In Situ Breast Cancer
Ductal carcinoma in situ, also called DCIS or intraductal carcinoma, is the only form of in situ breast cancer. In DCIS, cancer cells are found in the lining of the milk ducts, the tubes that carry milk to the nipple. DCIS is stage 0, meaning the cancer remains in the area where it began. The cancer will be tested for receptors to the hormones estrogen and progesterone. This can help your care team decide whether hormonal therapy would help reduce the risk of developing invasive breast cancer in the future.
Despite its name, lobular carcinoma in situ, or LCIS, isn’t actually a true breast cancer. Its a condition in which there is abnormal cell growth inside the breasts lobules, the sacs that produce milk. LCIS raises your risk of developing breast cancer in the future , but its not an immediate threat to your health. LCIS is much less common than DCIS.
Read more about DCIS and LCIS.
Special Invasive Breast Cancers And Carcinoma In Situ
Inflammatory breast cancer is an aggressive locally advanced breast cancer.
The main symptoms of IBC are swelling and redness in the breast. Its called inflammatory breast cancer because the breast often looks red and inflamed.
About 1-5 percent of breast cancers are IBC .
Learn more about IBC.
Paget disease of the breast is a rare carcinoma in situ in the skin of the nipple or in the skin closely surrounding the nipple. Its usually found with an underlying breast cancer.
About 1-4 percent of breast cancers also involve Paget disease of the breast .
What Is Metaplastic Carcinoma
Metaplastic carcinoma is a rare type of invasive breast cancer. It has a mix of 2 or more kinds of breast cancer cells, usually carcinoma and sarcoma. Its also called metaplastic breast cancer. Metaplastic means cancer that starts in cells that have changed into another kind of cell.
To treat metaplastic carcinoma, we first learn more about its genetics and biology. We find out if the tumor is more similar to carcinoma or sarcoma, because they have very different treatments.
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Types Of Breast Cancer
- Lobular carcinoma in situ
Invasive breast cancers
The most common types of breast cancers are:
- Invasive ductal carcinoma
Less common types of invasive breast cancer are:
- Locally advanced breast cancer
The subtypes of breast cancer are based on the genes a cancer expresses. The three main subtypes are:
- Hormone receptor positive breast cancer
- HER2-positive breast cancer
Survival Rates For Her2
Cancer survival statistics are typically reported using a 5-year survival rate. This is the percentage of individuals that are still living 5 years after their diagnosis.
Survival rates can vary based off of the subtype of breast cancer that you have. A publication from the reports 5-year survival rates for HER2-negative breast cancers as:
- 92 percent for HER2-negative, HR-positive breast cancer
- 77 percent for triple-negative breast cancer
Keep in mind that HER2 and HR status arent the only factors that can influence outlook. Other important factors at diagnosis include:
- the stage of the cancer
- the specific type of breast cancer
- your age and overall health
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Your Treatment Is Unique
HER2-positive breast cancer is different from other breast cancer types, so your treatment wonât necessarily be the same as someone else who has a different form of breast cancer. It may also be different than another HER2-positive patientâs therapy.
Each cancer is unique, so doctors try to develop the treatment course thatâs best for you. Things to consider include the size of your tumor, whether the cancer has metastasized , or your overall risk of recurrence.
In Situ Vs Invasive Breast Cancers
The type of breast cancer can also refer to whether the cancer has spread or not. In situ breast cancer is a pre-cancer that starts in a milk duct and has not grown into the rest of the breast tissue. The term invasive breast cancer is used to describe any type of breast cancer that has spread into the surrounding breast tissue.
Invasive breast cancer has spread into surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers.
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Proteins For Targeted Cancer Drugs
Testing cancer cells for particular proteins can help to show whether targeted drug treatments might work for your breast cancer.
Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer.
Some breast cancers have large amounts of a protein called HER2 receptor . They are called HER2 positive breast cancers. About 15 out of every 100 women with early breast cancer have HER2 positive cancer.
Targeted cancer drugs such as trastuzumab can work well for this type of breast cancer. These drugs attach to the HER2 protein and stop the cells growing and dividing.
Finding The Type Of Cancer
A pathologist looks at the cancer cells under a microscope to see which type of breast cancer it is. They can tell this by the shape of the cells and the pattern of the cells in the breast tissue.
Pathologists also sometimes use particular dyes to stain the cells and show up certain proteins or features of the cells.
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What Are The Stages Of Triple
- There are abnormal cells but they have not spread to nearby tissue.
- Cancer has spread to other tissue in a small area.
