Types of Breast Cancer and Treatment Responsiveness
Medically reviewed by Archana Sharma, DOMedically reviewed by Archana Sharma, DOBreast cancer has many different types. Proper treatment will be determined, in part, by the kind of cancer you have.Breast cancer can be classified as invasive or noninvasive. Types of breast cancer include invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), inflammatory breast cancer (IBC), and Paget disease of the breast.Subtypes of breast cancer are also based on whether the cancer cells have hormone receptors or human epidermal growth factor 2 (HER2) receptors.
Photo composite by Joules Garcia for Verywell Health; Getty Images
Types of Breast Cancer: Most to Least CommonBreasts are composed of several different types of tissue. Most breast cancers originate in glandular tissue, which includes the breast lobes, lobules, and ducts.Breast cancer starts when the DNA (genetic material) within breast cells becomes damaged or changed, causing uncontrollable cell growth. The type of cancer you have will be determined in part by the specific cells where these changes take place.Breast cancer can be categorized as invasive or noninvasive (in situ. meaning in the original place):When breast cancer is noninvasive, it means the cancer cells have remained isolated to their initial spot or origin. About 56,500 new U.S. cases of ductal carcinoma in situ (DCIS) are diagnosed yearly, in which the cancer cells have not spread from the milk ducts.When breast cancer is invasive, the cancer cells have spread to other areas of the breast or to areas outside of the breast. About 310,720 new cases of invasive breast cancer are diagnosed yearly in the United States.Breast cancer can affect people of any sex, but it is higher in females. Breast cancer affects 1 in 8 women in the United States. It affects 1 in 726 men. Approximately 1% of all cases occur in males aged 60 to 70.
A Note on Gender and Sex TerminologyVerywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them. Discuss your risk of breast cancer with a healthcare provider to ensure you get appropriate screenings.
Invasive Ductal Carcinoma (IDC)Invasive ductal carcinoma is also referred to as invasive breast cancer or as infiltrating carcinoma. IDC originates in the milk ducts of the breast. This type of cancer accounts for up to 80% (8 in 10) of all invasive breast cancers. IDC is the most common type of breast cancer diagnosed in males.Ductal carcinoma starts out as a noninvasive, stage 0 precancer (ductal carcinoma in situ). Thanks to early detection, 1 in 5 new breast cancers are discovered at this early stage.IDC originates in cells that line the milk ducts of the breast. As they grow and spread, the cancerous cells break through the duct’s wall, infiltrating nearby breast tissues. IDC can metastasize (spread) outside of the breast through the bloodstream or lymphatic system.IDC has less common subtypes. Each accounts for under 5% of all breast cancers and include:Medullary carcinomaMucinous carcinomaPapillary carcinomaTubular carcinomaTriple-Negative Breast Cancer (TNBC)Triple-negative breast cancer is an aggressive form of invasive breast cancer. About 10% to 15% of all invasive breast cancers are of this type.TNBC cancer cells do not have receptors for estrogen (ER) or progesterone (PR). These cells don’t manufacture significant amounts of human epidermal growth factor receptor 2, a type of protein. Because these cells are “negative” for all three of these markers, cancers that originate in them are referred to as triple-negative.Triple-negative breast cancer is more challenging to treat due to its faster growth and fewer treatment options.Invasive Lobular Carcinoma (ILC)Invasive lobular carcinoma accounts for around 10% (1 in 10) of all invasive breast cancers.ILC originates in the cells found in breast lobules. Lobules are breast glands that manufacture milk during pregnancy and lactation. It is estimated that around 1 in 5 females diagnosed with ILC have cancer in both breasts.Like ductal carcinoma, lobular carcinoma may be diagnosed as a precancer in stage 0. Lobular carcinoma in situ (LCIS) does not spread outside of the lobules, but it does increase your risk of getting breast cancer in either breast.Inflammatory Breast Cancer (IBC)Inflammatory breast cancer is a rare and aggressive form of breast cancer. IBC accounts for 1% to 5% of all breast cancers.IBC is technically a form of invasive ductal carcinoma. However, its symptoms and outlook are different. It also requires different types of treatment.IBC is caused by cancer cells that block lymph vessels. The blockage stops the drainage of lymph fluid from out of the breast. The result is inflammation in the breast and symptoms that mimic an infection, like swelling, a rash, and pitted skin. The discoloration of the rash may be red, purple, or dark.Paget's Disease of the BreastPaget's disease of the breast can affect people of any sex but is more common in females. It's associated with 1% to 4% of all breast cancer cases.This condition affects the skin of the nipple and the areola (skin surrounding the nipple). People with Paget's typically have breast tumors caused by invasive ductal carcinoma or ductal carcinoma in situ.It is unclear whether this condition is generated independently or if the cancerous cells in ductal carcinoma tumors travel through the milk ducts to the nipple and areola.Phyllodes Tumors of the BreastPhyllodes tumors account for less than 1% of all breast cancer cases. The cells in phyllodes tumors grow in a leaflike pattern. This type of breast cancer originates in the breast's connective tissue (stroma).Angiosarcoma of the BreastAngiosarcoma of the breast is a very rare and aggressive form of breast cancer that accounts for 0.1% to 