TESTS FOR BREAST CANCER

Whether youve never had breast cancer and want to increase your odds of early detection,
youve recently been diagnosed, or you are in the midst of treatment and follow-up, you know
that breast cancer and medical tests go hand in hand.
Most breast-cancer-related tests fall into one or more of the following categories:

Screening tests: Screening tests (such as yearly mammograms) are given routinely to
people who appear to be healthy and are not suspected of having breast cancer. Their
purpose is to find breast cancer early, before any symptoms can develop and the cancer
usually is easier to treat.

Diagnostic tests: Diagnostic tests (such as biopsy) are given to people who are
suspected of having breast cancer, either because of symptoms they may be experiencing or
a screening test result. These tests are used to determine whether or not breast cancer is
present and, if so, whether or not it has traveled outside the breast. Diagnostic tests also are
used to gather more information about the cancer to guide decisions about treatment.

Monitoring tests: Once breast cancer is diagnosed, many tests are used during and
after treatment to monitor how well therapies are working. Monitoring tests also may be used
to check for any signs of recurrence.
On the following pages, you can read more about the many tests you may have at different
points in the process of screening, diagnosis, and treatment. The tests are covered in
alphabetical order.
Biopsy
A biopsy is a small operation done to remove tissue from an area of concern in the body. If your
doctor feels anything suspicious in your breast, or sees something suspicious on an imaging
study, he or she will order a biopsy. The tissue sample is examined by a pathologist (a doctor
who specializes in diagnosing disease) to see whether or not cancer cells are present. If cancer
is present, the pathologist can then look at the cancers characteristics. The biopsy will result in
a report that lays out all of the pathologists findings.
Biopsy is usually a simple procedure. In the United States, only about 20% of women who have
biopsies turn out to have cancer. By contrast, in Sweden, where cost accounting is much stricter
and only the most suspicious lesions are biopsied, 80% of biopsies turn out to be cancerous
(malignant).
Biopsy techniques
Different techniques can be used to perform biopsy, and its likely that your surgeon will try to
use the least invasive procedure possible the one that involves the smallest incision and the
least amount of scarring. However, the choice of procedure really depends on your individual
situation. Biopsy can be done by placing a needle through the skin into the breast to remove the
tissue sample. Or, it can involve a minor surgical procedure, in which the surgeon cuts through
the skin to remove some or all of the suspicious tissue.
Fine needle aspiration biopsy
Fine needle aspiration (FNA) is the least invasive method of biopsy and it usually leaves no
scar. You will be lying down for this procedure. First, an injection of local anesthesia is given to
numb the breast. The surgeon or radiologist uses a thin needle with a hollow center to remove a
sample of cells from the suspicious area. In most cases, he or she can feel the lump and guide
the needle to the right place.
In cases where the lump cannot be felt, the surgeon or radiologist may need to use imaging
studies to guide the needle to the right location. This is called ultrasound-guided biopsy when
ultrasound is used, or stereotactic needle biopsy when mammogram is used. With ultrasoundguided biopsy, the doctor will watch the needle on the ultrasound monitor to guide it to the area

