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What Is Pre Breast Cancer

Types Of Breast Carcinomas

Fine Needle Aspiration Cytology of Breast Lump

Within the large group of carcinomas, there are many different types of breast cancer. The first major division is between in situ and invasive carcinoma. In situ carcinoma is “pre-invasive” carcinoma that has not yet invaded the breast tissue. These in situ cancer cells grow inside of the pre-exisiting normal lobules or ducts. In situ carcinoma has significant potential to become invasive cancer, and that is why it must be adequately treated to prevent the patient from developing invasive cancer. Invasive cancers have cancer cells that infiltrate outside of the normal breast lobules and ducts to grow into the breast connective tissue. Invasive carcinomas have the potential to spread to other sites of the body, such as lymph nodes or other organs, in the form of metastases.

Approximately 80% of breast carcinomas are invasive ductal carcinoma, followed by invasive lobular carcinomas which account for approximately 10-15% of cases. Invasive ductal carcinomas and invasive lobular carcinomas have distinct pathologic features. Specifically, lobular carcinomas grow as single cells arranged individually, in single file, or in sheets, and they have different molecular and genetic aberrations that distinguish them from ductal carcinomas. Ductal and lobular carcinomas may have different prognoses and treatment options, depending upon all of the other features of the particular cancer.

Benign hyperplasia of the breast epithelial cells lining the ducts and lobules.

A mass.

Atypical Ductal Hyperplasia Of The Clinging Type Flat Epithelial Atypia

In recent years, screening with mammography is being performed with increasing frequency to detect breast cancer at an early stage. Using mammography screening, microcalcifications are a relatively frequent finding, leading to guide-wired excisions or core needle biopsies from these areas of microcalcification. As a result, breast lesions leading to microcalcifications are seen by pathologists with increasing frequency.

A particular lesion detected by microcalcifications is described by Fraser et al. : ‘We have noted in breast biopsies performed for microcalcifications a spectrum of lesions in the terminal duct lobular unit characterised by columnar epithelial cells with prominent apical cytoplasmic snouts, intraluminal secretions, and varying degrees of nuclear atypia and architectural complexity. The appearance of some of these lesions is worrisome, but diagnostic difficulties arise because the histological features do not fulfil established criteria for the diagnosis of atypical ductal hyperplasia or ductal carcinoma in situ . We have termed such lesions columnar alteration with prominent apical snouts and secretions .’

Figure 2

How Is Ductal Carcinoma In Situ Diagnosed

The sooner this type of cancer is found, the sooner it can be treated. The following tests or procedures are usually used to diagnose DCIS:

  • Breast examination: A routine breast exam is usually part of a regular physical. It is the first step in detecting breast cancer. Although DCIS does not usually come with a noticeable lump, the doctor may be able to feel an abnormal growth in the breast, such as a small, hardened spot, during a physical examination. The doctor will also look for any skin changes, nipple changes or nipple discharge. Most times, though, the abnormal growth will show up on a mammogram.
  • Mammogram: DCIS is usually found during a mammogram. As old cells die off and pile up within the milk duct, they leave tiny, hardened calcium spots which show up as a shadow or white spot on a mammogram.
  • Biopsy: If a spot or a shadow is found on the mammogram, the doctor will recommend a biopsy.
  • Core needle biopsy: With this procedure, the doctor inserts a large needle into the breast to get a big sample of the breast tissue that looked abnormal on the mammogram. The doctor will first numb the skin at the site of the biopsy and then make a small incision in the skin to help get the needle into the breast. Because the skin has been cut, there will be a tiny scar which will fade over time.

Biopsies are only used to diagnose that there is cancer within the breast. If cancer is found, surgery will be recommended to remove the abnormal cells.

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What Is Breast Cancer

Click to see larger diagrams of the anterior viewimage icon and cross-section viewimage icon of the breast.

Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Who Can I Speak To

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An experienced team is available to help you. Many women find treatment for DCIS difficult to comprehend as they are facing treatments similar to women with invasive breast cancer, yet they have an early stage breast change, often without symptoms. Please talk to your doctor, nurse or radiation therapist about anything that is worrying you.

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What Is Stage 0 Lcis

Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.

If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.

