Patient education
Types of Breast Cancer
There are two main types of breast cancer:
- Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
- Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.
Other types of breast cancer include:
- Invasive (or Infiltrating) Ductal Carcinoma (IDC)
- Invasive (or Infiltrating) Lobular Carcinoma (ILC)
There are several types of breast cancer, although some of them are quite rare. It is not unusual for a single breast tumor to be a combination of these types and to have a mixture of invasive and in situ cancer.
Ductal Carcinoma In Situ (DCIS)
Ductal carcinoma in situ (also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.
About 1 out of 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.
When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for an area of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with necrosis.
Lobular Carcinoma In Situ (LCIS)
Although not a true cancer, LCIS (also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer, and this is why it is included here. It begins in the milk-producing glands but does not grow through the wall of the lobules.
Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast. For this reason, women with LCIS should pay close attention to having regular mammograms.
Invasive (or Infiltrating) Ductal Carcinoma (IDC)
This is the most common type of breast cancer. It starts in a milk passage (duct) of the breast, has broken through the wall of the duct, and invaded the fatty tissue of the breast. At this point, it may have the ability to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 out of 10 invasive breast cancers are infiltrating ductal carcinomas.
Invasive (or Infiltrating) Lobular Carcinoma (ILC)
Invasive lobular carcinoma starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers are ILCs. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.
Breast Cancer Facts
This list has been adapted from American Cancer Society materials.
- One out of eight women will be diagnosed with breast cancer… that’s one every three minutes.
- One woman will die of breast cancer every 13 minutes… nearly 40,000 women each year.
- Monthly breast self examinations and annual clinical exams and mammograms in women 50 years and older could prevent as many as 30 percent of those deaths.
- The American Cancer Society recommends women begin annual screening mammograms at age 40. Women should begin breast self examinations as early as in their 20s.
- Breast cancer death rates have been steadily decreasing due to increased awareness of the importance of early detection and because of improved treatments. Today, there are more than 2.5 million breast cancer survivors in the U.S.
- Between 5 to 10 percent of breast cancers are linked to inherited genes. Women who have inherited these genes are 80 percent more likely to develop breast cancer. If your family history includes close relatives on either your mother’s or father’s sides who have had breast cancer at an early age, you may wish to seek genetic counseling to learn if you are at higher risk for breast cancer.
- If your mother, sister, or daughter have had breast cancer, your risk for it more than doubles. Genetic counseling and aggressive surveillance/treatment may be recommended by your doctor.
- More than 85 percent of women diagnosed do not have a family history of breast cancer… that’s why breast self examinations and annual exams and mammograms by your doctor are so important to early detection, treatment, and survival.
- You can reduce your risk of breast cancer with simple lifestyle choices… maintain a healthy weight… exercise regularly, even if it’s just a brisk walk 20 minutes each day… eat healthy foods…. and drink alcohol in moderation.
- Tobacco use is clearly linked with many kinds of cancers and other diseases, such as cardiovascular disease. If you smoke, consider quitting.
Risk Factors and Stages
Risk Factors
Studies show that the risk of breast cancer increases as a woman gets older. This disease is very uncommon in women under the age of 35. Most breast cancers occur in women over the age of 50 and the risk is especially high for women over age 60. Some risk factors include:
- Personal history of breast cancer – women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
- Family history – a woman’s risk for developing breast cancer increases if a relative had breast cancer, especially at a young age. Ten percent of breast cancers are hereditary. Genetic counseling is available at Shands Healthcare.
- Estrogen, which may play a role in breast cancer in various forms, including women who began menstruation at an early age (before age 12), who experienced menopause late (after age 55), who never had children or those who took hormone replacement therapy for long periods of time.
- Late childbearing – women who have their first child after they are 30 years old.
- Radiation therapy -women exposed to radiation therapy have higher risk of developing breast cancer.
- Alcohol- some studies suggest a slightly higher risk of breast cancer among women who drink alcohol.
The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. You are encouraged to discuss the results and your personal risk of breast cancer with your doctor.
Stages of Cancer
- Stage I and II are early stages of breast cancer in which the cancer has spread beyond the lobe or duct and invaded nearby tissue.
- Stage III is also called locally advanced cancer. In this stage, the tumor in the breast is large (more than 2 inches across) and the cancer has spread to axillary lymph nodes.
- Stage IV is metastatic cancer. The cancer has spread beyond the breast to other parts of the body or involves the entire breast and skin of the breast.
- Recurrent cancer means the disease has come back in spite of initial treatment.
Symptoms, Detection and Prevention
Women should look for these symptoms regularly to detect breast cancer:
- Breast or armpit lump or thickening
- Nipple scaling, retraction, thickening or discharge
- Skin dimpling or erythema
- Swelling
- Ulceration
- Breast pain
Physicians recommend self-examinations, mammograms and clinical breast examinations to aid in early detection.
- Learn how to do a breast self-examination.
The following are the American Cancer Society’s guidelines for the early detection of breast cancer:
- Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
- A clinical breast exam should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
- Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
- Women at increased risk (for example, family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (for example, breast ultrasound or MRI) or having more frequent exams.
