in patient care before her diagnosis. However, after she was diagnosed with breast cancer, Anne's understanding of the lab's importance increased exponentially. Anne found that her lab results, in particular the type and grade of her cancer, made her decisions much easier.

On March 5th, 2019, Anne had a double mastectomy where both of her breasts were surgically removed. The lab continued to play a critical role in Anne's cancer journey after test results from the mastectomy showed she also had cancer on her left breast and on one of her lymph nodes. This helped determine the type of treatment that she needed, but Anne needed to heal from the double mastectomy operation before starting her chemo treatments.

Anne's advice to other patients who receive a diagnosis is to take the necessary tests, including the additional ones if it will help in your decision-making process of what to do next. Anne also encourages patients to research what tests are available to them to learn more about their diagnosis.

Anne has accepted her diagnosis as it is, keeping her mentality of not focusing on things she cannot change. She is more interested in knowing the facts. Pathology and lab test results have helped her to understand more about her diagnosis. She has become closer to people because of her diagnosis and is extremely grateful for the love and support from her family, friends, and colleagues. Before Anne left for the US, her father used to tell her "use your poverty as an inspiration". Anne uses her circumstances in the Philippines to inspire her to forge ahead and win the battle with cancer.

“Understanding what tests are ordered and what the lab work means is empowering. The knowledge you gain can be transformative. It was for me! Pathology is at the core of every diagnosis. Understanding what tests are ordered and what the lab work means is empowering.”

Michele's Story

In 2006, at age 46, a newlywed Michele went home and told her husband of eight months, Ray, that she had been diagnosed with breast cancer. She had Stage 1 Invasive Ductal Carcinoma. Her biopsy showed that the cancer was small--.9 cm, about the size of a pencil eraser—and hadn’t spread to lymph nodes. The couple vowed that they would fight Michele’s disease together. But not 30 minutes later, Ray suffered a stroke, and a month later passed away.

A week after her husband’s death, Michele started her treatment journey for her cancer, while at the same time dealing with the fallout from losing her husband. In such a short period of time, she had lost her home, her health, and financial stability, and it was a scary, lonely time for Michele.

Prior to her surgery, she had agreed to an experimental test on the tumor once it was removed. Michele had to pay for the test out of pocket to the tune of $3,500—a serious financial burden at the time—but the results of the test could determine whether or not she was a good candidate for chemotherapy. The laboratory test results showed that she had an intermediate risk of recurrence—and chemo may or may not help. With the advice of her doctor, Michele decided to go through with chemo anyway; she wanted to be certain she had done everything possible to beat the disease.

What followed were years of surgery, chemotherapy, radiation, and years of adjunctive therapy for what turned to be a Stage 1 Grade 2, aggressive tumor. Nine years later, in 2015 she completed the final phase of her treatment plan. She is currently in remission, but struggles with the possibility of recurrence, and the many side effects of the cancer drugs.

In 2018, Michele was diagnosed with osteoporosis. After her endocrinologist ordered blood work and urine studies, Michele contacted Dr. Keren, a pathologist at Michigan Medicine, to help her understand the results. He took the time, she says, to understand her history and diagnosis, and explained what the numbers of her tests meant, and this proved the catalyst to her discovery that a migraine drug she’d been taking was the primary cause of her osteoporosis as well as other issues she was having, such as hair loss and severe leg cramps. Understanding her laboratory reports has helped her in her treatments for this latest diagnosis.

Despite her worries, Michele doesn't let her cancer define her. She stays current on literature, and is encouraged by the strides that have been made in immunotherapy and targeted therapies. Before her cancer diagnosis Michele didn't know she could see her pathology report or speak to a Pathologist. However, a meeting with Dr. Myers, a pathologist at Michigan Medicine changed all that. He showed Michele her tumor slides and explained pathology report in detail.

“What I hope that my message will do is to encourage patients to take control of their own situation. Do not let anyone tell you that this is the way it is and you just have to do it. You have to do research; you have to try to find out what questions to ask. If you don’t know, you find someone who can help you.”

Cindy's Story

The inspiration for Patient Champions, Cindy was an ambassador to empower and educate patients and raise awareness of the crucial role the medical laboratory plays in patient care. By sharing her story, Cindy continues to encourage other patients to ask the right questions and understand their treatment options.

Cindy was also an inaugural member of the Patient Champions Advisory Board and served on that Board until her passing. Cindy was the first to receive the ASCP Patient Champion Award in September 2017, presented by ASCP Chief Executive Officer E. Blair Holladay, PhD, MASCP, SCT(ASCP)^CM, and ASCP Patient Champions. This award recognizes a Patient Champion who has gone above and beyond in his/her activities to increase awareness of the laboratory.

Cindy was passionate about service, volunteering, and her work as a laboratory professional. She was an active volunteer for ASCP and the laboratory profession throughout her career.

Cindy Johns Shares Her Legacy

The first Patient Champion, Cindy Johns shares her story of battling metastatic breast cancer.

Questions To Ask Your Doctor

What is the course of action based on my lab results?
How will the lab results impact my treatment plan?
What are all my treatment options?
Why do you recommend this particular treatment option?
What are the follow-up tests and what are we looking for?

How do we know the procedure was successful/what lab tests and which results indicate a successful procedure?
What are the tumor markers we are monitoring? What are the levels we are hoping for? What happens if the tumor markers are higher than we would like to see?