How Likely Is Dcis To Come Back

The chance of the DCIS coming back depends on various factors. But after mastectomy DCIS almost never comes back. In women who have just the area of DCIS removed the chance of it coming back is a bit higher. But it depends on the grade and type of DCIS.

Your doctor can give you more information about the chance of the DCIS coming back in your case.

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When To Consider Joining A Clinical Trial

If youre newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after diagnosis. So, theres time to look for a clinical trial that youre eligible for and fits your needs.

Once youve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.

Learn more about clinical trials.

What Are The Symptoms Of Dcis

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DCIS usually has no symptoms. Most cases of DCIS are found during routine breast screening or if a mammogram is done for some other reason.

Occasionally DCIS is found when someone has a breast change such as a lump or discharge from the nipple. However, if someone with DCIS has a breast change its more likely they will also have an invasive breast cancer.

Some people with DCIS also have a type of rash involving the nipple known as Pagets disease of the nipple, although this is rare.

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Should You Watch And Wait

Some experts believe âwatchful waitingâ is another valid option. About one third of the women with DCIS will likely get invasive cancer. Your doctor might suggest that you skip immediate treatment and keep a close eye on your condition instead.

Itâs controversial. If you have surgery right away, you might protect yourself from ever getting invasive cancer. On the other hand, you could end up going through painful procedures for no good reason.

But if you skip surgery and radiation at first and choose to get more frequent screening tests, there’s a chance you’ll end up with cancer that’s more advanced by the time doctors find it. It’s a choice only you and your doctor can make.

Show Sources

American Cancer Society: âBreast Cancer Survival Rates, by Stage,â “How is Breast Cancer Classified?” âHow is Breast Cancer Staged?â âUnderstanding Your Pathology Report,â “Breast Cancer.”

NIH National Cancer Institute: âNCI Dictionary of Cancer Terms,â âPaget Disease of the Breast.â

National Breast Cancer Foundation: âStages 0 and 1.â

Mayo Clinic: âDuctal Carcinoma In Situ .â

National Comprehensive Cancer Network: âNCCN Guidelines for Patients: Breast Cancer Carcinoma in Situ.â

UT Southwestern Medical Center: âPersonalized Treatment is Key for Stage 0 Breast Cancer.â

Prescrire International, December 2013.

What Are Tumor Marker Tests For Breast Cancer

Tumor markers are typically proteins that are produced by cancer cells, many of which can be found in the blood. Some examples of such tumor markers in breast cancer are:

  • CA 15-3 and CA 27.29: CA 15-3 and CA 27.29 are two related markers that are made in higher amounts by breast cancer cells. As such, when theyre found in the blood, they can signal the presence of breast cancer.
  • Carcinoembryonic antigen :CEA is a marker thats often used for colorectal cancer. However, it can also be applied to other types of cancer as well, including breast cancer.
  • CA 125: CA 125 is a marker thats most often associated with ovarian cancer, but can also be a sign of breast cancer.

Additionally, sometimes parts of a tumor can break off and circulate in the blood. These circulating tumor cells can also be used as a tumor marker. High amounts of CTCs in the blood can mean that cancer is growing and spreading.

Tumor marker tests can be used by doctors to gauge the level of cancer activity in your body. This information may be useful to:

  • evaluate how your cancer is responding to your current treatment
  • see if your cancer has spread to other areas
  • determine if a cancer thats been in remission has come back

Tumor marker tests can help to inform treatment decisions. For example, if a tumor marker is elevated, it may indicate that your current treatment isnt working. Your doctor may use this information to switch or adjust your treatment.

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What Does It Mean To Have Stage 1 Breast Cancer

In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.

Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.

What Is A Normal Breast

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No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institutes Breast Changes and Conditions.external icon

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How Is The Stage Determined

The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:

  • The pathologic stage is determined by examining tissue removed during an operation.
  • Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.

In both staging systems, 7 key pieces of information are used:

  • The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
  • The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
  • The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
  • Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
  • Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
  • HER2 status: Does the cancer make too much of a protein called HER2?
  • Grade of the cancer : How much do the cancer cells look like normal cells?

In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.

