Over 55,000 women in the UK are diagnosed with breast cancer each year, with the latest figures showing that one in eight will be diagnosed with the disease during their lifetime.
As a result of the large numbers of people in the UK affected by breast cancer, overall awareness of the disease is relatively high – especially when it comes to identifying the symptoms and causes. However, there is far less knowledge about the different categories of the disease which exist.
To tie in with Breast Cancer Awareness Month, which is taking place throughout October, here Dr Vivek Misra from The Christie Private Care, Part of HCA Healthcare UK, shares his expert insight on the key types of breast cancer and how they can be identified.
Ductal Carcinoma In Situ
Dr Vivek Misra says: “Ductal carcinoma in-situ is often referred to as ‘DCIS’. It is actually a pre-cancerous condition and occurs when cells in the lining of the breast milk duct have started to turn into cancer cells. DCIS is highly treatable, with patients undergoing surgery to remove the area of DCIS and a border of healthy tissue around it. In some circumstances, a patient with DCIS may choose to have the whole breast removed, which is called a mastectomy. Patients may also require radiotherapy following surgery, if it is a particularly aggressive form of DCIS.
There are three different types of DCIS: low grade, intermediate, and high grade. This scale gives doctors an idea of how the DCIS might behave and what type of treatment is needed.
The reason DCIS is classed as ‘pre-cancerous’ is because the abnormal cells are all contained inside the breast milk duct and haven’t spread into the surrounding tissue. That is why the term ‘in-situ’ is used for this early stage of the disease as it means ‘in the original place’. However, some doctors might use the alternative terms: pre-invasive, non-invasive or intra ductal cancer.”
Tubular, Medullary and Mucinous Cancers
Dr Vivek Misra says: “Other rarer types of breast cancer include Tubular, Medullary and Mucinous Cancers. These types of breast cancer are uncommon and carry a different prognosis to the more common IDC and ILC. The treatment plan and expected outcome from these cancers will be discussed by the patient’s surgeon or oncologist and may differ from person to person.”
There are also ‘biological’ subgroups of cancers, which are defined by the presence or absence of two hormone receptors (oestrogen or progesterone) and a protein called HER-2. The biopsy result will always report the status of these, and this also forms the basis of treatment recommendations. IDC, ILC or other special types of cancer (Tubular, Medullary and Mucinous) can be further sub-divided into these biological subgroups:
Invasive Ductal Carcinoma
Dr Vivek Misra says: “This will often be referred to as IDC. For some, if pre-cancerous DCIS is not treated it could become an invasive cancer. An IDC diagnosis indicates that the abnormal cancer cells that started in the milk ducts have now spread into other parts of the breast tissue.IDC is the most common type of breast cancer, and in many cases will be identified and diagnosed during a breast screening, such as a mammogram. The treatment patients receive for IDC varies depending on the size of the cancer and how abnormal the cells are. However, common treatment options include surgery, radiotherapy, chemotherapy, hormone therapy, or a combination of all of these.”
Hormone Receptor Positive Breast Cancer
Dr Vivek Misra says: “The presence of receptors for the hormones oestrogen and progesterone within the cancer cell makes the cancer ‘hormone receptor positive’. About 80% of breast cancers fall in this category. Drugs such as tamoxifen, letrozole, anastrazole, exemestane or fulvestrant can be used in early receptor positive cancers to reduce the risk of cancer returning after surgery, and/or chemotherapy. In more advanced cancers, they can be used to control the disease, improve symptoms and improve survival”
HER-2 Positive Breast Cancer
Dr Vivek Misra says: “The presence of the HER-2 protein on the cancer cell makes it HER-2 positive. These cancers can also be hormone receptor positive.
Drugs such as trastuzumab (also known by its brand name ‘Herceptin’) are used in early breast cancer along with chemotherapy to reduce the risk of cancer relapse after surgery. In more advanced cancers, trastuzumab, pertuzumab, and trastuzumab-emtansine are used to control the disease, improve symptoms and improve survival.
The availability of the HER-2 targeting drugs named above have dramatically improved the outcome in what used to be an aggressive type of breast cancer, to the point that HER-2 positive early breast cancer now has some of the best cure rates.”
Triple Negative Breast Cancer
Dr Vivek Misra says: “Triple negative breast cancer is a fairly uncommon type of the disease (10-15% of all breast cancers). It occurs when cancer cells are missing receptors for the hormones oestrogen, progesterone, and Her2 protein. As a result of this, unfortunately it means that common treatment methods such as hormone therapy (drugs that target oestrogen and progesterone receptors) and Her2 targeting drugs are ineffective. However, using chemotherapy to treat triple negative breast cancer is still an effective option, as well as surgery to remove either an area of or the whole breast.”
Inflammatory Breast Cancer
Dr Vivek Misra says: “Inflammatory Breast Cancer (IBC) is aggressive and fast growing, with cancer cells infiltrating the skin and lymph vessels of the breast. It is more likely to be an IDC, hormone receptor negative or HER-2 positive. While it is not a ‘biological subtype’, it is an important clinical subtype of breast cancer which differs from the more common clinical subtypes, which present as a lump or are picked up on a routine mammogram.
IBC often produces no distinct tumour or lump that can be felt within the breast however, because the lymph channels are blocked, symptoms to look out for include swelling, redness, and/or firmness of the breast – the breast can also be hot to the touch. IBC symptoms can appear over a short period of time, with other symptoms including: thickening of the skin around the breast, an inverted nipple, discharge from the nipple, and pitted skin.
As this is an aggressive form of cancer, the treatment is different to other types of the disease, with chemotherapy usually the first treatment option. Following chemotherapy, the next step is surgery which in most cases is to remove the whole breast (a mastectomy), after this, patients will go through radiotherapy. Patients may also have hormone therapy tablets following this, or other targeted cancer therapies. However, all cases are looked at individually and treatment depends on the health of the patient and whether they have any other existing medical conditions. This type of cancer is also very rare with only 1-5% of breast cancer diagnosis’s IBC.”
Metastatic Breast Cancer
Dr Vivek Misra says: “Metastatic breast cancer, or MBC, is also a clinical subtype of breast cancer and is classified as stage 4 breast cancer. In stage 4 cancer, the tumour can be any size, the lymph nodes may or may not contain cancer cells but the cancer has spread to other parts of the body – this may include the lungs, liver, bones or brain. The symptoms can vary depending on where the cancer has spread to however, all symptoms should be reported.
When considering the treatment options Doctors will take into account a number of factors to decide what is best for the patient, including where the cancer has spread to and how aggressive it is. However, is it important to remember, there is a lot of support out there and patients are never alone when deciding on treatments for any cancer diagnosis.
Patients should always discuss their diagnosis, prognosis and treatment options with their doctor and specialist nurse as these vary on a case-by-case basis and sometimes the prognosis and outcome may be better than the patient expects it to be. ”
If you have any concerns about breast cancer, speak to your GP. You can find out more about symptoms on the NHS website.