of concern. With stereotactic mammography, mammograms are taken from different angles to
pinpoint the location of the breast mass. The doctor then inserts the hollow needle to remove
the cell sample.
Core needle biopsy
Core needle biopsy uses a larger hollow needle than fine needle aspiration does. If you have
this type of biopsy, youll be lying down. After numbing the breast with local anesthesia, the
surgeon or radiologist uses the hollow needle to remove several cylinder-shaped samples of
tissue from the suspicious area. In most cases, the needle is inserted about 3 to 6 times so that
the doctor can get enough samples. Usually core needle biopsy does not leave a scar.
If the lesion cannot be felt through the skin, the surgeon or radiologist can use an image-guided
technique such as ultrasound-guided biopsy or stereotactic needle biopsy. A small metal clip
may be inserted into the breast to mark the site of biopsy in case the tissue proves to be
cancerous and additional surgery is required. This clip is left inside the breast and is not harmful
to the body. If the biopsy leads to more surgery, the clip will be removed at that time.
In addition to offering quick results without significant discomfort and scarring, both fine needle
aspiration and core needle biopsy give you the opportunity to discuss treatment options with
your doctor before having any surgery. In some cases, needle biopsy can be performed right in
the doctors office, unless your doctor needs the help of imaging equipment to guide the biopsy.
However, needle biopsy has a higher risk of a false negative result a result suggesting that
cancer is not present when it really is. This is likely because needle biopsy removes a smaller
amount of tissue than surgical biopsy does and may not pick up the cancer cells. Your doctor
may recommend a surgical biopsy in follow up to, or instead of, a needle biopsy. Together you
can decide what is best for your situation.
Vacuum-assisted breast biopsy
Vacuum-assisted breast biopsy, also known by the brand names Mammotome or MIBB (which
stands for Minimally Invasive Breast Biopsy), is a newer way of performing breast biopsy. Unlike
core needle biopsy, which involves several insertions of a needle through the skin, vacuumassisted biopsy uses a special probe that only has to be inserted once. The procedure also is
able to remove more tissue than core needle biopsy does.
For vacuum-assisted breast biopsy, youll lie face down on an exam table with special round
openings in it, where you place your breasts. First, an injection of local anesthesia is given to
numb the breast. Guided by mammography (stereotactic-guided biopsy) or ultrasound, the
surgeon or radiologist places the probe into the suspicious area of the breast. A vacuum then
draws the tissue into the probe. A rotating cutting device removes a tissue sample and then
carries it through the probe into a collection area. The surgeon or radiologist can then rotate the
probe to take another sample from the suspicious lesion. This can be repeated 8 to 10 times so
that the entire area of concern is thoroughly sampled.
In some cases, a small metal clip is placed into the biopsy site to mark the location, in case a
future biopsy is needed. This clip is left inside the breast and causes no pain or harm. If the
biopsy leads to more surgery, the clip will be removed at that time.
Vacuum-assisted biopsy is becoming more common, but it is still a relatively new procedure. If
you are having this form of biopsy, make sure that the surgeon or radiologist is experienced at
using the equipment.
Incisional biopsy
Incisional biopsy is more like regular surgery. After using local anesthesia to numb the breast
and giving you an injection to make you drowsy, the surgeon uses a scalpel to cut through the
skin to remove a piece of the tissue for examination.
As with needle biopsy, if the surgeon cannot feel the lump or suspicious area, he or she may
need to use mammography or ultrasound to find the right spot. Your surgeon also may use a
procedure called needle wire localization. Guided by either mammography or ultrasound, the
surgeon inserts a small hollow needle through the breast skin into the abnormal area. A small

wire is placed through the needle and into the area of concern. Then the needle is removed.
The doctor can use the wire as a guide in finding the right spot for biopsy.
Your doctor may recommend incisional biopsy if a needle biopsy is inconclusive that is, the
results are unclear or not definite or if the suspicious area is too large to sample easily with a
needle. As with needle biopsy, there is some possibility that incisional biopsy can return a false
negative result. However, you do get the results fairly quickly. Given that it is a surgical
procedure, incisional biopsy is more invasive than needle biopsy, it leaves a scar, and it may
require more time to recover.
Excisional biopsy
Excisional biopsy, the most involved form of biopsy, is surgery to remove the entire area of
suspicious tissue from the breast. In addition to removing the suspected cancer, the surgeon
generally will remove a small rim of normal tissue around it as well, called a margin.
As with incisional biopsy, if the surgeon cannot feel the lump or suspicious area, he or she may
need to use mammography or ultrasound to find the right spot. Your surgeon also may use
needle wire localization to mark the right area for biopsy.
Excisional biopsy is the surest way to establish a definite diagnosis without getting a false
negative result. Also, having the entire lump removed may provide you with some peace of
mind. However, excisional biopsy is more like regular surgery, and it will leave a scar and
require more time to recover. Like incisional biopsy, excisional biopsy is performed with local
anesthesia.
Before your biopsy
Biopsies are not medical emergencies and can be scheduled at your convenience. But for
peace of mind, most people want their biopsies done yesterday. Before proceeding with a
biopsy, be sure to ask your doctor to:

review the results of your mammogram and any other imaging studies with you

show you the area in question

discuss how and why the biopsy will be performed

answer any of your questions

arrange for you to sign required consent forms

tell you when and how you can get the biopsy results
Breast MRI (Magnetic Resonance Imaging)
Unlike a mammogram, which uses x-rays to create images of the breast, breast MRI
uses magnets and radio waves to produce detailed 3-dimensional images of the breast tissue.
Before the test, you may need to have a contrast solution (dye) injected into your arm through
an intravenous line. Because the dye can affect the kidneys, your doctor may perform kidney
function tests before giving you the contrast solution. The solution will help any potentially
cancerous breast tissue show up more clearly. Some people experience temporary discomfort
during the infusion of the contrast solution.
Cancers need to increase their blood supply in order to grow. On a breast MRI, the contrast
tends to become more concentrated in areas of cancer growth, showing up as white areas on
an otherwise dark background. This helps the radiologist determine which areas could possibly
be cancerous. More tests may be needed after breast MRI to confirm whether or not any
suspicious areas are actually cancer.

