Most breast malignancies arise from epithelial elements and are categorized as carcinomas. They differ based upon their appearance under a microscope and biologic behaviors. Breast cancer appears physically as a lump or changes in the anatomy of the breast, including dimpling of the skin, inversion of nipple or discoloration of the skin. To evaluate changes in breasts, a mammogram and breast ultrasound are usually needed initially and if a suspicious lesion is found, a breast biopsy is needed.
Breast Cancer is categorized as In situ carcinomas arise in ducts of the breast (called DCIS) or lobules of the breast (called LCIS). DCIS lesions are at higher risk of subsequent invasive carcinoma versus LCIS and are treated with lumpectomy followed by radiation therapy.
Invasive carcinomas invade beyond the ducts or lobules of the breast into surrounding tissues. Infiltrating ductal carcinomas make up 70-80 percent of invasive lesions, versus infiltrating lobular carcinomas, which make up 5-10 percent. The lobular type’s incidence rate is rising faster than the ductal type in the US, and postmenopausal hormone therapy may be strongly related to its risk. Other invasive breast cancers include tubular, mucinous, medullary, invasive micropapillary, metaplastic, and adenoid cystic carcinomas.
Breast cancer is further categorized into Hormone receptors (Estrogen and Progesterone) positivity as more than half of breast cancers require estrogen to grow. ER-positive cancers respond to hormone therapies, which either lower estrogen levels or block actions of estrogen.
Screening for breast cancer should incorporate an individual’s level of cancer risk and a person’s desire to do a screening. The most commonly used model to assess risk is the Gail Model, available online at cancer.gov/bcrisktool.
Please contact our office to discuss your risk for breast cancer and any of your concerns regarding this topic, including treatment.
