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Risk Management & Treatment

Breast cancer subtypes


Cell types

Breasts are made up of two main types of cells; the breast lobules, which make milk, and the breast ducts which carry the milk to the nipple.

  • Ductal carcinoma is cancer that starts in the ducts. This is the most common type of breast cancer.
  • Lobular carcinoma starts in the breast lobules. This is less common than ductal carcinoma.  

There are other, very rare types of breast cancer. Inflammatory breast cancer is a very fast growing type of ductal carcinoma. Paget's disease of the breast is a type of ductal carcinoma that affects the nipple and areola. Phyllodes tumors start in the connective tissue of the breast. 

image with anatomy of the breast
anatomy of the breast

Stages

The  of a cancer refers to whether the cancer has spread beyond the breast, and if so, where in the body the cancer has spread. Measuring the of breast cancer helps doctors decide how to treat it. Breast cancer most often starts as a lump within the breast that can grow and spread: 

  • within the breast
  • to nearby tissue (such as , skin or the chest wall)
  • through the blood stream or lymph system to distant organs (

In breast cancer, there are five major stages.  

  •  0: A  0 breast cancer is known as a ductal carcinoma in situ (), a non-invasive form of the disease. The tumor cells are contained within the ducts of the breasts, and have not invaded beyond the duct. Cancers caught and treated at  0 are very unlikely to recur or spread.
  • 1: A small tumor (< 2 cm) that is contained within the breast and has not spread to the .
  • 2: A  2 breast cancer can be either a larger tumor that involves the breast only, or a tumor that has spread to some  in the armpit.
  • 3: A  3 breast cancer can be either a tumor in the breast that invades the skin or chest muscle, or a tumor that involve several  surrounding the breast (in the armpit, near the collarbone, near the breast bone).  3 breast cancers are sometimes called “locally advanced.”
  • 4 or metastatic: A  4 breast cancer is one that has spread beyond the breast and the regional to another place in the body, such as the bone, lung, and/or liver.  IV breast cancers are also called “advanced” or “.”

Breast cancers diagnosed at stages 0-3 are considered curable, so treatment plans are made with the goal of cure.  breast cancer is often treatable at diagnosis. Over time, breast cancer is likely to progress or recur; sometimes after several different types of treatment. There are many different treatments available for breast cancer, and clinical trials testing new treatments are often available. 


Subtypes and biomarkers 

After a biopsy or surgery confirms breast cancer, pathologists look closely at the cells for additional clues on how to best treat the cancer. All breast cancers are tested for common changes, called tumor biomarkers: estrogen receptor (ER), progesterone receptor (PR), and . The results of these tumor tests play a major role in choice of cancer treatment:

ER/PR testing

  • Doctors use ER/PR tests to measure if cancers are "hormone sensitive" and might respond to hormone therapy.
    • ER/PR-positive: breast cancers with these biomarkers are called "hormone sensitive" breast cancers. These are usually treated with hormone therapy. Hormone therapy may be combined with chemotherapy or  depending on the  of the tumor and other factors. 
    • ER/PR-negative: these are almost always treated with chemotherapy and, or , because hormone therapy does not work well for these types of tumors.

testing

  • Doctors use  testing to measure the amount of protein on the surface of tumor cells. Cancers with a large amount of protein often respond to targeted therapies.
  • scores range from 0 to 3+.
    • HER2-positive: A tumor with a score of 3+ is considered . These cancers are often treated with a type of  known as "anti-HER2 therapy." Common anti-HER2 therapies include Herceptin (trastuzumab) and Perjeta (pertuzumab). Anti-HER2 therapy may be given with chemotherapy for people with , curable tumors. Patients whose tumors are  and ER-positive receive hormone therapy, as well as chemotherapy and anti-HER2 therapy.
    • HER2-low: In the past, a tumor with a score of 0 to 1+ was called and a score of 2+ was considered borderline. Updated scoring labels tumors with 1+ and 2+ as "HER2-low." Some people with advance or breast cancer that is HER2-low may benefit from an anti-HER2 therapy known as Enhertu (trastuzumab deruxtecan). 
    • HER2-negative: A tumor with a score of 0 is considered .  
       
possible  results
Test Result Status
Score is 0 Tumor is
Score is 1+ or 2+ Tumor is HER2-low
Score is 3+ Tumor is

  • Triple-negative breast cancers: tumors that are negative for all three markers (ER, PR and ) are referred to as  or sometimes "" for short. Triple-negative breast cancers are almost always treated with chemotherapy.

Additional tests can be performed on tumor samples or blood to help guide treatment.

  • For people with ( 1 or 2) cancer, prognostic tests can help guide decisions about chemotherapy and hormone therapy. These tests include Oncotype DX, MammaPrint, and Prosigna.
  • For people with advanced cancers, tumor testing can look for additional biomarkers to help guide the choice of targeted therapies. 
Last updated August 14, 2022

Get Support
Get Support

The following organizations offer peer support services for people with, or at high risk for breast cancer:

updated: 11/29/2022