MRI images showing two discrete areas of abnormali

Larger Version
For the breast MRI, you will need to pull down your hospital gown to your waist or open it in
front to expose your breasts. Then you lie on your stomach on a padded platform with
cushioned openings for your breasts. Each opening is surrounded by a breast coil, which is a
signal receiver that works with the MRI unit to create the images. The platform then slides into
the center of the tube-shaped MRI machine. You wont feel the magnetic field and radio waves
around you, but you will hear a loud thumping sound. You will need to be very still during the
test, which takes around 30 to 45 minutes. If youre claustrophobic, being confined within an
MRI machine for a long period of time can be difficult. Some facilities have an open MRI
machine to avoid this problem, or you may be given a mild sedative.
Because the technology uses strong magnets, it is essential that you remove anything metal
jewelry, snaps, belts, earrings, zippers, etc. before the test. The technologist also will ask you
if you have any metal implanted in your body, such as a pacemaker or artificial joint.
Where to have breast MRI
Its important to have breast MRI done at a facility with:

MRI equipment designed specifically for imaging the breasts. Not all hospitals and
imaging centers have this; instead, many have MRIs used for scanning the head, chest, or

abdomen.
The ability to perform MRI-guided breast biopsy. If the breast MRI reveals an
abnormality, youll want to have an MRI-guided breast biopsy (a procedure to remove any
suspicious tissue for examination) right away. Otherwise, youll need to have a breast MRI
again at another facility that offers an immediate MRI-guided breast biopsy.

If your doctor recommends that you have breast MRI for screening, diagnosis, or follow-up, ask
for help in finding the best place to have the test done. The American College of Radiology is
working on a system for accrediting breast MRI centers, which should make it easier to find
high-quality breast MRI facilities in the future.
Breast Physical Exam
A breast physical exam is a careful manual examination of the breasts by a doctor or
other health professional. This exam can help find lumps that women may miss with their
own self-exams.

While it's true that most lumps are found by women themselves, the abnormality in a
breast can be so difficult to feel that only someone with experience would recognize it.
Lumps, thickening, asymmetry (a difference in appearance between the two breasts)
changes in your breasts that you may not notice or think are normal may be
detected by a health professional who examines many breasts regularly. About 20% of
the time, breast cancers are found only by physical exam and not seen on a

mammogram.
The American Cancer Society recommends that women in their 20s and 30s have
a physical breast exam as part of a periodic (regular) health exam by a health
professional, preferably every 3 years. After age 40, women should have a breast exam

by a health professional every year.

During and after treatment

If you are being treated for breast cancer, your doctor will likely recommend that you
come in for a breast physical exam every 3 to 4 months. Regularly scheduled physical
exams will continue after you finish treatment, gradually decreasing in frequency to once
a year. Work with your doctor to figure out what is best for your situation.

Breast Self-Exam (BSE)

Breast self-exam (BSE), or regularly examining your breasts on your own, can be an important
way to find a breast cancer early, when it's more likely to be treated successfully. Not every
cancer can be found this way, but it is a critical step you can and should take for yourself.
Over the years, there has been some debate over just how valuable BSE is in detecting breast
cancer early and increasing the likelihood of survival. For example, in summer 2008, one study
of nearly 400,000 women in Russia and China reported that breast self-examination does not
reduce breast cancer mortality and may even cause harm by prompting unnecessary biopsies
(removal and examination of suspicious tissue). Because of the ongoing uncertainty raised by
this and other studies, the American Cancer Society has chosen to advise women that BSE is
an optional screening tool.
Breastcancer.org still believes that BSE is a useful and essential screening strategy, especially
when used in combination with regular physical exams by a doctor and mammography. About
20% of the time, breast cancers are found by physical examination rather than by
mammography. We recommend that all women routinely perform breast self-exams as part of
their overall breast cancer screening strategy. Read what Marisa Weiss, M.D., president and
founder of Breastcancer.org, has to say about the July 2008 study of breast self-exam.
Tips for performing BSE
Few women really want to do a breast self-exam, or BSE, and for many the experience is
frustrating you may feel things but not know what they mean. However, the more you
examine your breasts, the more you will learn about them and the easier it will become for you

to tell if something unusual has occurred. Breastcancer.org believes that BSE is an essential
part of taking care of yourself and lowering your risk of breast cancer.
Some tips for BSE:

