Pre-Breast Cancer

Atypical Hyperplasia[i]

Atypical hyperplasia is an accumulation of abnormal cells in a breast duct (atypical ductal hyperplasia) or lobule (atypical lobular hyperplasia). The condition is considered precancerous, but can be a forerunner to the development of breast cancer. Women with this condition are at a greater risk of developing breast cancer in the future. Doctors often recommend more frequent breast cancer screenings and careful consideration of medications and other strategies to reduce breast cancer risk. Atypical hyperplasia doesn’t cause any specific signs or symptoms.

Lobular Carcinoma In Situ[ii]

Lobular carcinoma in situ (LCIS) is an area of abnormal tissue growth that occurs within — and stays within — the lobules or milk glands located at the end of the breast ducts. It is not considered cancer, but women with LCIS have a higher 10 to 20 percent lifetime risk of developing invasive breast cancer in either breast. Lobular carcinoma in situ (LCIS) is diagnosed most often in women in their 40s, but it can also be diagnosed in older women. The condition isn’t associated with any signs or symptoms and usually doesn’t show up as abnormal cells on a mammogram. Many doctors discover that you have LCIS incidentally with a biopsy to test for a suspicious lump or if there is an abnormality on your mammogram.

Non-Invasive Breast Cancers

Ductal Carcinoma In Situ[iii] [iv] [v]

Ductal carcinoma in situ (DCIS) is noninvasive, meaning confined to the inside of the ductal system. In DCIS, abnormal cells multiply and form a growth within a milk duct of your breast. It occurs in about 1 in 5 new breast cancer cases. DCIS places you at a higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

DCIS is usually found during a mammogram screening, but can be difficult to detect. The radiologist identifies microcalcifications — tiny groups of calcium deposits — that may indicate the presence of a breast abnormality usually presenting as irregularly sized and shaped clusters of white spots. While DCIS isn’t life-threatening, it does require treatment to prevent the condition from becoming invasive. Most women with DCIS are effectively treated with breast-conserving surgery and radiation. 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%. In most cases, DCIS has no outward signs or symptoms.
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Invasive Breast Cancer (common)[iii] [iv] [vi]

Invasive or Infiltrating Ductal Carcinoma (IDC)

Invasive Ductal Carcinomas (IDC) is the most common type, representing about 80% of all breast cancers. IDC starts in the milk ducts (the “pipes” that carry milk from the milk-producing lobules to the nipple), but has spread to the surrounding breast tissues. Invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.

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.

Invasive or Infiltrating Lobular Carcinoma (ILC)

Invasive Lobular Carcinoma (starts in the milk producing area of the breast) and represents approximately 10% of all diagnosis. “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. It is the second most common type of breast cancer, ductal being first. 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. The tumor usually appears as a subtle thickening in the upper-outer quadrant of the breast. This breast cancer type is typically positive for estrogen and progesterone receptors, which respond well to hormone therapy.

Invasive Breast Cancer (Rare Types)

Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer is a rare and very aggressive type of breast cancer, accounting for 1% to 5% of all breast cancer cases in the United States. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed”. 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.

Inflammatory breast cancer doesn’t commonly form a lump, as occurs with other forms of breast cancer. Common symptoms of IBC include:

  • Rapid change in the appearance of one breast, over the course of days or weeks
  • 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.
  • Itching

Paget’s Disease of the Breast

Paget’s (PAJ-its) disease of the breast is a rare form of breast cancer that starts on the nipple and extends to the dark circle of skin (areola) around the nipple. Paget’s disease of the breast occurs most often in women older than age 50 and accounts for 1 percent of all cases of breast cancer. Most women with Paget’s disease of the breast have underlying ductal breast cancer (in situ or, less commonly, invasive). Only in rare cases is the cancer confined to the nipple itself. It’s easy to mistake the signs and symptoms of Paget’s disease of the breast for skin irritation (dermatitis) or another noncancerous (benign) skin condition. Signs and symptoms usually occur in one breast only. The skin changes may fluctuate early on, making it appear as if your skin is healing on its own. On average, women experience signs and symptoms for six to eight months before a diagnosis is made.

