WITN - Awareness - Misc

Types of Breast Cancer

Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. Here, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

DCIS - Ductal Carcinoma In Situ

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.

There are two main reasons this number is so large and has been increasing over time:

  • People are living much longer lives. As we grow older, our risk of breast cancer increases.
  • More people are getting mammograms, and the quality of the mammograms has improved. With better screening, more cancers are being spotted early.

DCIS generally has no signs or symptoms. A small number of people may have a lump in the breast or some discharge coming out of the nipple. According to the National Cancer Institute, about 80 percent of DCIS cases are found by mammography.

LCIS - Lobular Carcinoma In Situ

Lobular carcinoma in situ (LCIS) is an area (or areas) of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later on in life. Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. In situ or “in its original place” means that the abnormal growth remains inside the lobule and does not spread to surrounding tissues. People diagnosed with LCIS tend to have more than one lobule affected.

Despite the fact that its name includes the term “carcinoma,” LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term “lobular neoplasia” instead of “lobular carcinoma.” A neoplasia is a collection of abnormal cells.

LCIS is usually diagnosed before menopause, most often between the ages of 40 and 50. Less than 10% of women diagnosed with LCIS have already gone through menopause. LCIS is extremely uncommon in men.

LCIS is viewed as an uncommon condition, but we don’t know exactly how many people are affected. That’s because LCIS does not cause symptoms and usually does not show up on a mammogram. It tends to be diagnosed as a result of a biopsy performed on the breast for some other reason.

LCIS usually does not cause any signs or symptoms, such as a lump or other visible changes to the breast. LCIS may not always show up on a screening mammogram. One reason is that LCIS often lacks microcalcifications, the tiny specks of calcium that form within other types of breast cancer cells. On a mammogram, microcalcifications show up as white specks. It’s believed that many cases of LCIS simply go undiagnosed, and they may never cause any problems. It is difficult to detect LCIS on your own. Doctors usually find LCIS through an abnormal mammogram and a biopsy.

IDC - Invasive Ductal Carcinoma

Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80 percent of all breast cancers are invasive ductal carcinomas.

Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal means that the cancer began in the milk ducts, which are the “pipes” that carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive ductal carcinoma” refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.

According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. Most of them are diagnosed with invasive ductal carcinoma.

Although invasive ductal carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. Invasive ductal carcinoma also affects men.

At first, invasive ductal carcinoma may not cause any symptoms. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing.

In some cases, the first sign of invasive ductal carcinoma is a new lump or mass in the breast that you or your doctor can feel. According to the American Cancer Society, any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive ductal carcinoma:

  • 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

Less Common Subtypes of Invasive Ductal Carcinoma

There are some types of invasive ductal carcinoma that happen less commonly than others. In these cancers, the cells can look and behave somewhat differently than invasive ductal carcinoma cells usually do. If you’re diagnosed with one of these cancers, talk with your doctor about how this could affect your treatment plan. These include:

  • Tubular Carcinoma of the Breast - a rare subtype of invasive ductal carcinoma (cancer that begins inside the milk duct and spreads beyond it). Tubular carcinoma accounts for about one to two percent of all breast cancer cases. In this type of cancer, the tumor is usually small and made up of tube-shaped cells that are low grade. "Low grade" means they look somewhat similar to normal, healthy cells and tend to grow slowly. Tubular carcinoma of the breast is less likely to spread outside the breast than other types of breast cancer. It’s also easier to treat. Studies have found that the average age of diagnosis for tubular carcinoma ranges from the mid-40s to late 60s.

  • Medullary Carcinoma of the Breast - a rare subtype of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it), accounting for about three to five percent of all cases of breast cancer. It is called “medullary” carcinoma because the tumor is a soft, fleshy mass that resembles a part of the brain called the medulla. Medullary carcinoma can occur at any age, but it usually affects women in their late 40s and early 50s. Medullary carcinoma is more common in women who have a BRCA1 mutation. Studies have shown that medullary carcinoma is also more common in Japan than in the United States. Medullary carcinoma cells are usually high-grade in their appearance and low-grade in their behavior. In other words, they look like aggressive, highly abnormal cancer cells, but they don’t act like them. Medullary carcinoma doesn’t grow quickly and usually doesn’t spread outside the breast to the lymph nodes. For this reason, it’s typically easier to treat than other types of breast cancer.