Try to get in the habit of doing a breast self-examination once a month to familiarize
yourself with how your breasts normally look and feel. Examine yourself several days after
your period ends, when your breasts are least likely to be swollen and tender. If you are no
longer having periods, choose a day that's easy to remember, such as the first or last day of

the month.
Dont panic if you think you feel a lump. Most women have some lumps or lumpy areas
in their breasts all the time. In the United States, only 20% of women who have a suspicious

lump biopsied turn out to have breast cancer.

Breasts tend to have different neighborhoods. The upper, outer area near your
armpit tends to have the most prominent lumps and bumps. The lower half of your breast
can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of
large

grains.

Another

part

might

feel

like

lumpy

bowl

of

oatmeal.

Whats important is that you get to know the look and feel of YOUR breasts' various
neighborhoods. Does something stand out as different from the rest (like a rock on a sandy
beach)? Has anything changed? Bring to the attention of your doctor any changes in your

breasts that last over a full month's cycle OR seem to get worse or more obvious over time.
You may want to start a journal where you record the findings of your breast self-exams.
This can be like a small map of your breasts, with notes about where you feel lumps or
irregularities. Especially in the beginning, this may help you remember, from month to month,
what is normal for your breasts. It is not unusual for lumps to appear at certain times of the
month, but then disappear, as your body changes with the menstrual cycle (if you are still
menstruating). Only changes that last beyond one full cycle, or seem to get bigger or more
prominent in some way, need your doctor's attention.

Digital Tomosynthesis

It takes multiple x-ray pictures of each breast from many angles. The breast is
positioned the same way it is in a conventional mammogram, but only a little pressure is
applied just enough to keep the breast in a stable position during the procedure. The
x-ray tube moves in an arc around the breast while 11 images are taken during a 7second examination. Then the information is sent to a computer, where it is assembled

to produce clear, highly focused 3-dimensional images throughout the breast.

Early results with digital tomosynthesis are promising. Researchers believe that this new
breast imaging technique will make breast cancers easier to see in dense breast tissue
and will make breast screening more comfortable.

Mammograms
Page last modified on: April 28, 2009

Mammograms are probably the most important tool doctors have not only to screen for
breast cancer, but also to diagnose, evaluate, and follow people whove had breast cancer. Safe
and reasonably accurate, a mammogram is an x-ray photograph of the breast. The technique
has been in use for about 40 years.
Screening mammograms are typically done every year to check the breasts for any early
signs of breast cancer. Diagnostic mammograms are different from screening mammograms in
that they focus on getting more information about a specific area (or areas) of concern
usually due to a suspicious screening mammogram or a suspicious lump. Diagnostic
mammograms take more pictures than screening mammograms do. A mammography
technician and a radiologist would coordinate to get the images your doctor needs to address
that concern. The technician may need to magnify a suspicious area to produce a more detailed
picture that will help your doctor make the diagnosis.
Molecular Breast Imaging
Molecular breasting imaging (MBI) is an experimental method for detecting breast
cancer. The technique is also known as a Miraluma (pronounced mee-ra-LOO-ma) test,
sestamibi (pronounced ses-ta-MI-bee), scintimammography, or breast specific gamma imaging.
MBI uses a radioactive tracer that lights up any areas of cancer inside the breast. This tracer is
injected into the body through a vein in the arm. Breast cancer cells tend to take up the
radioactive substance much more than normal cells do. A special camera called a nuclear
medicine scanner then scans the breast, looking for any areas where the radioactive substance
is concentrated.
MBI is still being tested, but it appears to hold promise for detecting breast cancer in
women who are at higher-than-average risk for the disease and have dense breasts. When
women have a lot of dense breast tissue, tumors become hard to spot on mammograms. On