Coordinated Cancer Care
The team of University of Florida physicians and surgeons at the UF Health Breast Center provide comprehensive evaluation and treatment plans for new patients with breast cancer or suspected breast cancer and offer second opinions for breast cancer patients making treatment decisions.
Prior relevant medical tests are collected and reviewed before a new patient meets with physicians. The coordinated cancer care at the UF Health Breast Center gives new patients the opportunity to meet with multiple breast cancer specialists, as needed, on the day of their initial evaluation. The process also accelerates breast cancer treatment planning and allows the team to schedule additional diagnostic tests that may be required before the final treatment decisions are made.
The breast cancer specialists regularly discuss and formulate patient treatment plans during the center’s weekly multidisciplinary breast cancer tumor board.
Patients can expect the latest innovative technology to provide extensive treatment options. The University of Florida breast cancer specialists at the Breast Center offer a wide range of technologies in convenient outpatient settings, including:
- Digital screening and diagnostic mammography with ultrasound
- Comprehensive Breast Magnetic Resonance (MR)Imaging Program
- MR guided breast biopsy localization
- Fine needle aspiration
- Ultra sound and computer guided stereotactic-core biopsy
- Breast conservation surgery
- Skin sparing mastectomy
- Nipple areolar skin sparing mastectomy
- Prophylactic mastectomy with immediate reconstruction for high risk women
- Sentinel lymph node biopsy
- Surgery for locally advanced or recurrent breast cancer
- Chemotherapy before surgery
- Partial breast irradiation
- 3D conformal
- Interstitial
- Mammosite
- Intraoperative radiation using Intrabeam technology
- Intensity modulated radiation therapy (IMRT)
- Stereotactic body radiotherapy
Intrabeam Radiation Therapy
Intraoperative Radiation Therapy for Breast Cancer
The Intrabeam radiation treatment system is a mobile irradiation device used in the operating room to deliver precise doses of radiation directly to the breast tumor site during the surgical removal of the tumor. Using the Intrabeam system, radiation therapy can be delivered at the same time as breast cancer surgery, bypassing much time and associated issues of traditional radiation therapy.
The Intrabeam system converts electricity into low energy X-rays and delivers radiation treatment through a rod with a spherical tip, which is placed in the cavity left in the breast tissue immediately following surgical removal of the tumor. The tumor bed is then irradiated for a period of 20 to 30 minutes while the patient is under general anesthesia.
A tremendous benefit of Intrabeam irradiation for patients is that it reduces or even eliminates the need for weeks of external radiation treatment following surgery for early stage breast cancers. Traditional radiation therapy for breast cancer that typically requires three to six weeks of treatments can be accomplished in 20 to 25 minutes using the Intrabeam treatment system during the surgery of select patients.
The Intrabeam radiation treatment system for breast cancer is available in less than one dozen treatment facilities nationwide, and the UF Health Breast Center is the first program in the state of Florida to utilize this technology.
For more information about Intrabeam radiation therapy for breast cancer, visit meditec.zeiss.com/intrabeam.
High Risk Clinic
Are you at high risk for breast cancer? Today, the chance of a woman developing invasive breast cancer in her lifetime is a little less than one in eight. But for some women the risk of developing the disease is much higher.
The High Risk Program at the UF Breast Center not only identifies women at a higher risk level but also provides individualized preventive care to reduce that risk. The program, led by UF medical oncologist Dr. Karen Daily, aims to ensure early detection and prevention.
Once enrolled, patients will benefit from the expertise of a compassionate and talented multidisciplinary team, which includes radiology, surgical oncology, plastic and reconstructive surgery, gynecology, reproductive endocrinology and infertility, psychology and social work.
For more information about the High Risk Program at the UF Breast Center or to make an appointment, please visit shands.org/breastcenter or call 352-265-7070.
Women considered at high risk have
- Family history of breast or ovarian cancer
- Prior thoracic radiation therapy
- Multiple breast biopsies
- Extended exposure to estrogen through reproductive history or hormone replacement therapy
High Risk Program services
Individualized risk assessment and creation of a unique plan, which may include:
- Digital mammography
- Breast MRI
- Genetic counseling and testing
- Chemoprevention
- Lifestyle modification
- Risk-reducing surgery and reconstruction
Follow-Up Care
Patients will continue to meet with one of the Breast Center staff members during their follow-up appointments with their surgeons and physicians to provide continuity of care. They also receive assistance with obtaining follow-up referrals, diagnostic testing and surgery scheduling.
The UF Health Breast Center maintains and updates a system for storing and reviewing all clinical notes, imaging, referrals and other diagnostic testing.
Additionally, the Breast Center staff provides assistance with continuing education and serves as a resource of information for patients.
Patient’s of the UF Health Breast Center have access to a single phone number they can call to get information about their files, follow-up appointments and other information. All patients are encouraged to call the direct line to the UF Health Breast Center with their questions or any problems they experience: (352) 265-7070.
Additional Breast Cancer Resources
For more information on breast cancer, please refer to the websites listed below: