Hilary Axtmayer can pinpoint the moment her life changed. In 2023, Axtmayer-then a 40-year-old mother of two from Madison, Conn.-was receiving her regularly scheduled breast exam when her gynecologist paused mid-palpation. She'd found a lump.
"Everything went a little bit fuzzy," Axtmayer recalls. "I kind of just knew right then."
Axtmayer was later diagnosed with Stage III estrogen- and progesterone-positive breast cancer. Less than two weeks after her doctor first felt a lump, she found herself sitting across from Rachel Greenup, MD, MPH, chief of breast surgical oncology at Smilow Cancer Hospital and professor of surgery (oncology) at Yale School of Medicine (YSM). The transition from normal life to a cancer diagnosis was "overwhelming," Axtmayer says. She didn't know what to expect.
Then, as Greenup explained her treatment options, "she put her hand on my leg, and said, 'You're going to be ok. Your cancer is treatable and curable. You are going to get through this,'" Axtmayer says. "It was incredibly reassuring."
Axtmayer received the bulk of her cancer care at Smilow Cancer Hospital and Yale Cancer Center. Over the next year, physicians, nurses, and other medical staff helped her through several surgeries, chemotherapy, and radiation. They also helped connect her to a therapist and a social worker who could assist with managing the impact of her cancer diagnosis on her children.
This type of multidisciplinary care is at the core of Yale Cancer Center's mission. The center was founded in 1974 as one of the 58 congressionally funded comprehensive cancer care centers. To this day, the center provides state-of-the-art cancer care at 14 locations in Connecticut and Rhode Island. As part of its mission to reduce cancer mortality, the center also supports basic research and participates in clinical trials that help push the boundaries of cancer treatment.
"Yale is comprised of talented, empathetic clinicians who are driving the latest advances in breast care," says Maryam Lustberg, MD, MPH, director of the Center for Breast Cancer and chief of breast medical oncology at Smilow Cancer Hospital and Yale Cancer Center.
Bringing those clinicians together is essential for providing patients with the best care, says Eric Winer, MD, director of Yale Cancer Center and president and physician-in-chief of Smilow Cancer Hospital.
"The Center for Breast Cancer's approach makes sure our patients feel supported throughout every step of their treatment," says Winer. "As we expand the center, it means we can help even more patients and offer them unmatched excellence in care."
Team-based care
Around one in eight women will develop breast cancer in their lifetimes. While death rates have dramatically shrunk-dropping by 44% between 1989 and 2022-breast cancer is still the second leading cause of cancer death among women in the United States.
It's therefore not surprising that many people greet their diagnosis with trepidation. From surgery to hair loss, cancer treatment is "very daunting," says Sarah Schellhorn, MD, an associate professor of medicine at YSM and chief of ambulatory operations at Smilow Cancer Hospital.
Patients with cancer can sometimes wait weeks after diagnosis to receive care. Waiting for treatment can be agonizing, Schellhorn says, adding: "If you're diagnosed with cancer, you probably wanted to be seen two days ago."
Smilow Cancer Hospital aims to reduce waiting times by seeing patients within three days of receiving a referral. Once in, new patients can expect "a lot of meetings," as they are ferried between surgeons, oncologists, radiologists, and other experts needed to weigh into their care, says Mitchell Elliott, MD, a medical oncologist and assistant professor of medicine at YSM. These appointments often happen all in one day.
To do this, the center prioritizes a "team-based approach" to patient care, says Lustberg. One way the breast cancer team at Yale does this is by having weekly meetings where the entire medical staff discusses challenging cases. Elliott recently joined Yale Cancer Center. One thing that has stood out to Elliott is "how closely everyone works together" at Yale.
Making tough choices
What treatment looks like varies from patient to patient. Breast cancer comes in many shapes and sizes depending on its underlying biology, cancer stage, and the patient themselves.
Because breast cancer is so common, and people often know other people who've undergone treatment, patients will sometimes come into their first appointments with an idea of what the next year will look like, says Greenup. But she cautions not to "assume what you've heard prior to the appointment is right for you."
For instance, not all patients with cancer require chemotherapy. Some types of cancer require people to go on hormone suppressors for up to a decade after diagnosis. For people with Stage IV, or metastatic breast cancer-where cancer cells have spread outside the breast and lymph nodes-care is often focused around managing cancer as a chronic illness. Overall, breast cancer treatment is "quite individualized," says Elliott.
Because there is no one-size-fits-all treatment, patients often face several choices to make about their care. Take surgery. People in the early stages of breast cancer must sometimes decide between getting a mastectomy-where the entire breast is removed-or breast-conserving surgery. Getting a mastectomy sometimes means patients can avoid radiation and additional surgeries. But it also means that patients lose one or both breasts. Both treatment options have excellent survival outcomes, but they each come with drawbacks.
This isn't a small matter. Along with the health considerations, breasts are tied to body image and sexuality, and their removal can impact childcare goals. Breast surgery is "a highly vulnerable time" for many patients, says Greenup.
Certain types of breast cancer might require additional surgeries. Axtmayer, for example, underwent surgery to remove 19 lymph nodes after a biopsy revealed that cancer had spread to some of the nodes in her right arm. Since her breast cancer was fueled by hormones, she also had her ovaries and fallopian tubes removed to reduce estrogen production.
Axtmayer had already met her childbearing goals. But young patients facing breast cancer must sometimes confront what treatment means for theirs. For instance, some cancer treatments can cause early menopause. Patients with breast cancer can and do get pregnant after treatment, but working with fertility specialists to preserve eggs or embryos can be "a good backup plan," says Greenup.
Whatever treatment looks like, "we will be with patients every step of the way," she says. "We have the resources to help support them in their most difficult time."
Support through research
Fewer people are dying from breast cancer than in the past. But there is still much we don't understand about the disease and how to treat it.
In 1971, Congress passed the National Cancer Act in part to address cancer in the United States by training physicians and expanding research on cancer. Yale Cancer Center was founded a few years later as part of this effort. As such, cancer research has always been a foundational part of the center's mission.
In the past, Yale doctors pioneered breast-preserving lumpectomy surgeries. Today, Yale runs "research in pretty much every area that is currently relevant" to breast cancer, says Lajos Pusztai, MD, DPhil, a professor of medicine at YSM and co-leader of the Yale Cancer Center's Genomics, Genetics, and Epigenetics Program.
This research can make a big difference in patient outcomes. Starting in the 1980s, researchers discovered they could target breast cancer with specific biomarkers. For instance, around 70% of breast cancers respond to estrogen and progesterone. Researchers found that they could address these cancers in part by managing hormones. Later studies also identified that another 25% of breast cancers could be identified by the cell-surface protein HER-2.
Today, oncologists use hormones and other biomarkers as targets for cancer-killing medication. That's why breast cancer diagnosis contains information about hormonal and biomarker status, says David Rimm, MD, PhD, Anthony N. Brady Professor of Pathology at YSM.
Rimm is one of the researchers at Yale pushing the boundaries of breast cancer knowledge. His lab is working to improve biomarker diagnostics. A new method of his is now being deployed in some of the clinical trials at Smilow Cancer Hospital.
One of the advantages of receiving care at Yale is that "you're working with some of the doctors that are moving the field forward," he says.
Yale Cancer Center hosts several large, nationwide clinical trials. Some patients are concerned about participating in clinical trials because they worry they won't receive the best treatment, says Pusztai. But "most clinical trials today are designed really carefully to minimize the chances you get something inferior to standard-of-care," he says.
Rather, clinical trials "give you the option to receive tomorrow's treatment today," he says.
This is especially significant for addressing metastatic breast cancer. Stage IV breast cancer, affecting an estimated 170,000 people in 2025, is considered incurable. Treatment involves managing symptoms and improving quality of life. Yale is home to several clinical trials testing whether new therapies can improve on existing treatments-and one day cure Stage IV breast cancer.
