Understanding Breast Cancer
Signs and Symptoms
– Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all.
– In some cases, a lump may be too small for you to feel or to cause any unusual changes you can notice on your own. Often, an abnormal area turns up on a screening mammogram (X-ray of the breast), which leads to further testing.
– In other cases, however, the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender, soft, and rounded.
– It is important to have anything unusual checked by your doctor.
– Any of the following unusual changes in the breast can be a symptom of breast cancer:
- swelling of all or part of the breast
- skin irritation or dimpling
- breast pain
- nipple pain or the nipple turning inward
- redness, scaliness, or thickening of the nipple or breast skin
- a nipple discharge other than breast milk
- a lump in the underarm area
– These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. Again, it is important to get any breast changes checked out promptly by a doctor.
– Breast self-exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. If you are over 40 or at a high risk of breast cancer, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it.
– The actual process of diagnosis can take weeks and involve many kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique “big picture,” you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.
Screening & Testing
Medical tests are important for detecting breast cancer.
o Breast Cancer Tests: Screening, Diagnosis, and Monitoring
o Test Results and Medical Records
o Genetic Testing
o Types of Breast Cancer
Mammography: Benefits, Risks, What You Need to Know
– Mammograms do not prevent breast cancer, but they can save lives by finding breast cancer as early as possible.
– Finding breast cancers early with mammography has also meant that many more women being treated for breast cancer are able to keep their breasts. When caught early, localized cancers can be removed without resorting to breast removal (mastectomy).
– The main risk of mammograms is that they are not perfect. Normal breast tissue can hide a breast cancer so that it does not show up on the mammogram. This is called a false negative. And mammography can identify an abnormality that looks like a cancer but turns out to be normal. This “false alarm” is called a false positive. Besides worrying about being diagnosed with breast cancer, a false positive means more tests and follow-up visits, which can be stressful. To make up for these limitations, more than mammography is often needed. Women also need to practice breast self-examination, get regular breast examinations by an experienced health care professional, and, in some cases, also get another form of breast imaging, such as breast MRI or ultrasound.
– Some women wonder about the risks of radiation exposure due to mammography. Modern-day mammography only involves a tiny amount of radiation — even less than a standard chest X-ray.
o When you have a mammogram, a skilled technologist positions and compresses your breast between two clear plates. The plates are attached to a highly specialized camera, which takes two pictures of the breast from two directions. Then the technologist repeats the technique on the opposite breast. For some women, more than two pictures may be needed to include as much tissue as possible.
o Mammography can be painful for some women, but for most it is mildly uncomfortable, and the sensation lasts for just a few seconds. Compressing the breast is necessary to flatten and reduce the thickness of the breast. The X-ray beam should penetrate as few layers of overlapping tissues as possible. From start to finish, the entire procedure takes about 20 minutes. A diagnostic mammogram generally takes more time than a screening mammogram because it takes more pictures from more angles.
Breast Magnetic Resonance Imaging (MRI)
A breast MRI uses magnets and radio waves to take pictures of the breast. MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.
o Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider.
o Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.
Risks of Screening
– Harms can include false positive test results, when a doctor sees something that looks like cancer but is not. This can lead to more tests, which can be expensive, invasive, time-consuming, and may cause anxiety.
– Tests also can lead to over diagnosis, when doctors find a cancer that would not have gone on to cause symptoms or problems, or even may go away on its own. Treatment of these cancers is called over treatment. Over treatment can include treatments recommended for breast cancer, such as surgery or radiation therapy.
– Mammograms may also miss some cancers, called false negative test results, which may delay finding a cancer and getting treatment.
Types of Breast Cancer
Ductal Carcinoma in Situ (DCIS)
o Ductal carcinoma in situ (DCIS) is characterized by cancerous cells that are confined to the lining of the milk ducts and have not spread through the duct walls into surrounding breast tissue. If ductal carcinoma in situ lesions is left untreated, over time cancer cells may break through the duct and spread to nearby tissue, becoming an invasive breast cancer.
o DCIS is the most common type of noninvasive breast cancer, with about 60,000 new cases diagnosed in the United States each year. About one in every five new breast cancer cases is ductal carcinoma in situ.
o DCIS is divided into several subtypes, mainly according to the appearance of the tumor. These subtypes include micropapillary, papillary, solid, cribriform and comedo.