  • Mucinous Carcinoma of the Breast - sometimes called colloid carcinoma, it is a rare form of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it). Mucinous carcinoma of the breast accounts for about two to three percent of all breast cancer cases. In this type of cancer, the tumor is formed from abnormal cells that “float” in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus. Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Many types of cancer cells — including most breast cancer cells — produce some mucus. In mucinous carcinoma, however, the mucus becomes a main part of the tumor and surrounds the breast cancer cells. Mucinous carcinoma tends to affect women after they’ve gone through menopause. Some studies have found that the usual age at diagnosis is 60 or older. Mucinous carcinoma is less likely to spread to the lymph nodes than other types of breast cancer. It’s also easier to treat.

  • Papillary Carcinoma of the Breast - are rare, accounting for less than one to two percent of invasive breast cancers. In most cases, these types of tumors are diagnosed in older women who have already been through menopause. An invasive papillary carcinoma usually has a well-defined border and is made up of small, finger-like projections. Often it is Grade 2, or moderate grade, on a scale of 1 to 3 — with Grade 1 describing cancer cells that look and behave somewhat like normal, healthy breast cells, and Grade 3 describing very abnormal, fast-growing cancer cells. In most cases of invasive papillary carcinoma, ductal carcinoma in situ (DCIS) is also present. (DCIS is a type of cancer in which the carcinoma cells are confined to the breast duct.)

  • Cribriform Carcinoma of the Breast - the cancer cells invade the stroma (connective tissues of the breast) in nestlike formations between the ducts and lobules. Within the tumor, there are distinctive holes in between the cancer cells, making it look something like Swiss cheese. Invasive cribriform carcinoma is usually low grade, meaning that its cells look and behave somewhat like normal, healthy breast cells. In about five to six percent of invasive breast cancers, some portion of the tumor can be considered cribriform. Usually, some ductal carcinoma in situ (DCIS) of the cribriform type is present as well.

ILC - Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma (cancer that begins in the milk-carrying ducts and spreads beyond it). According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. About 10% of all invasive breast cancers are invasive lobular carcinomas. (About 80 percent are invasive ductal carcinomas.)

Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Lobular means that the cancer began in the milk-producing lobules, which empty out into the ducts that carry milk to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive lobular carcinoma” refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast. Over time, invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.

Although invasive lobular carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. ILC tends to occur later in life than invasive ductal carcinoma — the early 60s as opposed to the mid- to late 50s.

Some research has suggested that the use of hormone replacement therapy during and after menopause can increase the risk of ILC.

At first, invasive lobular carcinoma may not cause any symptoms. Sometimes, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing. Invasive lobular carcinomas tend to be more difficult to see on mammograms than invasive ductal carcinomas are. That’s because instead of forming a lump, the cancer cells more typically spread to the surrounding connective tissue (stroma) in a line formation.

In other cases, the first sign of ILC is a thickening or hardening in the breast that can be felt, rather than a distinct lump. Other possible symptoms include an area of fullness or swelling, a change in the texture of the skin, or the nipple turning inward.

According to the American Cancer Society, any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive lobular carcinoma:

  • swelling of all or part of the breast
  • skin irritation or dimpling
  • breast pain
  • nipple pain
  • redness, scaliness, or thickening of the nipple or breast skin
  • a nipple discharge other than breast milk
  • a lump in the underarm area

Paget's Disease of the Nipple

Paget's disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola (the dark circle of skin around the nipple). The nipple and areola often become scaly, red, itchy, and irritated.

According to the National Cancer Institute, Paget's disease of the nipple accounts for less than 5 percent of all breast cancer cases in the United States. Being aware of the symptoms is important, given that more than 97 percent of people with Paget's disease also have cancer, either DCIS or invasive cancer, somewhere else in the breast. The unusual changes in the nipple and areola are often the first indication that breast cancer is present.

Doctors are not yet completely sure how Paget's disease develops. One possibility is that the cancer cells start growing inside the milk ducts within the breast and then make their way out to the nipple surface. This would appear to explain why so many people with Paget's disease of the nipple have a second area of cancer within the breast. Another theory is that the cells of the nipple itself become cancerous. This theory would explain the small number of people who: (1) only have Paget's disease in the nipple, or (2) have a second breast cancer that appears to be completely separate from the Paget's disease.

Paget's disease of the nipple is more common in women, but like other forms of breast cancer, it can also affect men. The disease usually develops after age 50. According to the National Cancer Institute, the average age of diagnosis in women is 62, and in men, 69.

Paget's disease causes the skin on and around the nipple to become red, sore, and flaky, or scaly. At first, these symptoms tend to come and go.

