The different types of breast cancer

Cancer cells can develop in different regions of the breast, in the ducts or lobules that make it up. There are basically two types of breast cancer:

Different types of breast cancer explained

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The basics of breast cancer

It is the most common cancer in women but also one of those that are detected and best treated.

It is estimated that nearly 58,000 new cases of breast cancer occur each year in France. This cancer accounts for more than 30% of malignant tumor diseases diagnosed in women. Its incidence has increased slightly in recent years and its mortality has been steadily decreasing for the past ten years. This is explained in particular by an improvement in the effectiveness of treatments and by an earlier diagnosis of the disease (knowing that, for all cancers, the earlier the diagnosis, the better the chances of recovery).

A matter of age

The occurrence of breast cancer is rare before the age of 30, 22% of women were under 50 at the time of diagnosis, then the risk of occurrence increases with age. Its incidence is greatest between the ages of 50 and 74, which justifies the choice of this age group for screening by mammography.

What are the risk factors?

Although the precise mechanisms for the occurrence of breast cancer are not precisely known, a number of risk factors for this cancer have been identified:

• Age: the older you get, the more the frequency of breast cancer increases.
• Family history: when a close relative (mother or sister in particular) has had breast cancer, the risk of being affected by this disease is increased. There are thus genetic predispositions which concern 5 to 10% of breast cancers.
• Exposure to estrogens: the risk is increased in the event of precocious puberty, first pregnancy after 40 years of age or absence of pregnancy, late menopause and taking replacement therapy for menopause.

Other factors, such as being overweight or heavy alcohol consumption, could also play a contributing role.

How is the diagnosis made?

Cancer is linked to the multiplication of abnormal cells.

By accumulating, they end up forming a mass, more or less important, called a malignant tumor. Palpation of a breast, by the woman herself or by a doctor, can detect a lump suggestive of cancer. However, only a breast X-ray, mammography, is able to reliably detect any abnormalities present. This examination provides images of the inside of the breast. For each breast, two shots are taken, one from the front and the second obliquely.

The detection of an anomaly on the mammogram does not make it possible to know whether it is cancerous or benign. For this, the cells constituting the anomaly must be examined under a microscope by a specialized doctor, a pathologist. It is then necessary to take a tissue sample from the anomaly. Different sampling techniques exist (cytological puncture or biopsy) to detect breast cancer, the choice of one or the other essentially depending on the location of the anomaly and its size.

It may be decided to remove an anomaly without prior biopsy.

Surgery is then scheduled. The surgeon begins by removing some of the tissue, which he immediately has examined by a pathologist. The latter informs the surgeon of the result while the operation is still in progress. Depending on whether the anomaly is benign or cancerous, the surgeon then adapts the type of intervention to be performed.

Mammography: how often?

Currently, women over the age of 50 are recommended to have a mammogram every two years. In France, systematic screening has been gradually organized and since January 1, 2004, it concerns all departments. As part of this screening, all women between the ages of 50 and 74 receive an invitation every two years to have a free mammogram. This must be carried out in an approved center and the x-ray images must be seen by two radiologists. Before the age of 50 and after the age of 74, screening by mammography is done on an individual basis.

The different types of breast cancer

Cancer cells can develop in different regions of the breast, in the ducts or lobules that make it up. There are basically two types of breast cancer: those that are limited exclusively to the interior of a duct or a lobule, which are called cancer in situ, and those that have spread to the surrounding tissues, called invasive cancers. In the second case, it happens that cancerous cells spread to the lymph nodes located near the breast (in the armpit); this is called lymph node invasion.

Treatment methods

Surgery

The treatment of breast cancer is primarily based on surgery. The procedure performed aims to remove the tumour. If it is bulky or badly located, removal of the breast is necessary. But surgeons generally try to keep the breast as intact as possible. Once the operation has been carried out, other types of treatment are often offered, in a complementary way. They aim to eliminate any cancerous cells that would not have been removed during surgery and thus prevent the risk of recurrence of breast cancer. These treatments are also prescribed when surgery cannot be considered.

The choice of one or more of these treatments depends essentially on the characteristics of the tumour.

Chemotherapy

It is based on the administration of drugs that attack cancer cells. Chemotherapy is usually started in the weeks following surgery. It can also be prescribed before surgery. In this case, chemotherapy aims to eliminate as many cancer cells as possible in order to reduce the size of the tumor and increase the chances of success of the surgery. The choice of drugs prescribed, the rate of administration and the duration of treatment are determined according to each patient.

Radiation therapy

It involves exposing the area where the tumor was located to rays that destroy any remaining cancer cells. The number of radiotherapy sessions is adapted to each patient.

Hormone therapy

Some cancers are sensitive to estrogen, hormones produced by the body, which promote their development. A test carried out from a sample of the tumor makes it possible to determine whether it is “hormone-sensitive” or not. If this is the case, drugs that block the action of estrogen are prescribed: this is hormone therapy.

This type of treatment is usually given for several years.

Targeted therapies

There are also targeted therapies for the treatment of breast cancer. These are drugs whose mode of action depends on the existence of a specific target on which they act directly. Some targeted therapies are for women whose cancer cells overexpress a specific protein. The presence of this protein is detected thanks to a test carried out on a sample of the tumour.

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