Monday, January 19, 2026 – Closed
In observance of Martin Luther King Jr. Day.
Monday, January 19, 2026 – Closed
In observance of Martin Luther King Jr. Day.
Breast cancer is a disease that can be noninvasive (unable to spread) or invasive (able to spread throughout body) and occurs when breast cells start to multiply and grow abnormally. If they mutate enough, they become invasive, and these cancerous cells then have the ability to spread, or metastasize, to other parts of the body.
Men can also get breast cancer, though it is rare. The Centers for Disease Control and Prevention estimate that in the United States, 1 in every 100 diagnosed cases of breast cancer occur in males. Risk factors include age, genetic mutations and history of breast cancer in a close member of the man’s family. Treatments for men and women with the disease are similar.
Many women with breast cancer may not have symptoms, and their cancer is discovered by screening mammograms. There are some changes of the breast that can be suspicious for cancer. If women or men have the following conditions, they should notify their doctor.
cCARE’s Fresno location provides multidisciplinary-team care for patients that includes surgical oncology, medical oncology and radiation oncology – all under one roof.
The risk of breast cancer increases with age. Most breast cancers occur in women over 50 who have no other risk factor.
Women and men are more likely to develop breast cancer if they have a strong family history. However, only 5%-10% of breast cancers are inherited, meaning passed down from parents through abnormal genes.
The BRCA1 and BRCA2 genetic mutations are the most common hereditary risk factor. Other genetic mutations associated with breast cancer include such genes as PALB2, BARD1, CDH1, ATM, TP53, PTEN and CHEK2
The presence of benign breast lesions like atypical ductal hyperplasia, lobular carcinoma in situ and atypical lobular hyperplasia can significantly increase one’s risk of breast cancer, and chemoprevention may be recommended to lower the risk of developing breast cancer.
Several other factors can also contribute to an increased risk of breast cancer
Screening is used to try to diagnose cancer before any symptoms are present.Early detection may result in catching cancer before it becomes very advanced and may result in better treatment outcomes.
The size of the breast cancer and the extent of its spread are the most important factors in the prognosis for those with breast cancer, and screenings are more likely to detect breast cancers when they are smaller and have not yet spread. If any abnormal findings are present, additional steps may be taken, including obtaining a more detailed scan, repeating the scan after some time has passed or a biopsy.
When should women get a mammogram?
Recommendations on when to start mammogram screening are controversial and should be based on an individual’s own risk of developing breast cancer. Multiple national guidelines are published with different recommendations for patients of average risk. Obtaining mammograms at a younger age carries the risk of having additional biopsies that may not have been needed, and cancers can be harder to detect in younger women with dense breast tissue.
Mammograms, which use low-energy X-rays to produce images, should start between ages 40-50 and occur annually to every other year until age 74, or until less than 10 years of anticipated lifespan. The American College of Radiology and NCCN however, strongly recommend starting annual screening mammograms at age 40 for average risk patients. The recommendation maximizes proven benefits, which include reduction in breast cancer mortality and improved treatment options for those diagnosed with breast cancer.
Patients should be familiar with their breasts and any changes to them. For patients who have been screened and found to be at a higher risk of breast cancer, magnetic resonance imaging (MRI) or ultrasound evaluation may be indicated.
Patients who are deemed high risks for breast cancer should be followed in a high-risk clinic. cCARE offers high risk screening and follow-up through the breast specialty clinic in Fresno with Dr. Casandra Anderson.
If an abnormality is found on exam or during imaging (mammogram/ultrasound/MRI) of the breast, the next step is usually a needle biopsy. This involves taking a small amount of tissue that is checked under the microscope by a pathologist (a doctor who examines specimens to determine disease). Sometimes a needle biopsy will be inconclusive and a larger sample, called an excision biopsy, may be needed.
Once a cancer diagnosis is confirmed, more testing may be done to clinically stage the patient in a more precise manner.
There are two types of staging. Clinical stage is an estimate of stage based on physical exam and imaging. This is very important in determining the order of sequence of treatment. Some patients may have chemotherapy before surgery. Pathological stage is determined after surgery, when the pathologist has the cancer and can look at it under the microscope to determine the size of the tumor and definitively know whether cancer has spread to the lymph nodes.
Breast cancer is staged from stage 0 (zero) to IV (four). Staging is based on whether the cancer is noninvasive, which is stage 0, or invasive, which is I-IV. Staging invasive cancers is based on the size of the tumor, the receptor status (estrogen, progesterone, HER2negative), the lymph node status, and whether cancer has spread elsewhere in the body, such as in the lung or bone (metastatic disease). If a tumor has spread beyond the breast and lymph nodes, it is considered stage IV (metastatic), and this is the most advanced stage.
Breast cancer therapy needs to include a multidisciplinary treatment plan, meaning cooperation from multiple specialties of medicine. is constructed by a multidisciplinary team that includes:
At cCARE, we offer a multi-modality treatment team.