o Women with ductal carcinoma in situ are typically at higher risk for seeing their cancer return after treatment, although the chance of a recurrence is less than 30 percent. Most recurrences occur within five to 10 years after the initial diagnosis and may be invasive or noninvasive. DCIS also carries a heightened risk for developing a new breast cancer in the other breast. A recurrence of ductal carcinoma in situ will require additional treatment.
o The type of therapy selected may affect the likelihood of recurrence. Treating ductal carcinoma in situ with a lumpectomy (breast-conserving surgery) without radiation therapy carries a 25 percent to 35 percent chance of recurrence. Adding radiation therapy to the treatment decreases this risk to approximately 15 percent. Currently, the long-term survival rate for women with ductal carcinoma in situ is nearly 100 percent.
Invasive Ductal Carcinoma (IDC)
o Invasive ductal carcinoma (IDC) begins in the milk ducts and spreads to the fatty tissue of the breast outside the duct. IDC accounts for about 80 percent of invasive breast cancers.
o Invasive ductal carcinoma treatment options: Surgery typically is the first treatment for invasive ductal breast cancer. The goal of this treatment is to remove the cancer from the breast with a lumpectomy or mastectomy. The type of surgery recommended will depend on factors such as the location of the tumor, the size of the cancer and whether more than one area in the breast has been affected. For patients with ductal carcinoma, long-term systemic treatment with tamoxifen is recommended to prevent recurrence.
o Four types of invasive ductal carcinoma are less common:
- Medullary ductal carcinoma: This type of cancer is rare and accounts for only 3 percent to 5 percent of breast cancers. It is called “medullary” because under a microscope, it resembles part of the brain called the medulla. Medullary carcinoma may occur at any age, but it typically affects women in their late 40s and early 50s. Medullary carcinoma is more common in women who have a BRCA1 gene mutation. Medullary tumors are often “triple-negative,” which means they test negative for estrogen and progesterone receptors and for the HER2 protein. Medullary tumors are less likely to involve the lymph nodes, are more responsive to treatment, and may have a better prognosis than more common types of invasive ductal cancer.
- Surgery is typically the first-line treatment for medullary ductal carcinoma. A lumpectomy or mastectomy may be performed, depending on the location of the tumor. Chemotherapy and radiation therapy may also be used.
- Mucinous ductal carcinoma: This type of breast cancer accounts for less than 2 percent of breast cancers. Microscopic evaluations reveal that these cancer cells are surrounded by mucus. Like other types of invasive ductal cancer, mucinous ductal carcinoma begins in the milk duct of the breast before spreading to the tissues around the duct. Sometimes called colloid carcinoma, this cancer tends to affect women after they have gone through menopause. Mucinous cells are typically positive for estrogen and/or progesterone receptors and negative for the HER2 receptor.
- Surgery is typically recommended to treat mucinous ductal carcinoma. A lumpectomy or mastectomy may be performed, depending on the size and location of the tumor. Adjuvant therapy, such as radiation therapy, hormonal therapy, and chemotherapy, may also be required. Most mucinous carcinomas test negative for receptors for the protein HER2, so they are not typically treated with trastuzumab (Herceptin®).
- Papillary ductal carcinoma: This cancer is rare, accounting for less than 1 percent of invasive breast cancers. In most cases, these types of tumors are diagnosed in older, postmenopausal women. Under a microscope, these cells resemble tiny fingers or papules. Papillary breast cancers are typically small, and test positive for the estrogen and/or progesterone receptors and negative for the HER2 receptor. Most papillary carcinomas are invasive and are treated like invasive ductal carcinoma.
- Surgery is typically the first-line treatment for papillary breast cancer. A lumpectomy or mastectomy may be performed, depending on the size and location of the tumor. After surgery, adjuvant therapy may be required and may include radiation, chemotherapy and/or hormone therapy.
- Tubular ductal carcinoma: Another rare type of IDC, this cancer makes up less than 2 percent of breast cancer diagnoses. Like other types of invasive ductal cancer, tubular breast cancer originates in the milk duct, then spreads to tissues around the duct. Tubular ductal carcinoma cells form tube-shaped structures. Tubular ductal carcinoma is more common in women older than 50. Tubular breast cancers typically test positive for the estrogen and/or progesterone receptors and negative for the HER2 receptor.
