Recognized for its state-of-the-art treatment capabilities, Cleveland Clinic Florida's Breast Center has earned a three-year/full accreditation designation from the National Accreditation Program for Breast Centers (NAPBC) by the American College of Surgeons.
We are the first in Broward County and the third Breast Center in Florida to earn accreditation, which is given to centers that have voluntarily committed to provide the highest level of quality breast care and undergo a rigorous evaluation process and review of their performance.
Cleveland Clinic Florida’s Multidisciplinary Team
Our team includes fellowship trained breast surgeons, oncologists, plastic surgeons, radiologists, and pathologists, as well as nurses, a social worker and administrative staff who work collaboratively to treat patients with breast cancer.
Pioneers in Breast Reconstruction Techniques
Cleveland Clinic Florida’s plastic surgeons pioneered the Deep Inferior Epigastric Perforator Flap procedure (DIEP flap), to provide patients with reconstruction options after a mastectomy. They are also the first in the world to use laser assisted angiography to determine if there is enough healthy tissue to proceed with reconstruction immediately after a mastectomy. This revolutionary breakthrough reduces complications.
For more information about our success rates, services and programs, and research and education, please download the outcomes report.
Diagnosing Breast Cancer
Cleveland Clinic Florida offers the latest in diagnostic testing capabilities in a comfortable atmosphere. In addition to mammography and ultrasound, advanced technologies such as magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are being used as screening and diagnostic tools.
While mammography is still the primary method for diagnosing breast cancer, clinical breast exams and self-examinations are important for early detection. Breast exams can detect lumps that may not be detected by mammogram, and detecting breast cancer in its early stages, greatly improves chances of surviving the disease.
Patients can help ensure their breast health by performing monthly self-exams and having their physician conduct a clinical breast exam every year. If a lump is detected, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different (in size, texture, and movement) than benign lumps.
What is Breast Cancer?
Breast cancer results when abnormal cells in the breast tissue, ducts, or glands begin to grow and divide out of control, forming a malignant (cancerous) tumor. If untreated, the malignant tumor cells can grow into the tissue surrounding the breast and can travel through the body’s lymphatic system to other organs in the body.
What causes breast cancer?
A specific cause of breast cancer is not known; however, there are certain factors that may put a person at a higher risk of developing the disease. They include:
- Genetic factors
- Family history
- Personal health history
- Pregnancy history
- Menstrual history
- Poor diet
- Lack of exercise
- Radiation exposure
- Excessive use of alcohol
- Postmenopausal hormone therapy
Breast cancer statistics
Breast cancer is the leading cancer for women of all ethnicities in the United States, aside from non-melanoma skin cancer. Due to the difference in breast structure between men and women, and the level of estrogen, more than 99% of breast cancer cases are diagnosed in women.
Caucasian women have a slightly higher risk of developing breast cancer; however African American women have a slightly higher risk of developing aggressive, advanced-stage breast cancer.
Breast cancer risk doubles for women who have a first-degree relative who has had breast cancer — about 20%-30% of women diagnosed with breast cancer have a family member who also has had breast cancer. However, up to 80% of women diagnosed with breast cancer have no family history and it is believed that cancer occurs due to genetic abnormalities that result from the natural process of aging. About 5%-10% of breast cancers are linked to gene mutations a woman inherits from her mother or father. A woman who carries a gene mutation has an increased risk of up to (80%) of developing breast cancer during her life.
Women who are overweight or obese have a slightly higher risk of developing breast cancer or recurrence of breast cancer. In addition, not having children at all or not having a full-term pregnancy after age 30 is associated with a higher risk of breast cancer.
Male breast cancer
Although breast cancer in men is rare, men have a small amount of breast tissue and can develop the same types of breast cancers as women. Less than 1% of all new breast cancer cases develop in men. On average 2000 men are diagnosed with breast cancer in the US each year.
Risk factors for men are similar to those for women, but also include:
- Klinefelter syndrome, a congenital condition affecting about 1 in 1,000 men
- Testicular conditions
- Excessive use of alcohol
- Liver disease
- Radiation exposure
- Exposure to estrogen
Breast cancer risk in men increases with age. It is most commonly diagnosed between the ages of 50 and 70. Cancers related to gene mutations often occur in people younger than age 60. Symptoms of breast cancer in men are very similar to those in women. However, tumors are usually smaller but may be more advanced upon diagnosis because men have very little breast tissue; so the tumor doesn’t have far to grow before invading other tissues or the lymph nodes.
