Breast Health Center

The Breast Health Center is a collaborative program between Massachusetts General Hospital and Salem Hospital that provides the highest caliber of care in a supportive and patient-focused atmosphere. Our multidisciplinary team includes expert surgeons, radiologists and imaging technologists, medical and radiation oncologists, nurses and social workers, all specialized in breast health.

Convenient, Comprehensive Care

The Breast Health Center provides comprehensive breast care for women. Our services include:

• Breast screening exams including breast tomosynthesis (3D mammography) and breast MRI
• Breast cancer diagnostics
• Breast surgery
• Cancer care
• Patient support services

The Most Advanced Imaging Technologies

The Breast Health Center offers leading-edge technologies to improve early detection and treatment of breast cancer. Breast tomosynthesis is the latest breakthrough in mammography and was pioneered at Massachusetts General Hospital. Also called 3D mammography, it provides a clearer, more accurate view of the breast and enables doctors to pinpoint the size, shape and location of abnormalities more effectively. A complement to standard mammograms, it can result in fewer callbacks, better detection and greater peace of mind.

Multidisciplinary Approach

If a patient is diagnosed with cancer, our multidisciplinary team of breast cancer experts works together to develop and implement a personalized care plan. Depending on the stage and other characteristics of a patient’s cancer, treatment may include surgery, chemotherapy, radiation therapy or a combination of these therapies. Members of the care team meet with patients regularly and communicate frequently with their referring physician to ensure seamless coordination of care. Patients have access to physicians and specialists in Danvers and in Boston if they need additional care.

Imaging and Diagnostics

The Breast Health Center is dedicated to helping women stay one step ahead of breast cancer through annual screening and by providing the most advanced diagnosis and treatment available to our patients. Our patients receive personal, confidential care that is designed by a multidisciplinary team to meet their individual needs.

We offer the full spectrum of mammography screening and diagnostic exams, including:

• Annual screening mammograms
• Breast tomosynthesis (3D mammography)
• Diagnostic mammograms
• Diagnostic breast ultrasound
• Breast MRI services

Annual Screening Mammogram

We offer convenient screening mammography at the Breast Health Center and through Salem Hospital in Salem, Lynn, Danvers and Gloucester. All of our breast health facilities have been accredited by the American College of Radiology and the Massachusetts Department of Public Health Radiation Control Program.

All mammography performed at our center uses digital technology. This enables the radiologist to review electronic images of the breast on special high-resolution monitors and adjust the brightness, change contrast and zoom in for close ups of specific areas of interest which can lead to a more accurate diagnosis. Another advantage of digital mammography is that it reduces the need for additional images, therefore reducing exposure to radiation.

Diagnostic Mammogram

A diagnostic mammogram is used to evaluate a patient with abnormal breast symptoms or after an abnormal screening mammogram to determine the cause of the area of concern. Diagnostic exams are performed under direct supervision of an expert radiologist who interprets the images as they are taken and conveys results to the patient before they leave the appointment. If a suspicious area is detected, patients can work with their expert care team to promptly schedule a follow-up appointment or additional diagnostic procedures.

Breast Tomosynthesis (3D mammogram)

Breast tomosynthesis is a new type of mammogram pioneered at Massachusetts General Hospital. Also called 3D mammography, it takes images from multiple angles and uses computer processing to build these “slices” into a 3D image that a radiologist can manipulate, providing a clearer, more accurate view of the breast. This enables doctors to pinpoint the size, shape and location of abnormalities more effectively. Performed at the same time as a standard mammogram and used as a complement to improve a radiologists’ ability to screen for and detect potential breast cancers, breast tomosynthesis can result in fewer callbacks, better detection and greater peace of mind.

Diagnostic Breast Ultrasound

Ultrasound technology uses sound waves, rather than radiation, to produce a diagnostic image. It can distinguish between benign fluid-filled cysts and solid masses that may be cancerous, so it is often used to evaluate a patient after an abnormal mammogram.

Breast MRI Services

Breast MRI is an important tool in screening for and treating breast cancer because it can help distinguish between benign (non-cancerous) and malignant (cancerous) areas. It is suitable for some women with dense breast tissue or classified as having high risk for breast cancer. In women with newly discovered cancer in one breast, breast MRI is often used to thoroughly examine both the breast with the tumor and the other breast. Breast MRI is also used to assess whether cancer has spread, to plan surgery and to judge the effectiveness of chemotherapy.

Breast Surgery

Our multidisciplinary teams of breast surgery experts evaluate and diagnose conditions from benign breast disease to breast cancer. Working in concert with experts in Danvers and Boston, they map out an individual course of treatment tailored to each patient’s specific needs and diagnosis. In addition, they work in tandem with plastic surgeons to provide the best options for breast reconstruction, if necessary. Immediate reconstructive (plastic) surgery is possible in nearly all patients.

Our surgeons are specially trained to treat breast cancer. They perform:

• Breast biopsies
• Breast conservation therapy
• Mastectomy
• Sentinel lymph node biopsy
• Breast reconstruction surgery

Surgical Breast Biopsy

During a surgical biopsy, a breast surgeon will remove a sample of the lump or the suspicious area in the breast and send it for evaluation by a specialized pathologist. This biopsy may be aided by a pre-operative needle localization procedure, in which a breast radiologist uses mammographic or ultrasound guidance to place a thin localizing wire into the tissue to target the area to be biopsied. Surgical breast biopsies are outpatient surgical procedures, usually taking about one hour.

Surgery, Chemotherapy and Radiation Treatment

Surgeons at the Breast Health Center work collaboratively with medical oncologists and radiation oncologists at the Mass General Cancer Center to plan out the best course of treatment for each patient. In many cases, chemotherapy and/or radiation therapy may be required after surgery and can be provided here at the Mass General Cancer Center in Danvers.

