Stage 3 Breast Cancer
- Stage 3A:
- The cancer has spread to 49 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumor can be any size.
- Tumors are greater than 5 cm, and the cancer has spread to 13 axillary lymph nodes or any breastbone nodes.
What Do The Results Of Hormone Testing Mean
Breast cancer patients who test positive for both estrogen receptors and progesterone receptors usually have a better-than-average prognosis for survival and a complete recovery than those who have no receptors present. Also, the more receptors and the more intense their reaction, the better they respond to hormone therapy. Patients with one type of receptor but not the other may still reap benefits from this form of treatment, but likely not to the same degree. As mentioned earlier, if the cancer is both ER- and PR-negative, it probably wont respond to hormone therapy. Typical response rates to hormone therapy are as follows:
- ER and PR positive: 75-80%
- ER positive and PR negative: 40-50%
- ER negative and PR positive: 25-30%
- ER negative and PR negative: 10% or less
Whos Eligible For The Breast Cancer Index Test
You may be eligible for the Breast Cancer Index test if:
- you were diagnosed with early-stage breast cancer
- the cancer was hormone-receptor-positive
- there was no cancer in your lymph nodes or the cancer is lymph-node positive and is in one, two, or three lymph nodes
- youve been taking hormonal therapy for 4 to 5 years and want to know if taking hormonal therapy for more time will be beneficial
Research has shown that extending hormonal therapy for 5 more years for a total of 10 years of hormonal therapy can offer benefits for some women diagnosed with early-stage, hormone-receptor-positive disease.
The Breast Cancer Index test is performed on preserved tissue that was removed during the original biopsy or surgery.
Because many women have troubling side effects, including hot flashes and joint pain, from hormonal therapy, they want to know if extending the time they take hormonal therapy is worth tolerating the side effects.
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Genomic Tests To Predict Recurrence Risk
Doctors use genomic tests to look for specific genes or proteins, which are substances made by the genes, that are found in or on cancer cells. These tests help doctors better understand the unique features of each patients breast cancer. Genomic tests can also help estimate the risk of the cancer coming back after treatment. Knowing this information helps doctors and patients make decisions about specific treatments and can help some patients avoid unwanted side effects from a treatment that may not be needed.
The genomic tests listed below can be done on a sample of the tumor that was already removed during biopsy or surgery. Most patients will not need an extra biopsy or more surgery for these tests.
For patients age 50 or younger
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Recurrence score less than 16: Hormonal therapy is usually recommended, but chemotherapy is generally not needed
-
Recurrence score of 16 to 30: Chemotherapy may be recommended before hormonal therapy is given
-
Recurrence score of 31 or higher: Chemotherapy is usually recommended before hormonal therapy is given
For patients older than 50
The tests listed above have not been shown to be useful to predict risk of recurrence for people with HER2-positive or triple-negative breast cancer. Therefore, none of these tests are currently recommended for breast cancer that is HER2 positive or triple negative. Your doctor will use other factors to help recommend treatment options for you.
How Does The Oncotype Dx Breast Dcis Score Test Work
The Oncotype DX Breast DCIS Score Test analyzes the activity of 12 genes that can influence how likely the DCIS is to come back, either as another DCIS or as invasive breast cancer.
The Oncotype DX Breast DCIS Score Test assigns a Recurrence Score a number between 0 and 100 to the DCIS. You and your doctor can use the following ranges to interpret your results for DCIS:
- Recurrence Score lower than 39: The DCIS has a low risk of recurrence. The benefit of radiation therapy is likely to be small and will not outweigh the risks of side effects.
- Recurrence Score between 39 and 54: The DCIS has an intermediate risk of recurrence. Its unclear whether the benefits of radiation therapy outweigh the risks of side effects.
- Recurrence Score greater than 54: The DCIS has a high risk of recurrence, and the benefits of radiation therapy are likely to be greater than the risks of side effects.
You and your doctor will consider the Recurrence Score in combination with other factors, such as the size and grade of the DCIS and the number of hormone receptors the cancer cells have . Together, you can make a decision about whether or not you should have radiation therapy.