This is still a long way off. But, as Pusztai puts it, "as long as one person dies of breast cancer, there is room for improvement."
Ian Krop, MD, PhD, feels the same way. "Clinical trials are how we move treatment forward," says Krop, section chief of medical oncology and hematology, deputy director for clinical affairs, and director of clinical trials at Yale Cancer Center and Smilow Cancer Hospital. "It's important to us that we can bring the most innovative new therapies with greatest potential to our patients."
And research at Yale Cancer Center isn't limited to treating cancer; scientists are also working to improve detection as well. Ilana Richman, MD, MHS, studies the effectiveness of cancer screening with a goal of helping screening be more effective, particularly for older women.
Over the years, Richman has found that some of the existing data doesn't always line up with people's expectations. For instance, it takes about 10 years for breast cancer screenings to improve life expectancy. Patients often feel that mammograms are a critical component of their healthcare. Eventually, patients will age out of this type of screening. However, identifying which patients will continue to benefit from screening is not always straightforward, says Richman. This matters, because physicians want to ensure women get screened if it will help them while avoiding unnecessary procedures if it won't.
"Are there more nuanced ways to screen based on patients' individual risk factors?" says Richman. "I think this is an area of interesting and challenging ongoing research."
Beyond medical care
Cancer isn't just a medical issue. It's "unbelievably disruptive to your life," says Axtmayer. When she was first diagnosed, Axtmayer was working a full-time job and raising two kids under the age of 7. "There was no space for cancer in my life," she recalls. At first, she thought she could continue to operate at the same level as before. "I pretty quickly realized I wasn't going to be able to do it all," she says.
Patients with breast cancer face a litany of challenges, says Schellhorn. "'What if I need childcare during chemotherapy? What about my lost wages? What if my electric bill doesn't get paid?'" she says. "There's a lot of stuff that doesn't come up initially when you think about your breast cancer diagnosis."
It's not possible for one person to sort through all these issues. To deal with this, Yale Cancer Center works with experts in a variety of fields to help patients manage the sudden changes that cancer brings to their lives. For instance, the center employs social workers who can help connect patients with community resources and support groups.
For Axtmayer, working with a social worker helped her talk with her children about her cancer diagnosis. "Navigating hair loss with my daughter was one of the most traumatic experiences," she says. Talking through this problem with a social worker helped her with her approach; the social worker also connected her to a therapist.
Doctors work with other experts to manage the numerous side effects brought about by cancer treatment. One issue often faced by patients on chemotherapy, for instance, is nausea and appetite loss. To help patients maintain a healthy weight, the center works with licensed dietitians who craft meal plans for cancer patients.
Some breast cancer treatments, such as estrogen suppressors, can also contribute to issues like osteoporosis. Licensed physical therapists and massage therapists work with the center to help manage the stress that cancer treatment can have on the body.
At Yale Cancer Center, "our job is to help people figure out how to continue with their lives," says Greenup.
These additional services proved essential for Axtmayer. During her chemotherapy, Axtmayer would be visited by a masseuse who would rub her shoulders and feet during treatment. "I really came to rely on that support," she says.
Axtmayer's brush with breast cancer has left its mark. Along the way, she lost her hair, her ovaries, and partial function in her right arm. Today, Axtmayer continues to take estrogen suppressors and a targeted therapy to reduce the chance of cancer coming back. She will be on this treatment for years.
Still, her life has improved since that first year. "I don't think about it every day," she says. "I'm proud of getting through it."
Smilow Cancer Hospital and Yale Cancer Center were a part of that journey. "I feel really lucky to live so close to Smilow," she says. Now, when she meets with her medical oncologist and breast surgeon, they chat about their lives. "It's such a benefit of the relationships I've built with my physicians."
Looking back, not knowing what the future would hold was one of the hardest parts of her diagnosis, she says. "But once I got into a rhythm and had the support from Smilow, and my family, and my community, it was like, 'Ok, we're going to get through this.'"
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