Breast Cancer Early Stage

by Women's Health Information Center

What type of tumor do I have? What does "invasive" mean?

A "tumor" is an abnormal growth that can be "benign" or "malignant." Benign breast tumors do not threaten life and do not spread to other parts of the body. Malignant breast tumors are cancers that may threaten life and may spread to other parts of the body. A malignant tumor that grows into surrounding tissues is called "invasive." Invasive tumors are more likely to spread to other parts of the body than non-invasive tumors.

What does "lobular" mean? What does "ductal" mean? What does it mean for my treatment?

Each breast is composed of up to 20 sections called "lobes." Each lobe is made up of many smaller "lobules," where milk is made. Lobes and lobules are connected by small tubes called "ducts" that can carry milk to the nipple.

Lobular carcinoma in situ (LCIS) is a benign tumor that consists of abnormal cells in the lining of a lobule. Even though "carcinoma" refers to cancer, LCIS is not a cancer and there is no evidence that the abnormal cells of LCIS will spread like cancer. Instead, having LCIS means that a woman has an increased risk of developing breast cancer in either breast. Despite the increased risk, most women with LCIS will never get breast cancer. No treatment is necessary and surgery is not usually recommended for LCIS. Occasionally women with LCIS choose bilateral mastectomy as a preventive measure, but most surgeons consider this inappropriate. Some women choose to take tamoxifen to decrease the likelihood of breast cancer. LCIS is sometimes called "Stage 0" breast cancer, but that is not really accurate because it is not really cancer.

Ductal carcinoma in situ (DCIS) is made up of abnormal cells in the lining of a duct. It is a non-invasive malignant tumor, and is also called intraductal carcinoma. The abnormal cells have not spread beyond the duct and have not invaded the surrounding breast tissue. However, DCIS can progress and become invasive. There is no official recommended surgical treatment for DCIS, although a national Consensus Conference held in Philadelphia in 1999 concluded that "most women with DCIS" are eligible for breast-conserving surgery and that less than one in four require mastectomy. The addition of radiation therapy helps prevent recurrence of DCIS and the development of invasive breast cancer. If the DCIS is spread out or is in more than one location, some women will choose to undergo a mastectomy. In the treatment of DCIS, underarm lymph nodes usually are not removed with either breast-conserving surgery or mastectomy. Tamoxifen is sometimes used in combination with one of these two surgical treatment options.

DCIS is sometimes called Stage 0 breast cancer because it is not invasive.

What is an "early stage" breast cancer?

Invasive breast cancer is categorized as Stage I, II, III, or IV. Stages I and II are considered "early stage" invasive breast cancer and generally refer to smaller tumors that have not yet spread to distant parts of the body.

After the health professional explains surgical options, such as breast-conserving surgery (often called lumpectomy) with radiation, modified radical mastectomy, or simple mastectomy, these are the questions most patients will want to ask.

What's my chance of surviving this cancer with each treatment?

Most women who are newly diagnosed with early-stage breast cancer have a choice: breast-conserving surgery (such as lumpectomy) or a mastectomy (also called a modified radical mastectomy). The decision is not between your breast and your life. Women with early-stage breast cancer who undergo breast-conserving surgery with radiation therapy live just as long as those who undergo mastectomy. Life expectancy is the same regardless of which choice a woman makes.

When the patient is told that the survival rate for lumpectomy with radiation is the same as for mastectomy, some women may be surprised or skeptical.

Why would any woman pick mastectomy if the survival rate is the same?

Thanks to early detection, between 70 and 75 percent of women diagnosed with breast cancer today are possible candidates for lumpectomy or other breast-conserving surgery. Yet, half of these women undergo mastectomies instead. Some of those women are making a well-informed choice. Some do not know that they have a choice. And, because of the costs of health care, some cannot afford to make the choice they would prefer.

Unfortunately, cost sometimes prevents women from choosing breast-conserving surgery. Lumpectomy followed by radiation costs more in the short-term than mastectomy, and some insurance plans do not cover all the expenses of the lumpectomy or the radiation therapy. Reconstruction of the breast after mastectomy adds to the cost, but the law requires that insurance covers that expense. Despite the slightly higher cost of lumpectomy and radiation, that choice is actually less expensive if you look at costs for the five years after the initial diagnosis. Lumpectomy preserves the breast and there are few additional costs when the radiation treatment is completed, whereas breast reconstruction after a mastectomy may require several surgeries that add to the cost over time. This information may help women who are concerned about cost to decide what is best for them.

Another reason why women choose mastectomies is because they do not want to undergo radiation therapy or are unable to arrange radiation treatments. Radiation therapy is usually an outpatient procedure performed over a period of at least 5 weeks, and some women are not able to make that commitment. Some women live far away from radiation facilities, or can't afford to take the time for daily treatments. Others may have health conditions such as lupus or heart disease that prevent them from undergoing radiation. Since radiation reduces the chances of recurrence for women choosing lumpectomy, it is important that patients and their doctors consider the required time commitment to radiation therapy before deciding which surgical procedure is best for them.

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