- Treatment options for tubular ductal carcinoma depend on the aggressiveness of the cancer and its stage. Treatment often consists of surgery, which includes a lumpectomy or mastectomy, and additional (adjuvant) therapy, which may include chemotherapy, radiation and/or hormone therapy.
Invasive Lobular Carcinoma (ILC)
§ Lobular carcinoma begins in the lobes or lobules (glands that make breast milk). The lobules are connected to the ducts, which carry breast milk to the nipple.
§ Lobular carcinoma in situ (LCIS): It begins in the lobules and does not typically spread through the wall of the lobules to the surrounding breast tissue or other parts of the body. While these abnormal cells seldom become invasive cancer, their presence indicates an increased risk of developing breast cancer later. About 25 percent of women with LCIS will develop breast cancer at some point in their lifetime. This subsequent breast cancer may occur in either breast and may appear in the lobules or in the ducts.
§ Because LCIS is not actually cancer, treatment may not be recommended. If you are diagnosed with lobular carcinoma, you may want to discuss more frequent breast cancer screening with your doctor. Increasing surveillance may help ensure that any subsequent breast cancer is detected in its earliest, most treatable stages.
§ Invasive lobular carcinoma (ILC): It starts in the lobules, invades nearby tissue, and can spread (metastasize) to distant parts of the body. This breast cancer type accounts for about one out of every 10 invasive breast cancers.
§ The treatment options for invasive lobular carcinoma include localized approaches such as surgery and radiation therapy that treat the tumor and the surrounding areas, as well as systemic treatments such as chemotherapy and hormonal or targeted therapies that travel throughout the body to destroy cancer cells that may have spread from the original tumor.
Inflammatory Breast Cancer
– Unlike other breast cancers, inflammatory breast cancer (IBC) rarely causes breast lumps and may not appear on a mammogram. Inflammatory breast cancer symptoms include:
- Red, swollen, itchy breast that is tender to the touch.
- The surface of the breast may take on a ridged or pitted appearance, like an orange peel (often called peau d’orange)
- Heaviness, burning, or aching in one breast
- One breast is visibly larger than the other
- Inverted nipple (facing inward)
- No mass is felt with a breast self-exam
- Swollen lymph nodes under the arm and/or above the collarbone
- Symptoms unresolved after a course of antibiotics
– Unlike other breast cancers, inflammatory breast cancer usually does not cause a distinct lump in the breast. Therefore, a breast self-exam, clinical breast exam, or even a mammogram may not detect inflammatory breast cancer. Ultrasounds may also miss inflammatory breast cancer. However, the changes to the surface of the breast caused by inflammatory breast cancer can be seen with the naked eye.
– Symptoms of inflammatory breast cancer can develop rapidly, and the disease can progress quickly. Any sudden changes in the texture or appearance of the breast should be reported to your doctor immediately.
For women who are pregnant, or breast-feeding, redness, swelling, itchiness, and soreness are often signs of a breast infection such as mastitis, which is treatable with antibiotics. If you are not pregnant or nursing and you develop these symptoms, your doctor should test for inflammatory breast cancer.
Lobular Carcinoma in Situ (LCIS)
Lobular carcinoma in situ (LCIS) does not cause symptoms and cannot be seen with a mammogram. This condition is usually found when a doctor is doing a breast biopsy for another reason, such as to investigate an unrelated breast lump. If a person has LCIS, the breast cells will appear abnormal under a microscope.
Male Breast Cancer
– Male breast cancer symptoms can be like those experienced by women and may include:
- Lumps in the breast, usually painless
- Thickening of the breast
- Changes to the nipple or breast skin, such as dimpling, puckering or redness
- Discharge of fluid from the nipples
o Male breast cancer occurs when malignant cells form in the tissues of the breast. Any man can develop breast cancer, but it is most common among men who are 60 to 70 years old. About 1 percent of all breast cancers occur in men. About 2,000 men are diagnosed with breast cancer each year.
o Many men may be surprised to learn they can get breast cancer. Men have breast tissue that develops in the same way as breast tissue in women and is susceptible to cancer cells in the same way. In girls, hormonal changes at puberty cause female breasts to grow. In boys, hormones made by the testicles prevent the breasts from growing. Breast cancer in men is uncommon because male breasts have ducts that are less developed and are not exposed to growth-promoting female hormones.