- The cancer is invasive, but the tumor is still localized and has not spread beyond the breast. Its between 20 and 50 mm . It has spread to some lymph nodes. Or, the tumor is more than 50 mm but has not spread to lymph nodes.
- The cancer is regional. Its more than 50 mm . Its spread to more lymph nodes over a larger area. In some cases, theres no tumor.
- This is metastatic cancer that has spread beyond the breast to other parts of the body.
Her2 Positive Breast Cancer
Breast tissue sampled by a biopsy or after surgery is sent to a pathologist who will report on several features in the sample, including the status of molecular markers such as the estrogen receptor, progesterone receptor and HER2 . These results will help a treating clinician determine the best treatments, which may include hormonal or targeted drugs.Around 15-20% of all breast cancer cases are HER2 positive, meaning that the breast cancer cells produce excessive amounts of the HER2 protein, which promotes the growth of this type of breast cancer.
In non-cancerous cells, HER2 is responsible for normal cell growth as well as other essential cellular processes, whereas excessive levels of HER2 in cancer cells leads to fast growing tumours.
Around one in five women with breast cancer haveHER2 positive breast cancer, which can be more aggressive than someHER2 negative breast cancers. HER2 positive breast cancer may be hormone receptor positive or hormone receptor negative. This can affect the treatment chosen. HER2 positive cancers tend to spread faster than other breast cancers but are much more likely to respond to treatment with drugs that specifically target HER2 receptors. Since most HER2 positive tumours can be successfully targeted, HER2 is no longer a marker for a poor prognosis.
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Noninvasive Types Of Breast Cancer
In situ breast cancer cells are non-invasive and remain in a particular location of the breast, without spreading to surrounding tissue, lobules or ducts.
Breast cancer that does not spread beyond the milk ducts or lobules is known as in situ. The two types of in situ cancers are ductal carcinoma and lobular carcinoma.
Ductal carcinoma in situ
About 20 percent of newly diagnosed breast cancers are classified as DCIS, according to the ACS. DCIS starts out as a mass that grows in a milk duct, which carries milk from the lobules, or glands, to the nipple. A DCIS hasnt spread to other parts of the body. Over time, chances increase for the mass to break through the ductal walls into the surrounding tissue and fat of the breast. With advances in diagnostics and treatments, however, most patients treated for DCIS, also called stage 0 breast cancer, have positive outcomes.
Lobular carcinoma in situ
An LCIS is technically not considered cancer, but rather a change in the breast. In the breast are tens of thousands of tiny clusters of lobules to produce breast milk. Cells that resemble cancer cells may grow inside these lobules. LCIS tends to remain there and not spread. However, having LCIS puts you at an increased risk for invasive breast cancer, so your care team may want to monitor you in order to promptly address any changes.
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Adding To The Drift Away From Chemotherapy
In addition to improving progression-free survival and having fewer side effects, the ribociclib combination has an additional advantage, said Dr. Korde. Unlike chemotherapy, which requires frequent visits to the clinic for infusions, both ribociclib and hormone therapy are pills that patients can take at home.
Thats really important quality of life, she said.
The full results from the study still need to be reviewed and published before the ribociclib combination could become the standard of care, Dr. Korde added.
Some caution will also need to be used in interpreting the results from this trial since the study was a smaller phase 2 trial instead of a phase 3 study, Dr. Lu explained. Large phase 3 trials are usually needed to provide definitive answers about which treatment is better.
But considering the large difference in progression-free survival seen in this study, people might be less likely to volunteer for another study in which they might be assigned to receive chemotherapy, Dr. Korde explained.
Dr. Lu agreed, noting that “to conduct a phase 3 study … would be quite difficult, and I don’t expect that in the future there will be one.”
However, the progression-free survival difference between the two was so large that the likelihood comes from chance alone is relatively small. And its extremely reassuring that you can get a fast response with this therapy, Dr. Korde said.
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Her2 Positive Breast Cancer Treatment Information
HER2 positive breast cancer is a type of breast cancer that tests positive for the HER2 protein. In about 25 percent of all breast cancers, the HER2 gene, which is responsible for the production of the HER2 protein, has mutated, causing the body to make too many HER2 receptors. This causes breast cells to grow and divide uncontrollably.
HER2 positive breast cancer tends to be more aggressive than other types of breast cancer, as it is more likely to grow faster, spread and recur than other types of breast cancer. However, there are treatments designed to target HER2 specifically, and these have proven effective for many women with this malignancy.