What Is The Prognosis For Patients Who Have Ductal Carcinoma In Situ

Because DCIS is contained within a specific area of the breast and has not spread, the disease can be controlled and cured with appropriate treatment. After treatment, the outcome for the patient with DCIS is usually excellent.

However, those patients who have had DCIS, even if treated successfully, are at a greater risk than people who have never had breast cancer to have the cancer return or for another type of breast cancer to develop.

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Kinds Of Breast Cancer

The most common kinds of breast cancer are

  • Invasive ductal carcinoma. The cancer cells begin in the ducts and then grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body.
  • Invasive lobular carcinoma. Cancer cells begin in the lobules and then spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

What Is The Treatment For Dcis

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Lumpectomy with radiation. The standard treatment is breast-preserving surgery with radiation therapy, which results in successful outcomes for most patients. Cancers can be larger than expected, so about 20% of the time, patients need a re-excision lumpectomy another surgery to remove all of the cancer. Typically, the remaining breast will then have radiation therapy to reduce the risk of local recurrence. Lumpectomy plus radiation is a good alternative to mastectomy for treatment of DCIS.

Mastectomy. Some patients have ductal carcinoma in situ in more than one quadrant of the same breast . Sometimes, the DCIS is very large relative to the patients breast size. In these situations, a mastectomy is required to address malignant cells that are more widespread. Radiation therapy is not needed for DCIS treated with mastectomy.

Chemotherapy. Chemotherapy is not needed for DCIS since the disease is noninvasive.

Hormonal therapy. Hormonal therapy may be appropriate for those whose ductal carcinoma in situ is hormone receptor positive.

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How Common Is Ductal Carcinoma In Situ

The American Cancer Society expects that 63,960 new cases of DCIS will be found in 2018. Today more and more women are aware of the importance of early detection and are getting mammograms each year. Because of this, the number of cases of DCIS has increased. In addition, mammography technology has greatly improved as well and is better able to detect problems at an earlier stage. An estimated 12.4% of women in the U.S. will develop invasive breast cancer at some time in their lives.

Whole Exome Sequencing And Primary Analysis

Library preparation

DNA was sheared down to 200 base pairs using Adaptive Focused Acoustics on the Covaris E220 following manufacturer recommendations with 10L Low EDTA TE buffer supplemented with 5L of truSHEAR buffer using a microTUBE-15. Libraries were prepared using the Accel-NGS 2S PCR-Free DNA Library Kit . Ligated and purified libraries were amplified using KAPA HiFi HotStart Real-time PCR 2X Master Mix . Samples were amplified with 5L of KAPA P5 and KAPA P7 primers. The reactions were denatured for 45seconds at 98°C and amplified 1315 cycles for 15sec at 98°C, for 30sec at 65°C, and for 30sec at 72°C, followed by final extension for 1min at 72°C. Samples were amplified until they reached Fluorescent Standard 3, cycles being dependent on input DNA quantity and quality. PCR reactions were then purified using 1x AMPure XP bead clean-up and eluted into 20L of nuclease-free water. The resulting libraries were analyzed using the Agilent 4200 Tapestation and quantified by fluorescence .

Capture and sequencing

Sequencing reads processing and coverage quality control

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Symptoms Of Breast Cancer

Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should also see a GP if you notice any of these symptoms:

  • a change in the size or shape of one or both breasts
  • discharge from either of your nipples, which may be streaked with blood
  • a lump or swelling in either of your armpits
  • dimpling on the skin of your breasts
  • a rash on or around your nipple
  • a change in the appearance of your nipple, such as becoming sunken into your breast

Breast pain is not usually a symptom of breast cancer.

Find out more about the symptoms of breast cancer.

What Are The Symptoms Of Breast Cancer

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Breast pain can be a symptom of cancer. If you have any symptoms that worry you, be sure to see your doctor right away.

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer are

  • New lump in the breast or underarm .
  • Thickening or swelling of part of the breast.
  • Irritation or dimpling of breast skin.
  • Redness or flaky skin in the nipple area or the breast.
  • Pulling in of the nipple or pain in the nipple area.
  • Nipple discharge other than breast milk, including blood.
  • Any change in the size or the shape of the breast.
  • Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer.

If you have any signs or symptoms that worry you, be sure to see your doctor right away.

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