0.2% of all cases. It originates in lymph vessels or in the cells that line blood vessels. Angiosarcoma of the breast can start in the breast and the skin of the arm.The two types are:Primary angiosarcoma, which affects people who have never had breast cancerSecondary angiosarcoma, which results from earlier radiation treatment for breast cancerBreast Cancer Subtypes in FemalesBreast cancer types may also be grouped into hormone receptor (HR) status. This helps your cancer team better determine the types of treatments needed.Breast cancers that are hormone receptor-positive (HR-positive, sometimes appearing as HR+) are tumor cells that contain receptors for estrogen or progesterone. Both of these hormones may escalate hormone HR-positive tumor growth.While HER2 refers to human epidermal growth factor receptor 2, HER2-positive breast cancer tumor cells manufacture the HER2/neu protein. The presence of this protein is associated with some forms of aggressive breast cancer.If you are diagnosed with breast cancer, an immunohistochemistry test will be done to determine if the cancer cells contain estrogen and progesterone receptors.These are the HR breast cancer subtypes, ranked from most common to least common:HR-positive/HER2-negative accounts for around 70% of all female breast cancersHR-negative/HER2-negative accounts for around 11% of all female breast cancersHR-positive/HER2-positive accounts for around 10% of all female breast cancersHR-negative/HER2-positive accounts for around 4% of all female breast cancersAround 6% of female breast cancers have unknown HR status.How Treatment Changes Based on Breast Cancer TypesThe type of cancer and its stage will determine the kinds of treatments recommended. The goal of treatment may be cure or remission.Some treatments are used for multiple types of breast cancer, including invasive ductal carcinoma, triple-negative breast cancer, and invasive lobular carcinoma. Several treatments may be used together. They include:Surgery to remove breast cancer: Surgical options include mastectomy and lumpectomy. The lymph nodes nearest the breast may also be removed. People who opt for lumpectomy typically also receive radiation treatment. Surgery is typically used as a first-line treatment for many forms of breast cancer, including Paget's disease of the breast.Chemotherapy: Chemotherapy may be used prior to surgery to shrink cancer tumors. It may also be used after surgery to ensure the destruction of leftover cancer cells. Metastatic breast cancer (breast cancer that has spread outside of the breast), including inflammatory breast cancer, is routinely treated with chemo.Radiation: Radiation may be used after lumpectomy or mastectomy. It may also be used to treat breast cancer that has spread to other parts of the body.Hormone therapy (endocrine therapy): If the type of cancer you have is HR+, hormone therapy may be used. Two out of every three breast cancers are hormone receptor-positive. Hormone therapy drugs attack cancer cells in different ways. Some block estrogen from connecting to cancer cells. Others lower estrogen levels in the body.Targeted drug therapy: Targeted therapies may be used for several types of breast cancer, including HER2-negative and hormone receptor-positive breast cancers. A number of different medications fall under this umbrella, including monoclonal antibodies and kinase inhibitors. Targeted therapy is sometimes combined with chemotherapy to treat inflammatory breast cancer.Immunotherapy: Immunotherapy drugs are used to treat early-stage or metastatic triple-negative breast cancer and other types of breast cancer that have metastasized. This treatment works by strengthening the immune system to fight off cancer cells. It is typically done in conjunction with other treatments, including radiation and chemotherapy.Breast Cancer Types and StagingBreast cancer stages range from 0 to 4. The stage of cancer at diagnosis greatly influences treatment.The assignment of stage for breast cancer is complex and includes these factors:Tumor size and extent of the cancerSpread to lymph node(s)Spread to distant sites (metastasis)Estrogen receptor (ER) statusProgesterone receptor (PR) statusHER2 statusCancer grade (how much it looks like normal cells)Oncotype DX score (genetic testing)The American Cancer Society recommends you discuss the cancer stage assigned with your healthcare provider. Different combinations of factors can result in the same stage, and this can mean different treatments are recommended.Diagnostic Challenges in Certain Types of Breast CancerMammograms (a procedure that x-rays the breast) are the best line of defense for diagnosing breast cancer early. It can be harder to interpret a mammogram of dense breasts, in which there is more fibrous tissue and less fat. Additional screening tests, such as an ultrasound, may be recommended by your healthcare provider.Some forms of breast cancer, such as inflammatory breast cancer (IBC), may be harder to diagnose than more common types. IBC is sometimes misdiagnosed because its symptoms mimic mastitis or other types of breast infections. A missed diagnosis can give the cancer time to spread.SummaryThe most common type of breast cancer in people of any sex is invasive ductal carcinoma. Other types include invasive lobular carcinoma, inflammatory breast cancer, and Paget's disease of the breast. Breast cancer is also categorized by its hormone receptor and HER2 status.If you or a loved one is newly diagnosed, this may be confusing and feel overwhelming. However, breaking down breast cancer types by category helps to ensure that the treatments recommended to you are the most effective ones possible. Read the original article on Verywell Health.
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