Possible signs and symptoms of Paget’s disease of the breast include:

  • Flaky or scaly skin on your nipple
  • Crusty, oozing or hardened skin resembling eczema on the nipple, areola or both
  • Itching
  • Redness
  • A tingling or burning sensation
  • Straw-colored or bloody nipple discharge
  • A flattened or turned-in nipple
  • A lump in the breast
  • Thickening skin on the breast

Papillary Carcinoma of the Breast

Invasive papillary carcinomas of the breast are rare, accounting for less than 1-2% 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. 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

Invasive cribriform carcinoma accounts for 5-6% of invasive breast cancers. 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. Usually, some ductal carcinoma in situ (DCIS) of the cribriform type is present as well.

Tubular Carcinoma

Tubular carcinoma of the breast is a rare subtype of invasive ductal carcinoma (cancer that begins inside the milk duct and spreads beyond it). Tubular carcinoma accounts for about 1-2% 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. Typically this type of breast cancer is found in women aged 50 and above. It has an excellent 10-year survival rate of 95%. Like other types of breast cancer, tubular carcinoma of the breast may not cause any symptoms at first. Over time, a lump may grow large enough to be felt during breast self-exam or examination by a doctor. Tubular carcinomas are usually small — 1 cm or less in diameter — and feel firm or hard to the touch.

Mucinous Carcinoma (Colloid)

Mucinous carcinoma of the breast — sometimes called colloid carcinoma — is a rare form of invasive ductal carcinoma which is less likely to spread to the lymph nodes than other types of breast cancer. Mucinous carcinoma of the breast accounts for about 2-3% of all breast cancer cases and usually affect women after they’ve gone through menopause. Some studies have found that the usual age at diagnosis is 60 or older. Like other types of breast cancer, mucinous carcinoma of the breast may not cause any symptoms at first. Over time, a lump may grow large enough to be felt during breast self-exam or examination by a doctor. The tumors tend to range in size from 1 cm to 5 cm. It also has a favorable prognosis in most cases.

Medullary Carcinoma

Medullary carcinoma of the breast is a rare subtype of invasive ductal carcinoma (cancer that begins in the milk duct and spreads beyond it), accounting for about 5 – 7 % of all cases of breast cancer. Most cases of this type of breast cancer is diagnosed in women in their late 40s and early 50s. It is most diagnosed in women who have the BRCA1 mutation. Studies have shown that medullary carcinoma is also more common in Japan than in the United States. It is also more common in African American women than Caucasian women. Medullary carcinoma doesn’t usually spread outside the breast to the lymph nodes and is slow growing. It is typically easier to treat than other types of breast cancer. Like other types of breast cancer, medullary carcinoma may not cause any symptoms at first. Over time, a lump can form, and it may be soft and fleshy or somewhat firm to the touch. Most medullary carcinomas are small — less than 2 cm in size. Medullary carcinoma also may cause pain, swelling, redness, or tenderness in the breast.

[i] Mayo Clinic (2010). Atypical hyperplasia of the breast. Retrieved on October 20, 2010 from http://www.mayoclinic.com/health/atypical-hyperplasia/DS01018.
[ii] Mayo Clinic (2010). Lobular carcinoma in situ (LCIS). Retrieved on October 20, 2010 from http://www.mayoclinic.com/health/lobular-carcinoma-in-situ/DS00982.
[iii] BreastCancer.org (2010). Types of breast cancer. Retrieved on October 5, 2010 from http://www.breastcancer.org/symptoms/types/
[iv] National Breast Cancer Foundation, Inc. Types of Breast Cancer. Retrieved on October 15, 2010 from http://www.nationalbreastcancer.org/About-Breast-Cancer/Types.aspx
[v] Mayo Clinic.com (2010). Ductal carcinoma in situ (DCIS). Retrieved on October 20, 2010 from http://www.mayoclinic.com/health/dcis/DS00983.
[vi] Mayo Clinic.com (2010) Breast Cancer. Retrieved on October 15, 2010 from http://www.mayoclinic.com/health/breast-cancer/DS00328.