Sentinel Lymph Node Biopsy

Our surgeons use the most advanced techniques for the surgical treatment of breast cancer. Part of the evaluation of patients with invasive breast cancer is the testing of lymph nodes in the areas surrounding the breast to see if cancer has spread outside of the breast. Knowing whether tumor cells have spread to lymph nodes helps guide recommendations for treatment, including chemotherapy, hormonal therapy and radiation therapy.

Lymphatic mapping with sentinel-node biopsy removes only the lymph nodes closest to the breast, which are the ones most likely to harbor cancer if the cancer has spread. By sparing most of the lymph nodes in the armpit area, there is a much lower risk of lymphedema, or arm swelling.

Breast Reconstruction Surgery

For women who prefer reconstruction after mastectomy, our breast cancer surgeons work closely with plastic and reconstructive surgeons to evaluate the woman’s goals, medical history, physical condition and potential need for additional cancer treatment to decide on the best type of reconstruction for each patient.

Our breast reconstructive surgeons can offer women a number of reconstructive options, most of which can be done at the time of the mastectomy. Our breast surgeons have expertise in performing skin-sparing and nipple-sparing mastectomies.

Implant-based reconstruction may be performed in a single-stage procedure in which the permanent breast implant is placed at the time of mastectomy. Alternatively, a two-stage procedure may be performed. In a two-stage reconstruction, a saline-filled tissue expander is placed into the site of the removed breast. After surgery, the tissue expander is gradually filled over a series of office visits until the desired volume is reached. Once this is done, the tissue expander is surgically removed and a permanent breast implant, either saline- or silicone-filled, is placed in the cavity created by the expander.

Another method of reconstruction involves transferring tissue from the abdomen or back to construct a breast from the patient’s own tissues. With most forms of reconstruction, either the patient’s original nipple is spared and reattached or her skin is used later to reconstruct a nipple, which is subsequently tattooed the same color as the other nipple.

Cancer Care

The multidisciplinary breast cancer clinic in Danvers provides patients with access to specialists with a wide range of expertise, including medical oncology, radiation oncology and breast surgery – all working together to provide the highest quality care in a timely and coordinated fashion. Our experts will also offer a second opinion to help patients evaluate their treatment options.

Treatment is offered for the following breast cancer conditions:

• Ductal carcinoma in situ (DCIS)
• Invasive breast cancer
• Inflammatory breast cancer
• Recurrent or metastatic breast cancer
• Male breast cancer

Multidisciplinary breast cancer clinic

We work closely with patients to help them transition from diagnosis to treatment. Each patient’s case is reviewed by a breast surgeon, medical oncologist, radiation oncologist, pathologist and nurses who create a comprehensive and individualized treatment plan. Our patients have access to physicians and specialists in Boston if additional care is needed.

Individual courses of treatment may include the following innovative approaches:

• Lymphatic mapping and sentinel node biopsy, which can determine whether cancer has spread
• Nipple-sparing mastectomy techniques
• Partial mastectomy/lumpectomy
• Oncoplastic surgery
• Breast reconstruction (implant-based or tissue-transfer)
• Anti-estrogen hormonal therapy
• Chemotherapy, either before or after surgery
• Supportive care therapies to eliminate or reduce symptoms that can interfere with quality of life
• Advanced radiation techniques that minimize the heart’s exposure to radiation and use of image-guided technologies to pinpoint the treatment area
• Partial-breast irradiation (PBI)
• Clinical trials of promising new therapies, some of which are determined by tumor and genotyping
• Genetic testing and cancer risk assessment counseling

Medical Oncology

Our medical oncologists work with specialized breast surgeons, radiation oncologists, pathologists and other members of the care team to determine the best course of treatment. We use the latest chemotherapy regimens and anti-estrogen therapies to achieve the best possible results for each patient. Some women may have the option of starting with systemic chemotherapy treatment (neoadjuvant therapy) before surgery is performed. Shrinking a tumor in advance through chemotherapy can avoid extensive breast surgery to remove a tumor. The neoadjuvant approach also can help oncologists determine how well a tumor is responding to treatment. In some cases, chemotherapy may be required after surgery, and radiation therapy is always required after a lumpectomy to destroy any possible remaining cancer cells. Our oncologists also may use oncotype tumor testing, which helps determine the likelihood of the breast cancer recurring and whether a patient is likely to benefit from commonly used chemotherapy regimens.

Radiation Oncology

Our radiation oncologists offer patients the latest treatment regimens and innovative techniques such as partial breast and prone breast radiation therapy. State-of-the-art linear accelerators provide radiation therapy, including intensity modulated radiation therapy that is targeted and exact. These options target the cancer while reducing radiation exposure to the heart, lungs and other surrounding organs and tissue.

Genetic testing and cancer risk assessment counseling

Some patients have an increased risk of developing breast cancer based on their family history. Our team of certified genetic counselors is available to meet with patients to discuss genetic testing and gather the information they need to make informed healthcare decisions.

Clinical Trials

Our patients have access to clinical trials of new treatments and therapies with the goal of improving patient care and advancing scientific knowledge. Massachusetts General Hospital offers one of New England’s largest clinical trial programs. Eligible patients can participate at any stage of disease. Patients are encouraged to speak with their oncologists about enrolling in clinical trials that may be appropriate for them.

High-risk Management

Patients with an increased risk for breast cancer based on family history or personal health will work with a special team of breast experts and medical oncologists to assess options and manage their care. Recommendations may include earlier, more frequent and advanced diagnostic testing, genetic testing and counseling, breast cancer prevention medications or a change of lifestyle factors. For more information, visit the Center for Cancer Risk Assessment at the Mass General Cancer Center.