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Magnetic Resonance Imaging May Be Used To Screen Women Who Have A High Risk Of Breast Cancer
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging . MRI does not use any x-rays and the woman is not exposed to radiation.
MRI may be used as a screening test for women who have a high risk of breast cancer. Factors that put women at high risk include the following:
- Certain gene changes, such as changes in the BRCA1 or BRCA2 genes.
- A family history with breast cancer.
- Certain geneticsyndromes, such as Li-Fraumeni or Cowden syndrome.
An MRI is more likely than mammography to find a breast mass that is not cancer.
Women with dense breasts who have supplemental screening show higher rates of breast cancer detection, but there is limited evidence about whether this leads to better health outcomes.
Colonoscopy Sigmoidoscopy And Stool Tests
Several screening tests have been shown to reduce the risk of dying from colorectal cancer. Colonoscopy and sigmoidoscopy not only detect colorectal cancer early but also help prevent the disease in the first place. That’s because these tests can find abnormal colon growths that can be removed before they become cancer. Expert groups generally recommend that people who are at average risk for colorectal cancer have screening with one of these tests at ages 50 through 75. For more information, see the Tests to Detect Colorectal Cancer and Polyps fact sheet and the PDQ® Colorectal Cancer Screening summary.
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After Treatment Maintain A Healthy Weight
Obese women have higher levels of estrogen circulating in their bodies than women who are in their ideal body weight range.
Many studies including a study conducted by researchers from the Iranian Institute for Health Sciences Research in Tehran, Iran, have demonstrated an association between body mass size and breast cancer in post-menopausal women.
If youre overweight, Taylor recommends losing weight through a healthy diet and regular exercise once youve finished treatment. Weight loss during treatment isnt typically encouraged, as this is often associated with undesired muscle loss, leading to fatigue, a suppressed immune system and a slower healing process.
Allow your body the nutrients it needs to fight cancer, she says. Once your treatment is done, consider meeting with a dietitian for individualized recommendations to decrease recurrence risk and support a healthy weight.
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Breast Cancer Gene Expression Tests
Gene expression tests are a form of personalized medicine – a way to learn more about your cancer and tailor your treatment.
These tests are done on breast cancer cells after surgery or biopsy to look at the patterns of a number of different genes. This process is sometimes called gene expression profiling.
The patterns found can help predict if certain early stage breast cancers are likely to come back after initial treatment. Doctors can also use the information from some of these tests to know which women will most likely benefit from chemotherapy after breast surgery.
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The Pathologist’s Assessment Of Biomarkers
Many factors influence the accuracy of detection of ER, PR, and HER-2 in the laboratory. These include pre-analytical factors , analytic factors , and post-analytic factors . Importantly, the results of these tests alone are the key determinants of what treatment is selected. The goal is to provide the right treatment to the right patient. The role of the pathologist is to accurately assess these biomarkers, which as indicated above is quite challenging and involved. The role of the oncologist is to treat the patient with one of several standardized therapies, such as endocrine therapy for ER/PR positive carcinomas, or trastuzumab for HER-2 positive carcinomas.
The Patient Undergoes A Breast Biopsy
Different methods may be used to get a sample of breast tissue to submit to the pathologists for evaluation. These methods include skin punch biopsy, fine needle aspiration , core needle biopsy, and excisional biopsy. The decision of which method to use is influenced by the characteristics of the mass as well as the patient’s breast tissue.
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What Are The Symptoms Of Inflammatory Breast Cancer
Symptoms of inflammatory breast cancer include swelling and redness that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange . These symptoms are caused by the buildup of fluid in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.
Other symptoms of inflammatory breast cancer include a rapid increase in breast size sensations of heaviness, burning, or tenderness in the breast or a nipple that is inverted . Swollen lymph nodes may also be present under the arm, near the collarbone, or both.
It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.
Breast Cancer Hormone Receptor Status
Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they fuel the cancer growth. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. Ask your doctor about your hormone receptor status and what it means for you.