mammograms, fatty breast tissue looks dark, but dense tissue is light, like tumors, so it can hide
any cancerous areas that may be present.
A 2008 Mayo Clinic study of 940 high-risk women with dense breasts found that MBI was better
than mammography at finding tumors in the breast. However, one drawback of MBI is that it
involves a much greater dose of radiation than mammograms do. A new study plans to compare
MBI to MRI (magnetic resonance imaging), which is often the preferred tool for evaluating
women who are considered high-risk and have dense breasts. However, MRI is more expensive
than MBI and often can return false positive results, leading to unnecessary biopsies.
If you are at average risk for breast cancer and do not have dense breasts, mammography
remains the screening tool of choice for you. Many doctors believe that, for most women,
mammography is better than MBI at detecting breast tumors when they are small and generally
easier to treat.
Oncotype DX
The Oncotype DX test may be able to help you and your doctor determine whether or not the
cancer is:

likely to recur

likely to benefit from chemotherapy

How does Oncotype DX work?

Oncotype DX is known as a genomic assay it looks at groups of genes and how
active they are, which can influence how a cancer is likely to grow and respond to treatment. A
genomic test is different from a genetic test. A genetic test looks for mutations (unusual
changes) in genes that are inherited, or passed from one generation to the next.
The Oncotype DX test uses a sample of your breast tumor tissue to analyze the activity of 21
different genes. Genes control the behavior and activities of all cells, including cancer cells.
When cells are behaving abnormally, this can often be traced back to unusual activity by certain
genes.
Looking at this set of 21 genes can provide specific information on:

the likelihood that the breast cancer will return

whether you are likely to benefit from commonly used chemotherapy regimens

So, Oncotype DX is both a prognostic test, since it provides more information about how likely
(or unlikely) the breast cancer is to come back, and a predictive test, since it predicts the
likelihood of benefit from chemotherapy treatment. Studies have shown that Oncotype DX is
useful for both purposes. The American Society for Clinical Oncology and the National
Comprehensive Cancer Network now include the Oncotype DX test in their treatment guidelines
for early breast cancer.
If you think you are eligible, talk to your doctor about having the Oncotype DX test. The
pathology lab that originally preserved and examined your tumor tissue would need to send out
samples toGenomic Health, the company that performs the test. The test involves extracting

RNA (part of the genomic makeup of the cells) from the tumor sample and analyzing it to
determine the level of activity or expression of each of 21 genes.
Based on this analysis, Oncotype DX assigns the breast cancer a Recurrence Score. This score
is a number between 0 and 100 that corresponds to a specific likelihood of experiencing breast
cancer recurrence within 10 years of your initial diagnosis. The lower your score, the less likely
the cancer is to recur. The higher the score, the more likely the cancer is to recur.
PET Scans
SPoT-Light HER2 CISH
Thermography
Ultrasound
Blood Cell Counts
Blood Chemistries
Blood Marker Tests
Bone Scans
CT (CAT) Scans
Chest X-Rays
Ductal Lavage
FISH Test (Fluorescence In Situ Hybridization)
IHC Tests (ImmunoHistoChemistry)

http://www.breastcancer.org/symptoms/testing/types/
http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp#how

MEDICATIONS FOR BREAST CANCER

Abraxane IV
This medication is used to treat advanced breast cancer. Paclitaxel is a cancer chemotherapy
drug that works by slowing or stopping cancer cell growth.

Aredia IV
This medication is used to treat high blood calcium levels (hypercalcemia) that may occur with
cancer. Pamidronate is also used to treat a certain type of bone disease (Paget's disease) and
bone problems that may occur with certain cancers (breast cancer, multiple myeloma).
Pamidronate belongs to a class of drugs known as bisphosphonates. It works by reducing the
amount of calcium released from your bones into your blood.

Arimidex Oral
This medication is used to treat breast cancer in women who have gone through "the change of
life" (menopause). Anastrozole works by lowering estrogen hormone levels to help shrink
tumors and slow their growth.

Aromasin Oral
This medication is used to treat certain types of breast cancer (such as hormone-receptorpositive breast cancer) in women after menopause. Exemestane is also used to help prevent
the cancer from returning. Some breast cancers are made to grow faster by a natural hormone
called estrogen. Exemestane decreases the amount of estrogen the body makes and helps to
slow or reverse the growth of these breast cancers.

Cytoxan Oral
Cyclophosphamide is used to treat various types of cancer. It is a chemotherapy drug that works
by slowing or stopping cell growth.

Epirubicin IV
Epirubicin is used to treat breast cancer. It belongs to a class of drugs known as anthracyclines
and works by slowing or stopping the growth of cancer cells.

