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Invasive Ductal Carcinoma of the Breast
By Jennifer Reilly, MD candidate and Kitt Shaffer, MD (May 11, 1998)
Breast cancer (CA) is one of the few cancers in which screening has a proven effect on mortality rates. Multiple studies have demonstrated that the use of screening mammography in asymptomatic women can reduce breast cancer mortality by as much as 20-30%, particularly in women over 50 years. The use of mammography is believed to decrease mortality because it can be used to detect small, nonpalpable lesions which are more likely to be "node negative" than palpable breast lesions noted by the patient or physician on breast exam. Negative axillary node status is a strong prognostic indicator for survival.
The classic signs of occult malignancy on mammogram include clustered microcalcifications and spiculated masses. Between 75% and 85% of spiculated lesions are later found to be malignant. Microcalficiations, which are generally associated with ductal carcinoma in situ (DCIS), are found to be malignant in 20-25% of biopsies. Other indirect signs of malignancy include architectural distortion, increasing tissue density, asymmetric breast tissue, and the presence of a single dilated duct. Benign lesions, in contrast, are typically well circumscribed lesions (less than 1 cm in diameter) without microcalcifications and do not change over time. Though benign fibroadenomas can calcify, such calcifications appear coarser, denser and larger than the microcalcifications associated with malignancy (classic "popcorn" calcifications). Breast masses can also be evaluated using ultrasound to determine whether they are solid or cystic. Ultrasound images are routinely obtained for non-spiculated masses noted on mammography.
Core needle biopsy is an attractive alternative to both surgical biopsy and fine needle aspiration (FNA) because
- it is highly accurate,
- it has been demonstrated by several studies to be as successful as surgical biopsy at acheiving diagnosis,
- it does not leave a scar,
- it is much less costly than surgery, and
- it has minimal associated morbidity.
Ductal Carcinoma In Situ (DCIS)
In ductal carcinoma in situ, cancer cells are present inside the milk ducts but they have not yet spread through the walls of the ducts into the fatty tissue of the breast. For this reason, nearly 100% of women diagnosed at an early stage can be cured. The best way to monitor and prevent getting ductal carcinoma in situ is with a yearly mammogram. Left unchecked, it may develop into invasive breast cancer.
Invasive Ductal Carcinoma Picture
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma accounts for nearly 80% of breast cancers. It also begins in a milk duct, but unlike ductal carcinoma in situ, it invades the fatty tissue of the breast. This invasive carcinoma has the potential to metastasize [meh-TAS-ti-size], or spread to other parts of the body through the bloodstream or lymphatic system. It is important to detect and treat invasive ductal carcinoma before it has had time to metastasize and spread to other organs.
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