For both women and men with a strong family history of breast cancer, it is important to do monthly self exams and to have any changes examined immediately by your physician.
Breast Cancer Treatment Options
A range of treatment options is available to patients who have been diagnosed with breast cancer: surgery, radiation, hormone therapy, chemotherapy, and clinical trials, to name a few. Cleveland Clinic’s team of breast care specialists will help to determine the best treatment plan based on type of breast cancer, size and location of the tumor, disease stage, lab test results, and a patient’s overall health.
Breast cancer treatments are local or systemic. A patient may have just one form of treatment or a combination. Local treatments include surgery and radiation, which are used to remove, destroy, or control the cancer cells in a specific area. Systemic treatments include chemotherapy and hormone therapy, which are used to destroy or control cancer cells throughout the body.
Surgical Treatment Options
The various surgical techniques differ in the amount of breast tissue that is removed with the tumor. Cleveland Clinic Florida’s team of physicians and surgeons includes surgeons with fellowship training specifically in breast surgery. A tumor board consisting of members from our multidisciplinary staff meets each week to review patient cases and discuss treatment options. Cleveland Clinic Florida offers the following treatment options for patients diagnosed with breast cancer:
- Lumpectomy/partial mastectomy involves removing the cancerous portion of the breast and surrounding tissue, while striving to preserve the normal appearance of the breast. Lymph nodes under the arm may also be removed.
- Partial or segmental mastectomy is when the surgeon removes up to one quarter or more breast tissue than is removed in a lumpectomy.
- Simple Mastectomy is the removal of the breast, skin, and nipple.
- Modified radical mastectomy is recommended when the tumor is large and/or has spread to the surrounding lymph nodes. It is a surgical procedure in which the entire breast is removed, including the skin, areola and nipple. Lymph nodes in the armpit area also are removed.
- Nipple-areola sparing mastectomy is a technique in which the surgeon attempts to preserve the patient’s nipple and areola during removal of the breast tissue. This helps to avoid reconstructive surgery in the area, but it is only done if the cancerous area is 2 cm or more away from the tissue to be saved.
- Skin sparing complete mastectomy involves removing cancerous breast tissue through a small incision around the areola while leaving most of the breast skin. The remaining “pocket” is filled with a breast implant or with tissue from another part of the patient’s body.
- Oncoplastic surgery is a procedure in which surgical reconstruction is combined with lumpectomy. A plastic surgeon removes the cancerous breast tissue while sculpting the remaining tissue to restore a natural appearance and shape.
- Prophylactic complete mastectomy is surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast cancer. Those at high risk for breast cancer may be able to reduce their risk by 90% with this procedure.
- Sentinel lymph node biopsy is removal of one or a few of the lymph nodes under the arm. If they have cancer, then patients may then need to have all of the lymph nodes removed, called an axillary lymph node dissection.
- Axillary lymph node dissection is the removal of all of the lymph nodes under the arm to determine whether the cancer has spread.
Chemotherapy is a systemic treatment using a combination of drugs administered orally or intravenously to slow or stop the growth of cancer cells. Chemotherapy may be given after a lumpectomy or mastectomy to reduce the chance of cancer recurrence. It also may be given before surgery to shrink the tumor, making it easier to remove or so that a lumpectomy can be performed rather than a mastectomy. Side effects of treatment typically depend on the types and amounts of drugs used.
Radiation therapy uses strong beams of energy to target and destroy cancer cells that may have been left behind after surgery. It can reduce the risk of recurrence by 70%. Most commonly, radiation is delivered externally by a high energy beam. In some cases, radiation can be delivered internally in the lumpectomy site, by implanting small pieces of radioactive material, called seeds, which emit radiation to a small area.
Endocrine (hormone blockers) may be prescribed for women whose breast cancer is hormone-receptor positive, which means that estrogen levels affect cancer cell growth. This type of treatment lowers the amount of estrogen in the body as well as blocks estrogen from acting on breast cancer cells to slow the growth of cancer or help to shrink tumors. There are several types of hormone therapy medicines, which your physician can prescribe based on specific characteristics of the individual cancer.
