Invasive carcinoma of the breast

This condition is the result of atypical neoplastic cells (as seen in DCIS/LCIS) crossing the basement membrane (i.e. invasive).  This infiltration of the normal parenchyma increases the risk of metastasis and mortality.


  • Commonest female cancer and commonest cause of female cancer deaths
  • Incidence is on the increase (at the moment 1 in 9 women will develop breast cancer at some stage)

Risk factors

  • Age; geography; genes (BRCA); oestrogens (HRT carries a small risk- more likely to be high levels occuring naturally)
  • Length of reproductive life (early menarche/late menopause- again, hormone dependent); nulliparity; age of 1st child (the later the pregnancy the more risk); obesity; FHx/PMHx


  • Genes
    • BRCA 1/2
    • FHx
  • Hormones (oestrogens)
    • No. of menstrual cycles
    • (Exogenous hormones)
  • Environment
    • Smoking, diet etc

Pathological Types

  • Invasive carcinoma can arise from different tissues within the breast:
    • Ductal (70%)
    • Lobular (10)
    • Mucinous (2%)
    • Medullary (3%)
    • Tubular (2%)
    • Others e.g. cribiform/papillary
    • Mixed

Prognosis and Predictive factors

  • Grade (Degree of differentiation) (1-3)
    • Tubular differentiation (/3)
    • Nuclear pleomorphism (/3)
    • Mitotic activity (/3)
      • If =<5 – 1; if >5/=<7 – 2; if >7 – 3
  • Stage (TNM)
  • Completeness of excision
  • ER/Her2 status
    • Oestrogen receptor positive cancers are potentially responsive to anti-oestrogens (tamoxifen) and/or aromatase inhibitors (eg letrazole- more used in post-menopausal/obese women)
    • Human epidermal growth factor receptor 2 (her2) positive cancers are a potential target for trastuzimab (herceptin) (around 15% of all cancers)
  • Nottingham Prognostic Index
    • 0.2 × tumour size (cm) + Grade + Lymph node status (from TNM)
      • <3.4 has a good prognosis (similar to population survival)
      • 3.41-5.4 have a medium survival (42% at 5 years)
      • >5.41 have a poor prognosis (13% 5 year survival)


Mix of surgery, radiotherapy, chemotherapy and hormonal therapy depending on the severity.

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