o Just like in women, breast cancer in men may begin in the ducts and spread to surrounding cells. More rarely, men may develop inflammatory breast cancer or Paget’s disease of the breast, if a tumor that began in a duct beneath the nipple moves to the surface. Male breasts have few if any lobules, and so lobular carcinoma rarely, if ever, occurs in men.
o Men should also be aware of gynecomastia, the most common male breast disorder. Gynecomastia is not a form of cancer but does cause a growth under the nipple or areola that can be felt, and sometimes seen. Gynecomastia is common in teenage boys due to hormonal changes during adolescence, and in older men, due to late-life hormonal shifts. Certain medications can cause gynecomastia, as can some conditions, such as Klinefelter syndrome. Rarely, gynecomastia is due to a tumor. Any such lumps should be examined by your doctor.
o Male breast cancer treatment typically consists of mastectomy, followed by radiation therapy, chemotherapy, hormone therapy and/or targeted therapy. Since many male breast cancers are hormone receptor-positive, the drug tamoxifen (Nolvadex®) is often a standard therapy for male breast cancer.
o For men, whose cancer has not spread to the lymph nodes, adjuvant therapy (therapy given after surgery) is generally the same as for a woman with breast cancer. For men, whose cancer has spread to the lymph nodes, adjuvant therapy may include chemotherapy plus tamoxifen and/or other hormone therapy. Treatment for men with cancer that has spread to other parts of the body may include hormone therapy and/or chemotherapy.
Molecular Subtypes of Breast Cancer
– The most common molecular subset of breast cancer is defined by its ability to respond to the female hormone, estrogen. Genomic research has led to more detailed ways to classify breast cancers, based on their genes and proteins, by dividing them into four main molecular subtypes: HER2, luminal A, luminal B, and triple negative.
- One in five invasive breast cancers is HER2-positive, making this one of the more common breast cancer subtypes in the United States. HER2-positive cancers are ER- and PR-negative and human epidermal growth factor receptor 2 (HER2)-positive.
- HER2-positive breast cancer cells carry too many copies of the HER2 gene, which makes HER2-protein receptors, found on breast cells. When they work normally, HER2 receptors control how a healthy breast cell grows, divides, and repairs itself. When they proliferate, the receptors tell the cells to divide and grow rapidly and without control. That is because their cells absorb too much of a substance called human epidermal growth factor 2, which energizes cell growth. Doctors often test breast cancer tissue for excess HER2-positive genes to determine whether the patient may benefit from targeted therapy options, which are designed to block HER2 from energizing cancer cell growth.
- Symptoms of HER2-positive breast cancer are like those of other breast cancer types. They include a lump in the breast, changes to the breast’s shape, pain, swelling and abnormal discharge.
- Depending on the cancer’s stage, treatment options for HER2-positive breast cancer may include a combination of surgery, radiation therapy, chemotherapy and/or administration of a targeted therapy such as the immune monoclonal antibody, trastuzumab (Herceptin®). Learn more about advanced treatments for breast cancer.
- Luminal A is the most common subtype for every race and age. These tumors tend to be estrogen receptor (ER)-positive and progesterone receptor (PR)-positive and are typically slow growing. Treatment typically involves hormonal therapy.
- § Luminal B includes tumors that are estrogen receptor positive, progesterone receptor negative and HER2 positive. These tumors tend to grow more quickly than luminal A tumors. Luminal B breast cancers are likely to benefit from chemotherapy and may benefit from hormone therapy and treatments targeting the HER2 receptor.
Triple-negative breast cancer
- What is triple-negative breast cancer? In this type of cancer, the cells do not contain receptors for estrogen, progesterone or HER2. This type of breast cancer is usually invasive and usually begins in the breast ducts.
- Healthy breast cells contain receptors for the hormone’s estrogen and progesterone. They also contain receptors for a protein called HER2, which stimulates normal cell growth. About two out of three women with breast cancer have cells that contain receptors for estrogen and progesterone, and about 20 percent to 30 percent of breast cancers have too many HER2 receptors.
- Breast cancer that is estrogen receptor (ER)- and progesterone receptor (PR)-positive can be treated with hormone therapy. Breast cancer with excess amounts of HER2 can be treated with anti-HER2 targeted therapy drugs such as trastuzumab.
- In women with triple-negative breast cancer, the malignant cells do not contain receptors for estrogen, progesterone or HER2. Breast cancer that is ER-, PR- and HER2-negative cannot be treated with hormone therapy or medications that work by blocking HER2, such as trastuzumab.