Audit Of Discordant Cases
Of all cases, only 16 had discordant HER2 results between blocks tested. The features of these cases are summarized in . Testing of the largest focus yielded the most positive HER2 result in 242 of 246 cases. In 3 of the remaining 4 discordant cases , 2 different tumor foci showed different histologic types, with the smaller focus having the most positive HER2 result. The fourth discordant case was of 2 tumor foci with the same size, grade, and histologic type and ER/PR status . The largest tumor focus did not have the highest grade in all 246 cases . Nevertheless, in our series of all discordant cases with a difference in histologic grade, the tumor focus with the highest grade was also the largest.
Nine of the 16 discordant cases had invasive ductal carcinoma at all foci tested, with 1 of 9 cases showing different morphologic patterns. The remaining 7 of 16 cases had different histologic types at different foci . Three of the 16 cases had a different ER/PR status at each focus , and all 3 cases also had differences in either histologic type or grade between foci.
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What Is Her2 Breast Cancer Testing
HER2 stands for human epidermal growth factor receptor 2. It is a gene that makes a protein found on the surface of all breast cells. It is involved in normal cell growth.
Genes are the basic units of heredity, passed down from your mother and father. In certain cancers, especially breast cancer, the HER2 gene mutates and makes extra copies of the gene. When this happens, the HER2 gene makes too much HER2 protein, causing cells to divide and grow too fast.
Cancers with high levels of the HER2 protein are known as HER2-positive. Cancers with low levels of the protein are known as HER2-negative. About 20 percent of breast cancers are HER2-positive. HER2 positive cancers tend to grow and spread faster than other types of breast cancer. But treatments that specifically target HER2-positive breast cancer can be very effective.
HER2 testing looks at a sample of tumor tissue to find out whether you have HER2-positive breast cancer.
Other names: human epidermal growth factor receptor 2, ERBB2 amplification, HER2 overexpression, HER2/neu tests
What Is Invasive Lobular Carcinoma
Invasive lobular carcinoma starts in the breasts lobules. This cancer spreads to nearby tissue. ILC is the second most common type of invasive breast cancer, after invasive ductal carcinoma. Out of every 100 cases of breast cancer, 10 to 15 are ILC.
People who have ILC may notice a thick or full area that does not feel like the rest of the breast. ILC doesnt always form a lump.
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Cancer And The Female Breast
Figure: Breast and Adjacent Lymph Nodes
Figure: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Inside a woman’s breast are 15 to 20 sections, or lobes. Each lobe is made of many smaller sections called lobules. Fibrous tissue and fat fill the spaces between the lobules and ducts . Breast cancer occurs when cells in the breast grow out of control and form a growth or tumor. Tumors may be cancerous or not cancerous .
Additional Information
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30 107:djv048. doi: 10.1093/jnci/djv048. Print 2015 Jun.
What Does Her2 Positive Mean
HER2 is a protein that helps cancer cells to grow. HER2-positive cancers make too much HER2, so the cancer may grow more quickly. There are treatments that can target HER2, which are often good at keeping the cancer under control.
Is it common for cancers to be HER2 positive?
About 1 in 5 women has HER2-positive breast cancer.
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What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 1+, the cancer is considered HER2-negative. These cancers do not usually respond to treatment with drugs that target HER2, but new research shows that certain HER2 drugs might help in some cases .
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
Some breast cancers that have an IHC result of 1+ or an IHC result of 2+ along with a negative FISH test might be called HER2-low cancers. These breast cancers are still being studied but appear to benefit from certain HER2-targeted drugs.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
Her2 And Survival Analyses
Among the 420 women with available HER2 status, a total of 102 women experienced recurrences during follow-up. HER2 positivity in the primary DCIS was not a risk factor for IBE in women undergoing BCS ), . Interestingly, divided by type of IBE, HER2 positivity showed a borderline statistically significant increased risk of in situ IBEs , and no association with risk of invasive IBEs ), . Results from the multivariate analyses did not differ substantially from the univariate analyses .
Fig. 1
Ipsilateral Breast cancer Events according to HER2 status of the primary DCIS. Kaplan-Meier plots showing ipsilateral recurrence-free survival analyses among women with DCIS treated with breast conserving surgery with respect to HER2 status of the primary DCIS regarding all ipsilateral events , ipsilateral in situ events , and ipsilateral invasive events
The risk of IBCRs was statistically significantly lower subsequent to a HER2 positive DCIS compared to a HER2 negative primary DCIS ) . Remarkably, the curves in the Kaplan-Meier plot did not separate until after almost 10 years . In the multivariate analyses, HRs after adjustments were very similar to the crude analyses .
Fig. 2
Invasive recurrence-free-survival according to HER2 status of the primary DCIS. Kaplan-Meier plot showing invasive recurrence-free survival analyses among women with a DCIS with respect to HER2 status of the primary DCIS
Fig. 3
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