Screening & Detection Archives - Dr. Lindsay Keith | Surgical Breast Oncologist | Breast Cancer Surgeon

When you are first diagnosed, your doctor will determine your “clinical stage”, which is based on a number of things. As of January 1, 2018, the biology, or receptor status of breast cancer cells, became part of staging.

All breast cancers will have the receptor status determined by a pathologist, who will determine if the tumor is positive or negative for estrogen (ER), progesterone (PR) or HER2 receptors. The staging is now very complex as a result of this addition but this information along with the size of your tumor, whether the cancer appears to have spread to lymph nodes or other organs will determine your clinical stage.

Initial treatment of your breast cancer will be determined by this clinical stage, and final stage is determined after surgery. A breakdown of the stages of breast cancer is provided below. Breast cancer and most other cancer stages are named with numbers and letters beginning with 0 (or in situ disease) and then described with Roman numerals progressively with I through IV. These stage numerals are followed by A, B or C in most cases.

Here is a general breakdown of the stages*

*please note that the tumor biology will change this slightly and this is a general overview

Stage 0

If you are going to get breast cancer, this is the earliest stage at which it can be detected, or “picked-up”, typically but not always as calcifications that appear on your mammogram. This type of breast cancer starts in the “milk ducts” that carry milk from the milk lobules (where milk is made) and carry milk to the nipple. A common term for this stage of cancer is “in situ”, meaning “in place” or non-invasive breast cancer. This means that it is entirely contained within the duct and has not invaded into the surrounding breast tissue.

By definition, this type of breast cancer by itself cannot spread to lymph nodes or other organs, because it does not have access to lymphatic or blood supply in order to do so. Because of this, many people call this type “pre-cancer”, but it is still breast cancer and is treated as such. In fact, non-invasive cancer is often seen combined with invasive breast cancer, which does have the ability to spread outside the breast, described below.

Stage I

Stage I breast cancer is the first stage of invasive cancer. It is further classified into IA and IB.

In general, stage IA and IB describes a tumor that is small (≤2cm) and has either no spread to the lymph nodes or minimal spread to the lymph nodes.

Stage II

In general, stage II breast cancers are still considered early, but either the tumor is somewhat large (>2cm but ≤5cm) or there is some degree of spread to a limited number of lymph nodes, but not both.

This is further divided into Stage IIA or IIB depending on which factor above is true and the biology of the tumor.

Stage III

The cancer is considered late stage at this point and is becoming more difficult to fight, but is still considered curable.

Stage IIIA – The tumor can be any size but does not involve the chest wall or breast skin, and has also spread to at least 4-9 lymph nodes OR the tumor is >5cm and involves only 1-3 lymph nodes.
Stage IIIB – Here, a tumor of any size has grown into the chest wall (ribs beneath the breast) or into the skin of the breast or may be “inflammatory breast cancer”. It still may or may not have spread to any lymph nodes, or may be in up to 9 axillary or internal mammary lymph nodes, but has not spread to the rest of the body.
Stage IIIC – This describes a tumor that involves 10 or more lymph nodes in the axilla, internal mammary lymph nodes or lymph nodes surrounding the collarbone. This includes inflammatory breast cancer as well but still has not spread to other parts of the body.

Stage IV

At this stage, the breast tumor can be any size, involve any number of lymph nodes, but has spread to other parts of the body. The lungs, liver, bones or brain are the most common sites that this particular tumor tends to spread to. The common medical term for Stage IV cancer is “metastatic”. This means the cancer has spread beyond the region of the body where it originated. Breast cancer is only metastatic at diagnosis about 5-6% of the time, most often when breast cancer is inflammatory or neglected for some time.

Where to go for treatment of breast cancer treatment by stage

If you live in Tennessee and suspect you may have breast cancer or have already received that diagnosis, contact Lindsay Keith, M.D. for professional,caring guidance to treat it. She is affiliated with Murfreesboro Surgical Specialists, and you can reach her by phone at (615) 900-2621.

How serious is breast cancer in men?

We used to think that breast cancer in men was more severe than it was in women, but now we understand that survival based on stage at diagnosis is the same. Furthermore, in comparison to women, male breast cancer tends to occur later in life, have early nipple involvement and have a higher grade and stage at diagnosis. Also, male breast cancer tends to be the most common type of breast cancer, invasive ductal carcinoma, and expresses estrogen receptors more often than in women. Unfortunately, there is no routine screening (i.e., yearly mammogram) available for men, as the cost of screening every man for a rare disease would not be justified. Thus, men often present to the doctor because of a mass that is felt in their breast, or other symptoms.

What are the symptoms of breast cancer in men?

Since men have less breast tissue than women, and the breast tissue is centrally located right behind the nipple, it may be easier to feel a new lump in the male breast. But unlike women, men tend to delay going to the doctor until they have more severe symptoms or the mass has grown quite large.

Symptoms of male breast cancer include:

New lump that you have not noticed before

Bleeding from the nipple

Inversion of the nipple

Skin dimpling

What are the risk factors for developing male breast cancer?

Genetics & family history

15-20% of male breast cancers are associated with a positive family history

BRCA 2 – 6.5% risk by age 70, also prostate cancer
Cowden (PTEN)
Li-Fraumeni (p53)
Orchitis/epididymitis
Klinefelter syndrome (XXY) – atrophic testes, high FSH/LH

Low Testosterone

Gynecomastia

Chronic liver disease – unable to metabolize estrogen

Morbid obesity

How is breast cancer diagnosed and treated in men?

The same techniques that are used to diagnose breast cancer in women are used in men: physical exam, mammography, ultrasound and biopsy, where a small piece of tissue is removed and examined under a microscope. Also, the same treatment modalities that are used to treat breast cancer in women are used to treat men. Chemotherapy, hormone therapy and biologic therapy (anti-HER2) are also used to treat breast cancer in men, with the same indications as in women.

The major differences are that breast conservation, also known as a “lumpectomy”, is generally not feasible because males do not have a lot of breast tissue and it is centrally located. Therefore, men often have a total mastectomy to remove all of the breast tissue. The lymph nodes are positive for metastatic cancer in about 50% of males at diagnosis, making the sentinel lymph node biopsy, or targeted sampling of the lymph nodes underneath the arm, a very important procedure. Men require removal of involved nodes under the arm more often than women, also known as an axillary dissection. Also, unlike women, men often require radiation after having a mastectomy if they have skin or chest wall involvement, or lots of positive lymph nodes, which is the same indication for post-mastectomy radiation in women.

If I think I may be at risk for developing male breast cancer, or I have a new lump, what should I do?

If another male in your family or multiple females in your family have been diagnosed with breast cancer, especially at younger ages, you may be at risk of developing breast cancer. Talk to your primary care physician, who can refer you to a genetic counselor or a breast surgeon to discuss genetic testing. If you have a new lump, your primary care physician can examine you and order a mammogram to evaluate this further. If needed, the radiologist can perform a biopsy or refer you to a breast surgeon for biopsy. Early detection is key when it comes to all cases of cancer, but especially male breast cancer. Please do not wait!

What Stage is My Breast Cancer?