A strong research program at Cleveland Clinic Florida provides patients with the most up-to-date treatment options. At any given time, patients can participate in a number of leading-edge research trials to test new drug therapies and investigate new treatment protocols.
Breast reconstruction involves recreating one or both breasts following lumpectomy or mastectomy. The reconstruction can take place during the removal or it can be performed at a later time. Additionally, a surgeon can use the patient’s own skin and soft tissue, or the patient can opt for breast prostheses, which intend to simulate the look and feel of natural breasts. Reasons for rebuilding the breasts, how and when to do it are very personal and vary by individual. Cleveland Clinic Florida plastic surgeons provide a variety of options, including the DIEP flap, which is a procedure that uses a woman’s own skin and soft tissue from the abdomen to rebuild the breasts. Our surgeons were the first in the world to pioneer this procedure.
Cleveland Clinic Florida’s Breast Center brings together a unique team of experts from several specialties who collaborate to diagnose and treat patients with both benign and malignant breast conditions. This team approach to patient care enhances communication among physicians, which facilitates the speed and quality of the patient’s treatment.
- Cassann Blake, MD
Director, Surgical Breast Oncology
- Steven Roshon, MD
Center Director, Taussig Cancer
- Margaret Gilot, MD
- Elizabeth Stone, MD
- Christopher Chen, MD
- Martin Newman, MD
- Maria Artze, MD
- Diane Carlson, MD
- Carmel Celestin, MD
Vascular Medicine Specialist
Women’s Imaging Center
As part of the Breast Cancer Program, Cleveland Clinic Florida’s accredited Women’s Imaging Center provides state-of-the-art screening in a soothing environment. The imaging center makes early and accurate detection a priority, offering digital mammography, breast ultrasound, breast MRI and breast CAD (computer aided detection).
Our two locations at Weston and West Palm Beach have been designated Breast Imaging Centers of Excellence by the American College of Radiology (ACR). The Imaging Centers are part of an elite group of imaging centers in Florida to achieve this level of excellence. Only three percent of the state’s nearly 500 ACR-accredited centers are recognized as breast imaging centers of excellence. The latest and most innovative breast imaging services include:
- Minimally invasive diagnostic breast biopsies are often performed by a radiologist or surgeon who uses computerized imaging to guide him or her in taking tissue samples using a sterilized needle.
- Stereotactic vacuum-assisted biopsy is a minimally invasive diagnostic technique in which a doctor uses a vacuum probe inserted into a small incision to take small tissue samples guided by mammogram images of the breast.
- Ultrasound-guided vacuum-assisted biopsy is a minimally invasive diagnostic technique in which a doctor uses a vacuum probe inserted into a small incision to take small tissue samples guided by ultrasound images of the breast.
- MRI guided core biopsy is a minimally invasive diagnostic technique in which a radiologist uses a vacuum probe inserted into a small incision to take small tissue samples guided by magnetic resonance images of the breast.
- Digital mammography is a system that captures the X-ray image of the breast to a digital file that can be viewed on the computer rather than capturing the image as photographic film. The image can be viewed immediately. The radiologist can zoom in and adjust the size, brightness, and contrast.
- Breast MRI (magnetic resonance imaging) is an imaging test in which a contrast dye is administered to highlight different tissue structures of the breast. A scan is conducted which captures dozens of images of the breast using magnets and radio waves. Each image is a slice, which when compiled on the computer, provide the radiologist detailed, cross-sectional views of the breast tissue.
- Breast ultrasound is an imaging technique in which a small, hand-held instrument called a transducer is placed against the skin. The device emits sound waves that bounce off body tissues and are converted into a black and white image that is displayed on a computer screen.
- Breast CAD (computer-aided detection) is a test that accompanies either film or digital mammograms. The image is analyzed by a computer, which then provides the radiologist an image flagging any suspicious areas that should be checked more closely.
Research & Clinical Trials
Clinical research has been fundamental to the mission of Cleveland Clinic since its establishment. At Cleveland Clinic Florida, our robust research program is designed to provide patients with the most up-to-date treatment options.
In general, clinical trials are used to test the safety and effectiveness of drugs and medical procedures in a human population, but the trials rely on the participation of human volunteers. This ongoing collaboration between physician investigators and study volunteers is one of the foundations of modern healthcare, because clinical trials help set the standards for patient care.