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Does A Benign Breast Condition Mean That I Have A Higher Risk Of Getting Breast Cancer
Benign breast conditions rarely increase your risk of breast cancer. Some women have biopsies that show a condition called hyperplasia . This condition increases your risk only slightly.
When the biopsy shows hyperplasia and abnormal cells, which is a condition called atypical hyperplasia, your risk of breast cancer increases somewhat more. Atypical hyperplasia occurs in about 5% of benign breast biopsies.
Can Breast Cancer Be Prevented
You may be able to help prevent breast cancer by making healthy lifestyle changes such as
- Staying at a healthy weight
- Limiting alcohol use
- Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy
If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy to prevent breast cancer.
It’s also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.
NIH: National Cancer Institute
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Clinical Breast Exams And Regular Breast Self
Routine examination of the breasts by health care providers or by women themselves has not been shown to reduce deaths from breast cancer. However, if a woman or her health care provider notices a lump or other unusual change in the breast, it is important to get it checked out. For more information, see the PDQ® Breast Cancer Screening summary.
Molecular Breast Imaging Gives An Inside Look At Cancer Cell Activity
Researchers are also exploring the possibility of using molecular breast imaging to detect breast cancer. It may be used together with a mammogram or ultrasound for women who have dense breast tissue or are at higher risk of developing breast cancer.
This form of imaging works by injecting small amounts of radioactive material into the arm. Then, small cameras record the tracer for about 40 minutes to create images of each breast. Cancer cells absorb the tracer faster than regular cells, so areas that show the most tracer will appear highlighted in the image. This technology may help doctors get a better look at breast tissue to determine whether a biopsy is needed, which can help you avoid unneeded procedures.
Molecular breast imaging is a new technology and is not yet widely available. You can learn more from Mayo Clinic.
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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 or 1+, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
- 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.
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.
Triple-positive breast tumorsare HER2-, ER-, and PR-positive. These cancers are treated with hormone drugs as well as drugs that target HER2.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Revised: September 20, 2019
Breast Cancer Signs And Symptoms
Any of the following symptoms should be checked out by your doctor. They could occur for a number of reasons including breast cancer or non-cancerous conditions. It is always best to report any changes to determine the causes.
- Lump or mass
- Change in size or shape of the breast or nipple
- Change in color to breast or nipple
- Inverted nipple
- Swelling or thickening of the breast
- Consistent pain
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Who Needs Hormone Receptor Testing
Hormone receptor testing is generally recommended for all breast cancers, including DCIS. If your doctor orders this test, you may be asked to discontinue taking any prescribed hormones for a period of time before the breast tissue sample is obtained. Usually, the sample comes from a biopsy, but the test may also be performed on tissue removed during a lumpectomy or mastectomy. It is standard of care however to obtain these types of pathology results on biopsy tissue.
Risk Factors For Male Breast Cancer
You may be at increased risk of developing male breast cancer if you have a family history of breast cancer or an inherited mutation, or alteration, in BRCA1 and BRCA2, the breast cancer genes. Breast cancer gene mutations are rare in men, but male breast cancers can be associated with them.
Normally, BRCA1 and BRCA2 produce proteins that help prevent cancer growth. When either one of these genes mutates, or becomes abnormal, it raises a persons risk of developing breast cancer.
These gene mutations are rare in the general population. They occur more often in people of Ashkenazi Jewish descent. BRCA1 and BRCA2 testing, which involves a blood test, is available at NYU Langone.
If you have been diagnosed with male breast cancer, your NYU Langone doctor may encourage you to be tested for these gene mutations. If the test is positive, your doctor may recommend that your family members be tested. If other men in your family have BRCA1 or BRCA2 mutations, your doctor can discuss breast cancer screening options with them. NYU Langone also offers a screening and prevention program for women at high risk of developing breast cancer.
Older age also increases breast cancer risk in men. Most men who are diagnosed are 60 to 70 years old.
Symptoms of male breast cancer may include a painless lump in the breast thickening, scaling, or redness around the nipple or nipple discharge.
After a physical exam, NYU Langone doctors may perform one or more diagnostic tests.
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