Faslodex IM
Fulvestrant is used to treat breast cancer that has spread to other areas of the body in women
who have gone through "the change of life" (menopause). It is used in patients who have not
responded well to other medications (e.g., tamoxifen). Breast cancer cells need the hormone
estrogen in order to grow. Fulvestrant works by blocking the effect of estrogen, slowing tumor
cell growth.

Femara Oral

This medication is used to treat certain types of breast cancer (such as hormone-receptorpositive breast cancer) in women after menopause. Letrozole is also used to help prevent the
cancer from returning. Some breast cancers are made to grow faster by a natural hormone
called estrogen. Letrozole decreases the amount of estrogen the body makes and helps to slow
or reverse the growth of these breast cancers.

Gemzar IV
Gemcitabine is used alone or with other treatments/medications to treat certain types of cancer
(including breast, lung, ovarian, pancreatic). It is a chemotherapy drug that works by slowing or
stopping the growth of cancer cells.

Herceptin IV
Trastuzumab is used alone or with other medications to treat certain types of breast cancer
(tumors that produce more than the normal amount of a certain substance called HER2 protein).

Neulasta SubQ
Pegfilgrastim is a long-acting form of the drug, filgrastim. These drugs, called colony-stimulating
factors, are used to help stimulate the bone marrow to make white blood cells in patients who
are not able to produce enough white blood cells on their own.

Neupogen Inj
This medication stimulates the blood system (bone marrow) to make white blood cells, helping
you fight infections. This medication is given to those whose ability to make white blood cells
has been reduced. Filgrastim (also known as G-CSF, or granulocyte colony stimulating factor) is
a man-made version of a certain natural substance found in the body. It is produced using a
certain bacteria.

Procrit Inj
This medication is used to treat anemia (low red blood cell count) in people with long-term
serious kidney disease (chronic renal failure), people receiving zidovudine to treat HIV, and
people receiving chemotherapy for certain types of cancer (non-myeloid cancers). It may also
be used in anemic patients to reduce the need for blood transfusions before certain planned
surgeries that have a high risk of blood loss (usually combined with the "blood thinner" warfarin).
Epoetin alfa helps to reverse anemia and improves your energy and activity level. It works by
signaling the bone marrow to make more red blood cells. This medication is very similar to the
natural substance in your body (erythropoietin) that prevents anemia.

Tamoxifen Oral
Tamoxifen is used to treat breast cancer that has spread to other parts of the body (metastatic
breast cancer), to treat breast cancer in certain patients after surgery and radiation therapy, and
to reduce the chances of breast cancer in high-risk patients.

Taxotere IV

This medication is used to treat certain types of cancer (e.g., breast, lung, and prostate cancer).
Docetaxel is a member of a family of drugs called taxanes. This drug works by slowing cell
growth.

Toremifene Oral
Toremifene is used in postmenopausal women to treat breast cancer that has spread to other
parts of the body (metastatic breast cancer). It is usually used to treat cancer that needs
estrogen, a female hormone, in order to grow (estrogen-receptor positive). Toremifene is a
nonsteroidal antiestrogen that blocks the effects of estrogen in the breast tissue, thereby
slowing or stopping the growth of cancer.

Vinorelbine IV
Vinorelbine is used to treat various types of cancer. It is a chemotherapy drug that works by
slowing or stopping cancer cell growth.

Xeloda Oral
Capecitabine is used alone or with other treatments/medications to treat certain types of cancer
(e.g., of the breast, colon, rectum). It works by slowing or stopping cancer cell growth and by
decreasing tumor size.

Zoladex SubQ
Goserelin is used in men to treat prostate cancer. It is used in women to treat certain breast
cancers or a certain uterus disorder (endometriosis). It is also used in women to thin the lining of
the uterus (endometrium) in preparation for a procedure to treat abnormal uterine bleeding.

Zometa IV
This medication is used to treat high blood calcium levels (hypercalcemia) that may occur with
cancer. Zoledronic acid is also used to treat bone problems that may occur with a certain type of
cancer (multiple myeloma) and other types of cancer. Zoledronic acid belongs to a class of
drugs known as bisphosphonates. It works by reducing the amount of calcium released from
your bones into your blood.

Ixempra IV
This medication is used alone or with other medications to treat advanced cancer. Ixabepilone is
a chemotherapy drug that works to slow or stop cancer cell growth.

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