Therapy is based on the size of the tumor, whether there is lymph node involvement and if the cancer has metastasized. Many of the therapies are used in combination. Examples of breast cancer therapies are listed below.
Surgery
Surgery is used to remove the cancer from the body, which is referred to as local-regional control. cCARE has an experienced surgical oncologist dedicated to breast surgery, Dr. Casandra Anderson in Fresno who offers the latest in breast cancer surgical therapy.
Types of surgery include:
Radiation therapy
Radiation is the use of high-energy X-rays to destroy cancer cells and reduce the chance of the cancer coming back. Radiation for breast cancer is most often delivered using a large machine called a linear accelerator. Cancer cells are more susceptible to damage by radiation compared to normal cells. To balance side effects to normal tissues, radiation is often given over several treatments rather than a single visit.
Typically, radiation is delivered daily on weekdays (but not the weekend) over the course of 5-6 weeks. If possible, short course (also known as “hypofractionated”) radiation is offered over the course of 3-4 weeks with shorter overall treatment length due to slightly more radiation given per day. There are criteria that factor into whether this is a good option for the individual, but the effect of radiation between the two is equivalent.
Deep inspiration breath hold (DIBH)
Left sided breast cancer is unique from right sided breast cancer in that the heart is more left-sided. Although radiation is aimed primarily at the breast tissue, the heart is directly under the chest wall and may receive some radiation. Although the heart is able to handle a certain amount of radiation and short-term risks are relatively low, we do our best to reduce the amount of radiation it receives because radiation is not good for the heart in the long run.
To reduce this risk, we can offer a technique called deep inspiration breath hold (DIBH). A deep intake of breath will typically cause the lungs to expand and push the heart away from the chest. Our equipment will record how large a breath is taken so that it can be reproduced in the same way for treatments. The machine will only treat when within a safe range of that deep breath.
If a patient’s doctor decides this is a good option for her or him, it is also helpful to practice lying down with arms above the head and taking deep breaths at home. There are also other techniques we use when planning radiation to reduce the amount of radiation going to the heart.
When is radiation used for breast cancer?
There are also certain situations where radiation may be omitted, depending on stage of cancer and the patient’s age and overall health. The doctor will discuss the pros and cons and help the patient through the options.
Although these are general situations where radiation is used, every person is unique in terms of their cancer and care must be individualized based on this. In order to come up with the best treatment plan for the individual, the medical team of breast surgeon, medical oncologist and radiation oncologist will communicate regularly and coordinate the patient’s treatment plan.
cCARE has three expert radiation oncologists: In Fresno, Drs. Chang-Halpenny, Batth and Monson; in San Diego, Drs. Straka and Hoopes.
Systemic therapy
Medical oncologists use many different medications to kill cancer cells throughout the body. This can be in the form of IV medications or pills. These medications are used to help prevent cancers from returning, or treating cancers that have already spread (metastastic disease).
Chemotherapy is usually IV medication used to kill breast cancer cells or impede or stop their growth. Chemotherapy also can stop the growth of normal cells, and because of this may have side effects including hair loss or diarrhea. When recommended in the situation of early-stage disease, this is to prevent cancer from coming back. If a tumor is large or is found in lymph nodes at time of presentation, chemotherapy can sometimes be used before surgery (called neoadjuvant treatment) to shrink tumors to allow for less surgery to be performed.
This illustrates the importance of an evaluation with a multidisciplinary team. In some instances, surgeries with more complications and risks can be avoided if patients respond to upfront systemic treatment with chemotherapy. In the metastatic setting (when cancer has travelled to somewhere further in the body), chemotherapy is used to control the disease. Recommendations for chemotherapy are based on the type of breast cancer and its receptor status and grade.
Genomic signatures of the tumor are also sometimes used by medical oncologists to determine treatment regimens. Examples of these include the MammaPrint and Oncotype.
Targeted therapies
Targeted therapies are also an example of systemic therapy. This type of therapy can be administered by IV or orally and is designed to kill cancer cells by interfering with receptors or molecules that cause the cell to grow.
One type of targeted therapy is also called hormone or endocrine therapy. Tamoxifen is an example of an oral drug that blocks the estrogen receptor and causes cancer cells to stop growing. Another example is Herceptin. This is an IV drug that targets breast cancer with the HER2negative receptor.
Other targeted therapies for breast cancer include monoclonal antibodies, cyclin-dependent kinase inhibitors and tyrosine kinase inhibitors.
Immunotherapy
Since 2019, immunotherapy has also made its way into breast cancer treatment. Currently immunotherapy is being used for both early stage and metastatic triple negative breast cancer, which is the most aggressive type of breast cancer. Unlike chemotherapy, immunotherapy does not kill cancer cells directly but instead it allows the immune system to detect or see the cancer and attack it.
Global CTA: Rewriting The Cancer Story
I would recommend adding a link to scheduling again here.
At cCARE, we’re transforming how breast cancer is treated—combining advanced technology with compassionate, personalized care. Every patient’s story is unique, and we’re here to help you write yours with strength, hope, and confidence.