At any given time, patients can participate in a number of leading-edge research trials to test new drug therapies and investigate new treatment protocols. There are potential benefits, for clinical trial volunteers. Volunteers with existing diseases or conditions can play a more active role in their own healthcare, gain access to new research treatments before they are widely available, and help others by contributing to medical research.
Today, Cleveland Clinic Florida is participating in many clinical trials of various types.
Patient Family Support Services
It is difficult for patients and loved ones when there is a breast cancer diagnosis. Cleveland Clinic Florida offers a number of individualized programs and services to help patients and their families face the challenges associated with diagnosis and treatment.
Survivorship and Support Group Programs
Cleveland Clinic Florida offers access to groups and programs to help patients and family members deal with the variety of physical and emotional issues that may arise during cancer treatment.
Cleveland Clinic Florida offers free services to patients undergoing cancer treatment to help them deal with appearance-related side effects.
For more information, call 954.689.5393.
Our social workers are certified patient navigators skilled in addressing the counseling, support and advocacy needs of patients and their families. Our mission is to reduce the social and emotional obstacles to healthcare resources and information.
Counseling services are available to help patients and family members:
- Adjust to the diagnosis of cancer
- Communicate with family members and doctors
- Cope with changes in self-image
- Access crisis intervention
- Find caregiver support
- Arrange for grief counseling
- Gain referrals to other mental health providers
We can provide:
- Referrals to community resources
- Confidential outreach from a cancer survivor
- Referrals for spiritual support, nutrition counseling and complementary therapies
- Referrals for home health care, palliative care and hospice
Advocacy helps patients and families:
- Navigate the health care system
- Address financial, insurance, disability and employment concerns
- Access needed prescriptions
- Explore transportation options
- Arrange school intervention for adults or children
- Discuss advance care planning--living will/durable power of attorney for healthcare
If you have an issue you would like to discuss or you would like to meet with a social worker, please call: 954.689.5393.
Resource Center/Education Center
Our Patient Resource and Education Center provides patients and their friends and families information and resources about cancer, including:
- Pamphlets and informational brochures
- Computer terminals that can be used for conducting internet searches
- WiFi access for laptops
- Conference area where you can sit with a nurse and ask questions
- Listings and registrations for support groups and other patient programs
- Listings of resources such as wigs, transportation, and lodging
The Patient Resource and Education Center is open to help you obtain cancer information from 8 a.m. - 4:30 p.m., Monday - Friday.
American Cancer Society Participation
Cleveland Clinic Florida continues to play an active role in supporting the American Cancer Society’s community outreach efforts to raise awareness about cancer prevention, research, education and support services.
Cleveland Clinic Florida’s Smoking Cessation Program uses the S.M.A.R.T. Quit approach to help patients overcome nicotine addition. The S.M.A.R.T. approach is as follows: Strategy: Develop a program tailored for each patient’s success. Motivation: Encourage patients to make a pact with themselves to keep trying. Awareness: Teach patients about nicotine addiction, withdrawal and triggers. Reasons: Help patients compare pros and cons and identify their top reasons to quit. Tobacco-Free Life: Help patients set a date; then commit to living without tobacco.
The Cancer Registry plays an integral role in the success of Cleveland Clinic Florida Cancer Program, providing data management services to meet mandatory state cancer reporting requirements, as well as those of the American College of Surgeons Commission on Cancer. The Cancer Registry maintains data on all cancer patients and the data is made available to the medical staff for special studies, audits and research.
Cleveland Clinic Florida offers genetic testing for both men and women with a strong family history of breast cancer. A blood sample drawn in a lab or physician’s office can be screened for mutations in the BRCA genes, which have been linked to hereditary breast cancer. BRCA testing can also assist physicians in determining future risk, appropriate imaging tests, risk reducing medications and whether prophylactic mastectomy to reduce the risk of breast cancer is recommended.
Women who have been treated for breast cancer may be at risk for arm, breast and chest swelling called lymphedema. Cleveland Clinic Florida has a physician and specialists who are dedicated to the prevention and treatment of this condition. Physical and occupational therapists use manual lymph drainage, decongestive exercise, compression therapy, and provide education on skin care guidelines to reduce swelling and prevent infection and other complications.