- Fortunately, triple-negative breast cancer can be treated with other drugs, such as chemotherapy, radiation therapy and non-HER2 targeted therapy.
Angiosarcoma of the Breast
– Angiosarcoma is rare cancer that starts in the cells that line blood vessels or lymph vessels. Many times, it is a complication of previous radiation treatment to the breast. It can happen 8-10 years after getting radiation treatment to the breast.
Signs and symptoms of angiosarcoma
– Angiosarcoma can cause skin changes like purple colored nodules and/or a lump in the breast. It can also occur in the affected arms of women with lymphedema, but this is not common. (Lymphedema is swelling that can develop after surgery or radiation therapy to treat breast cancer.)
How is angiosarcoma of the breast diagnosed?
– One or more of the following imaging tests may be done to check for breast changes:
- Diagnostic mammogram
- Breast ultrasound
- Breast MRI (magnetic resonance imaging) scan
– Angiosarcoma is diagnosed by a biopsy, removing a small piece of the breast tissue, and looking at it in the lab. Only a biopsy can tell for sure that it is cancer.
– Angiosarcomas tend to grow and spread quickly. Treatment usually includes surgery to remove the breast (mastectomy). The axillary lymph nodes are typically not removed.
Paget’s Disease of the Nipple
o Paget’s disease of the breast is a form of breast cancer that causes distinct skin changes on the nipple. A rare disease, accounting for fewer than 3 percent of all breast cancers, it is named for Sir James Paget, the English surgeon who first documented the condition in 1874. Under a microscope, Paget’s cells look very different from normal cells, and divide rapidly. About half of the cells test positive for estrogen and progesterone receptors, and most test positive for the HER2 protein. Although women with Paget’s disease of the breast sometimes have tumors inside the breast tissue, its most noticeable symptoms involve changes to the skin of the nipple or areola (the darker, circular area around the nipple of the breast), creating oozing or the appearance of eczema. The cancer is typically diagnosed with a biopsy of the tissue, sometimes followed by a mammogram, sonogram, or MRI to confirm the diagnosis. Paget’s disease of the breast is not related in any medical way to other conditions named after Sir James Paget, such as Paget’s disease of the bone.
o The main symptoms of Paget’s disease of the breast are superficial skin changes, limited to the nipple or areola, that are sometimes mistakenly dismissed as innocuous. Those symptoms include:
- A skin rash on the nipple or areola, resembling eczema, with the skin developing flakiness, redness, or itchiness
- Discharge from the nipple
- A burning, painful or tingling sensation, especially in advanced stages of the disease
- Nipple changes, such as inverted nipples
- Changes to the breast, such as a lump, redness, oozing, crustiness, or a sore that does not heal
o The primary treatment for Paget’s disease of the breast is most often the surgical removal of the tumor. Cancers that are diagnosed in the early stages may be treated with breast-conserving lumpectomy, while more advanced malignancies may require a mastectomy.
o As with other breast cancers, your care team may recommend chemotherapy, radiation therapy or other treatments for Paget’s disease of the breast. Learn more about advanced treatments for breast cancer.
o In papillary carcinoma, the cancer cells are arranged in finger-like projections, or papules. Under a microscope, the cells appear fern-like.
o Papillary carcinoma is a rare type of breast cancer, accounting for about three percent of all breast cancers. Papillary carcinoma typically has a better prognosis than other, more common breast cancers.
o The primary difference between papillary carcinoma and other types of breast cancer is that the cancer cells are arranged in finger-like projections, or papules. Under a microscope, the cells appear fern-like. Sometimes, the cancer cells are very small in size, in which case the cancer may be called micropapillary.
o Most papillary carcinomas are invasive and are treated like invasive ductal carcinoma. However, invasive papillary carcinoma usually has a better prognosis than other invasive breast cancer. Most often, invasive papillary carcinoma occurs after the development of noninvasive papillary carcinoma.
o Papillary carcinoma may also be detected when it is still noninvasive. Noninvasive papillary carcinoma is usually considered a variety of ductal carcinoma in situ (DCIS). In its earliest stages, when the cancer cells are just beginning to affect the ducts, this disease may be referred to as infiltrating papillary carcinoma.
o Treatment for papillary carcinoma often consists of a combination of surgery, radiation, chemotherapy, hormone therapy and/or therapy that targets the HER2 protein.