Over time, symptoms of Paget's disease usually worsen and may include:

  • itching, tingling, and/or a burning sensation
  • pain and sensitivity
  • scaling and thickening of the skin
  • flattening of the nipple
  • yellowish or bloody discharge from the nipple

Because Paget's disease of the nipple is rare, doctors often mistake it for eczema (severe skin rash and inflammation), an infection or injury, or some other skin condition. For many people, it can take several months to get a correct diagnosis. If you have any of the above symptoms and they persist in spite of treatment, get them checked out by a breast specialist. In most cases, Paget's disease affects one breast, not both.

Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. According to the National Cancer Institute, about one to five percent of all breast cancer cases in the United States are inflammatory breast cancers.

Inflammatory breast cancer usually starts with the reddening and swelling of the breast instead of a distinct lump. IBC tends to grow and spread quickly, with symptoms worsening within days or even hours. It’s important to recognize symptoms and seek prompt treatment. Although inflammatory breast cancer is a serious diagnosis, keep in mind that treatments today are better at controlling the disease than they used to be.

The average age at diagnosis for inflammatory breast cancer in the United States is 57 for white women and 52 for African American women. These ages are about 5 years younger than the average ages at diagnosis for other forms of breast cancer. According to the American Cancer Society, inflammatory breast cancer is more common in African American women. A 2008 study found that being overweight makes a person more likely to develop IBC. Like other forms of breast cancer, IBC can also affect men.

Although most breast cancers begin as lumps or tumors, inflammatory breast cancer usually starts with a feeling of thickness or heaviness in the breast. You also may develop red, inflamed skin on the breast. IBC tends to grow in the form of layers or “sheets” of tissue, which doctors sometimes call “nests.”

The breasts swell and become inflamed because the cancer cells clog the vessels that carry lymph. Lymph is a clear, watery fluid that transports white blood cells and removes bacteria and proteins from the tissues.

Common symptoms of IBC include:

  • Redness of the breast: Redness involving part or all of the breast is a hallmark of inflammatory breast cancer. Sometimes the redness comes and goes.
  • Swelling of the breast: Part of or all of the breast may be swollen, enlarged, and hard.
  • Warmth: The breast may feel warm.
  • Orange-peel appearance: Your breast may swell and start to look like the peel of a navel orange (this is called “peau d’orange”).
  • Other skin changes: The skin of the breast might look pink or bruised, or you may have what looks like ridges, welts, or hives on your breast.
  • Swelling of lymph nodes: The lymph nodes under your arm or above the collarbone may be swollen.
  • Flattening or inversion of the nipple: The nipple may go flat or turn inward.
  • Aching or burning: Your breast may ache or feel tender.

Some of these symptoms are similar to those caused by mastitis, a breast infection that can occur in women who are breastfeeding. Unlike inflammatory breast cancer, however, mastitis usually causes a fever and is easily treated with antibiotics. If you are diagnosed with mastitis that is not responding to treatment, ask your doctor about testing for inflammatory breast cancer. The same holds true if you are told you have cellulitis, which is a bacterial infection of the breast skin. Any persistent breast changes should be looked at by a breast specialist.

Male Breast Cancer

Breast cancer in men is a rare disease. Less than one percent of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

One study found that male breast cancer is on the rise, with a 25 percent increase over the 25 years from 1973 to 1988. But it's still rare. It's unclear whether the reported rise means the disease is slowly becoming more common, or whether men better understand the symptoms and report their symptoms, leading to diagnoses that might have been missed in the past.

It's important to understand the risk factors for male breast cancer — particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast cancer:

  • Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The median age of men diagnosed with breast cancer is about 67. This means that half the men who are diagnosed are over 67 and half are under.
  • High estrogen levels: Breast cell growth — both normal and abnormal — is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
    • taking hormonal medicines
    • being overweight, which increases the production of estrogen
    • having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body)
    • being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels
    • having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
  • Klinefelter syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
  • A strong family history of breast cancer or genetic alterations: Family history can increase the risk of breast cancer in men — particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer. This risk of developing breast cancer by age 70 is approximately 1 percent with the BRCA1 gene and 6 percent with the BRCA2 gene. Overall, that's about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.
  • Radiation exposure: Having radiation therapy to the chest before age 30, and particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)

If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

  • a lump felt in the breast
  • nipple pain
  • an inverted nipple
  • nipple discharge (clear or bloody)
  • sores on the nipple and areola (the small ring of color around the center of the nipple)
  • enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Sometimes the breasts can become quite large. Non-cancer-related enlargement of the breasts can be caused by medications, heavy alcohol use, weight gain, or marijuana use.

A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that — just like women — they need to go to their doctor right away if they detect any persistent changes to their breasts.

Information provided by BreastCancer.org.


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