Breast cancer isn’t just one disease.
It’s classified in several different ways, and each one plays an important role in determining treatment and outcomes.
Anu Gaba, M.D., is a specialist in hematology and oncology at the Sanford Roger Maris Cancer Center in Fargo, North Dakota.
She said one important distinction for patients is whether the cancer is early stage or metastatic:
- Stages 1-3 are considered “early stage” and are often curable when detected early.
- Stage 4, also known as metastatic breast cancer, means the cancer has spread beyond the breast to other organs like the bones, liver, lungs or brain. While it can be treated, it’s not considered curable.
Doctors determine stage based on how far cancer has progressed while considering tumor size, involvement of the lymph nodes and if cancer has spread to other organs.
Diagnosis and defining ‘Stage Zero’
“Stage Zero” breast cancer refers to a condition called ductal carcinoma in situ (DCIS), a non-invasive precancerous condition.
This means abnormal cells are present, but they haven’t spread beyond the milk ducts.
“When we talk about breast cancer, we really mean invasive breast cancer,” Dr. Anu Gaba said. “DCIS is a single layer of cancerous cells that have not spread into deeper tissue.”
There’s some ongoing debate in the medical community, she said, about whether DCIS should be labeled as cancer since it behaves differently from invasive disease.
“But right now, we still treat it to prevent progression.”
The other important piece includes the status of the receptors to help doctors decide the best course of action.
Hormone receptors and their roles
There are three: the estrogen receptor, the progesterone receptor and the HER2 receptor.
- The estrogen receptor responds to the hormone estrogen.
- The progesterone receptor responds to progesterone.
- The HER2 receptor is a protein that controls how cells grow and divide.
According to Dr. Gaba, the most common type of breast cancer, based on markers, is estrogen receptor (ER)-positive, progesterone receptor (PR)-positive and HER2-negative, or ER/PR+ and HER2-.
She said that makes up about 70% of all cancers based on the receptor status.
Recognition of this pattern is important, she added, because this affects and can guide treatment.
“Patients who are ER-positive, PR-positive and HER2-negative actually have the best outcomes,” she said.
With this type of cancer, most times treatment can involve endocrine therapy without chemotherapy.
“The next best prognosis is ER/PR+ and HER2+,” she explained. “We may do not only endocrine therapy but chemotherapy along with a drug that targets the HER2 receptor.”
After that, the third category is ER/PR- and HER2+ where patients may not benefit from endocrine therapy but they would benefit from chemotherapy and HER2 targeted therapy.
“Triple negative breast cancer – no ER, PR or HER2 – is the most aggressive and treated with chemotherapy,” she said.
After nearly two decades of practice, Dr. Gaba said there are so many more options for treatment.
“We can now use less toxic and more effective drugs first,” she said.
Treatment and tumor boards
Cancer centers, like the Edith Sanford Breast Center, take a unique approach to improved cancer care with a tumor board involving medical specialists from multiple disciplines combining their shared expertise.
When they diagnose someone, a provider presents their patient’s case to a variety of specialists at cancer-specific tumor boards. The board reviews that diagnosis and collaborates on the patient’s best plan forward, providing the patient with a room full of expert opinions. Each case is also screened for clinical trial eligibility and the potential for research involvement.
Play podcast to learn more about tumor boards
“We have the ability to offer patients not just traditional treatment but a lot of supportive care throughout their journey,” Dr. Gaba said.
Teams include pathology, radiology, surgeons, psychological oncology programs, palliative care, genetic counseling and other support teams.
Why mammograms matter
While breast cancer affects 1 in 8 women, a screening mammogram is still the gold standard to detect and diagnose early.
Bottom line, mammograms are lifesaving.
“For a woman who receives regular mammograms, we can pick up cancers before a patient can palpate them, before they spread to the lymph nodes or other organs,” Dr. Gaba said. “By not getting regular mammograms, they may only become palpable when they’re really large, really noticeable with back pain for example. And ultimately when you get tested, the cancer has already advanced to Stage 4 and the treatment is more aggressive.”
For women at average risk, mammograms are recommended every year starting at age 40.
“That is the most important thing that patients need to know,” Dr. Anu Gaba said, “and the earlier we can catch this cancer, the better the chances of cure.”
Learn about screening and scheduling mammography at Sanford Health.
Learn more
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- Mammogram results are in. Now what?
- Young mom diagnosed with breast cancer 6 months postpartum
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Posted In Cancer, Cancer Screenings, Cancer Treatments, Healthy Living, Women's