Metastatic Breast Cancer
– Metastatic breast cancer symptoms depend on the part of the body to which the cancer has spread and its stage. Sometimes, metastatic disease may not cause any symptoms.
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the bones are affected, symptoms may include pain, fractures, constipation, or decreased alertness due to high calcium levels.
- If tumors form in the lungs, symptoms may include shortness of breath or difficulty breathing, coughing, chest wall pain or extreme fatigue.
- If the liver is affected, symptoms may include nausea, extreme fatigue, increased abdominal girth, swelling of the feet and hands due to fluid collection and yellowing or itchy skin.
- If breast cancer spreads to the brain or spinal cord and forms tumors, symptoms may include pain, confusion, memory loss, headache, blurred or double vision, difficulty with speech, difficulty with movement or seizures.
Breast Cancer Staging
– If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment you need.
– What is stage 0 breast cancer?
o Also called carcinoma in situ; stage 0 is the earliest breast cancer stage. At stage 0, the breast mass is noninvasive, and there is no indication that the tumor cells have spread to other parts of the breast or other parts of the body. Often, stage 0 is considered a precancerous condition that typically requires close observation, but not treatment.
o Stage 0 breast cancer is difficult to detect. There may not be a lump that can be felt during a self-examination, and there may be no other symptoms. However, breast self-exams and routine screening are always important and can often lead to early diagnosis when the cancer is most treatable. Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.
o There are two types of stage 0 breast cancer:
- Ductal carcinoma in situ (DCIS) occurs when breast cancer cells develop in the breast ducts. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings. DCIS can become invasive, so early treatment can be important.
- Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. These cells are not cancerous, and this condition rarely becomes invasive cancer. However, women who develop LCIS may be at increased risk for developing breast cancer in the future. For women who develop LCIS, the risk of getting an invasive cancer is 20 percent to 25 percent over 15 years after the initial diagnosis.
– What is stage I (stage 1) breast cancer?
o This breast cancer is the earliest stage of invasive breast cancer. In stage I, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.
o Because a stage I tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis when the cancer is most treatable.
o Stage I breast cancer is divided into two categories:
- Stage IA (Stage1A): The tumor measures 2 cm or smaller (about the size of a pea or shelled peanut) and has not spread outside the breast.
- Stage IB (Stage1B): Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
o The survival rate for stage IA breast cancer may be slightly higher than for stage IB. However, all women with stage I breast cancer are considered to have a good prognosis.
o At stage I, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage I breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N0: Usually, cancer has not spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
– What is stage II (stage 2) breast cancer?
o Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage II breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage I disease. However, stage II means the cancer has not spread to a distant part of the body.
o At stage II, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis when the cancer is most treatable.
o Stage II breast cancer is divided into two categories:
- Stage IIA (Stage 2A): One of the following is true:
- There is no tumor within the breast, but cancer has spread to the axillary (underarm) lymph nodes, or
- The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
- The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.
- Stage IIB (Stage 2B): One of the following is true:
- The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
- The tumor is larger than 5 cm, but cancer has not spread to the axillary lymph nodes.
- The survival rate for stage IIA breast cancer may be slightly higher than for stage IIB. However, all women with stage II breast cancer are considered to have a good prognosis.
o At stage II, TNM designations help describe the extent of the disease. Most commonly, stage II breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N1: Cancer has spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
– What is stage III (stage 3) breast cancer?
o Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage III breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary (underarm) lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
o Stage III breast cancer is divided into three categories:
- Stage IIIA (Stage 3A): One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breastbone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
- Stage IIIB (Stage 3B): The tumor may be any size, and the cancer:
- Has spread to the chest wall and/or skin of the breast, and
- May have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
- Cancer that has spread to the skin of the breast is inflammatory breast cancer.
- Stage IIIC (Stage 3C):
- There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or skin of the breast.
- Cancer cells are present in lymph nodes above or below the collarbone.
- Cancer cells may have spread to axillary lymph nodes or lymph nodes near the breastbone.
- Cancer that has spread to the skin of the breast is inflammatory breast cancer.
- Stage IIIC breast cancer may be operable or inoperable
o Operable stage IIIC: The cancer is found in 10 or more axillary lymph nodes, or is in lymph nodes below the collarbone, or is in axillary lymph nodes and lymph nodes near the breastbone.
o Inoperable stage IIIC: The cancer has spread to the lymph nodes above the collarbone.
o The survival rate for stage IIIA breast cancer may be slightly higher than for stage 3B, and the survival rate for stage IIIB may be slightly higher than for stage IIIC. However, all women diagnosed with stage III breast cancer have several promising treatment options.
o At stage III, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage III breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N1: Cancer has spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
– What is stage IV (stage 4) breast cancer?
o Also known as metastatic breast cancer, the cancer in this stage has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The cancer has spread elsewhere in the body. The affected areas may include the bones, brain, lungs, or liver and more than one part of the body may be involved.
o At stage IV, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage IV breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor.
- N1: Cancer has spread to the lymph nodes
- M1: The disease has spread to other sites in the body
Triple Negative Breast Cancer
– What Is Triple-Negative Breast Cancer?
o Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer.
o Think of cancer cells as a house. The front door may have three kinds of locks, called receptors.
- One is for the female hormone estrogen.
- One is for the female hormone progesterone.
- One is a protein called human epidermal growth factor (HER2).
o If your cancer has any of these three locks, doctors have a few keys (like hormone therapy or other drugs) they can use to help destroy the cancer cells.
o But if you have triple-negative breast cancer, it means those three locks are not there. So, doctors have fewer keys for treatment. Fortunately, chemotherapy is still an effective option.
o Think of a cancer cell as a house. To get inside to destroy the cancer, we must bypass three locks on the front door: estrogen, progesterone, and HER2.
o If your cancer tests positive for these three locks, which are known as receptors, then doctors have a few keys they can use to get inside the cell to destroy it.
o If you have triple-negative breast cancer, those locks are not there. So, the keys doctors usually use will not work. But chemotherapy is still an effective option.
– How Is Triple-Negative Breast Cancer Treated?
Often, patients first need to have the lump removed (a lumpectomy) or the entire breast removed (a mastectomy). Then they have chemotherapy treatments to target any cancer cells that cannot be seen cells remaining in the breast or that may have spread into other parts of the body. Sometimes doctors recommend chemotherapy before surgery to shrink the cancer.
Triple-negative breast cancer symptoms
– Although triple-negative breast cancer does not look different from other breast cancer, it has several unique characteristics, including:
- Receptor status: Tests that detect receptors for estrogen, progesterone and HER2 will be negative, which means hormone therapy, a traditional breast cancer treatment, is not effective. Instead, triple-negative breast cancer treatment options will include chemotherapy, targeted therapy, and radiation.
- More aggressive: A greater tendency to spread and recur after treatment compared to other breast cancer types. This risk decreases after the first few years following therapy.
- Cell type and grade: Triple-negative breast cancer cells tend to be “basal-like,” meaning that they resemble the basal cells lining the breast ducts. The cells may also be higher grade, which means that they no longer resemble normal, healthy cells.
Survival rates for triple-negative breast cancer
– Triple-negative breast cancer (TNBC) is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time it’s found and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
– Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They cannot tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
– Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cannot predict what will happen in any person’s case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
What is a 5-year relative survival rate?
– A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who don’t have that cancer to live for at least 5 years after being diagnosed.
Where do these numbers come from?
– The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
– The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.). Instead, its groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver, or bones.
Understanding the numbers
– Women now being diagnosed with triple negative breast cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on women who were diagnosed and treated at least four to five years earlier.
– These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later if the cancer grows, spreads, or comes back after treatment.
– These numbers do not take everything into account. Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment, tumor grade, and other factors can also affect your outlook.
Treating triple-negative breast cancer
– Triple-negative breast cancer has fewer treatment options than other types of invasive breast cancer. This is because the cancer cells do not have the estrogen or progesterone receptors or enough of the HER2 protein to make hormone therapy or targeted drugs work.
– If the cancer has not spread to distant sites, surgery is an option. Chemotherapy might be given first to shrink a large tumor followed by surgery. It might also be given after surgery to reduce the chances of the cancer coming back. Radiation might also be an option depending on certain features of the tumor.
– Because hormone therapy and HER2 drugs are not choices for women with triple negative breast cancer, chemotherapy is often used. In cases where the cancer has spread to other parts of the body (stage IV) chemotherapy and other treatments that can be considered include PARP inhibitors, platinum chemotherapy, or immunotherapy.