How Serious Is Invasive Ductal Carcinoma?

Invasive ductal carcinoma describes the type of tumor in about 80 percent of people with breast cancer. The five-year survival rate is quite high -- almost 100 percent when the tumor is caught and treated early. Once the cancer has metastasized to distant organs like the bones or liver, the five-year survival rate drops by almost three fourths.

Invasive ductal carcinoma (also called infiltrating ductal carcinoma) is the most common type of breast cancer, accounting for about 80% of all cases of breast cancer. Invasive ductal carcinoma begins in the milk ducts of the breast and invades the surrounding breast tissue. It can also spread (metastasize) to the lymph nodes and other areas of the body.

What Are Symptoms of Invasive Ductal Carcinoma?

Invasive ductal carcinoma may not cause any symptoms initially. 

When symptoms of invasive ductal carcinoma do occur, they may include: 

• New lump or mass in the breast 
• Swelling in all or part of the breast
• Skin irritation 
• Dimpling of skin on the breast
• Breast pain
• Nipple pain 
• Nipple turning inward
• Redness, scaliness, or thickening of the nipple or breast skin
• Nipple discharge other than breast milk
• Lump in the underarm area

These can also be symptoms of other types of breast cancer. 

Invasive ductal carcinoma is caused by cells in the milk ducts of the breast growing abnormally and out of control. The reason for this occurring is unknown. 

Risk factors for developing invasive ductal carcinoma and other breast cancers include: 

• Alcohol consumption
• Being overweight or obese
• Physical inactivity
• Not having children
• Not breastfeeding
• Use of hormonal birth control
  • Oral contraceptives
  • Birth control shot 
  • Birth control implants, intrauterine devices (IUDs), skin patches, vaginal rings
• Hormone therapy after menopause
  • Combined hormone therapy (HT)
  • Bioidentical hormone therapy
  • Estrogen therapy (ET) (may only be a slight increased risk)
• Breast implants
• Being born female 
  • Men can get breast cancer too, but it is much more common in women
• Age
  • Most breast cancers occur in women age 55 and older
• Inherited genes
  • BRCA1 and BRCA2 genes: the most common cause of hereditary breast cancer 
  • Other gene mutations can also lead to inherited breast cancers, but they are much less common than the BRCA genes
• Family history of breast cancer
  • About 15% of women with breast cancer have a family member with the disease
• Personal history of breast cancer
• Race and ethnicity
  • White women are slightly more likely to develop breast cancer than African American women
  • In women under age 45, breast cancer is more common in African American women, and African American women are more likely to die from breast cancer at any age
• Being taller than average
• Having dense breast tissue
• Having certain benign (non-cancerous) breast conditions
• Starting menstrual periods early, especially before age 12
• Going through menopause after age 55
• Having radiation therapy to the chest
• Exposure to diethylstilbestrol (DES)

Invasive ductal carcinoma is diagnosed with a physical examination and tests including: 

• Imaging tests 
  • Mammogram
  • Ultrasound 
  • Breast magnetic resonance imaging (MRI)
• Biopsy
  • Fine needle aspiration 
  • Core needle biopsy 
  • Incisional biopsy 
  • Excisional biopsy 

Treatment for invasive ductal carcinoma includes one or more of the following:

• Surgery to remove the tumor: usually the first treatment
  • Lumpectomy to remove only the tumor (the “lump”) and some of tissue that surrounds it, and sometimes underarm (axillary) lymph nodes are removed for examination as well
  • Mastectomy to remove some or all of the breast tissue
  • Lymph node surgery
• Chemotherapy 
  • Doxorubicin (Adriamycin)
  • Epirubicin (Ellence)
  • Cyclophosphamide (Cytoxan) 
  • Docetaxel (Taxotere)
  • Paclitaxel (Taxol)
  • Capecitabine (Xeloda)
  • Ixabepilone (Ixempra)
  • Methotrexate
  • Fluorouracil (5-fluorouracil or 5-FU)
• Radiation therapy 
  • External beam radiation
  • Internal partial-breast irradiation (brachytherapy)
  • External partial-breast irradiation
• Hormonal therapy 
  • Selective estrogen-receptor response modulators (SERMs)
    • Tamoxifen (Nolvadex, Soltamox)
    • Raloxifene (Evista) 
    • Toremifene Fareston)
  • Aromatase inhibitors
    • Anastrozole (Arimidex)
    • Exemestane (Aromasin 
    • Letrozole (Femara)
  • Estrogen-receptor downregulators (ERDs)
    • Faslodex (fulvestrant) 
  • Ovarian shutdown or removal
    • Goserelin (Zoladex) 
    • Leuprolide (Lupron)
    • Surgical removal of the ovaries (oophorectomy)
• Targeted therapy
  • HER2 inhibitors
  • PARP inhibitors
  • CDK4/6 inhibitors
  • PI3K inhibitors

Staging refers to the extent of a cancer. A cancer is always referred to by the stage it was determined to be at diagnosis, even if it spreads. 

Stages of invasive ductal carcinoma include:

• Stage I: Breast tumor is smaller than 2 centimeters in diameter and the cancer has not spread beyond the breast
• Stage II: Breast tumor measures 2 to 4 centimeters in diameter or cancerous cells have spread to the lymph nodes in the underarm area
• Stage III: Cancer is more extensive but it is confined to the breast, surrounding tissues, and lymph nodes
• Stage IV: Breast cancer has spread (metastasized) to lymph nodes beyond the underarm area or to distant sites, such as the lungs, liver, bones, or brain

Life expectancy for breast cancer such as invasive ductal carcinoma is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Breast cancer 5-year survival rates:

• Localized (no sign the cancer has spread outside the breast): 99%
• Regional (cancer has spread outside the liver to nearby structures or to nearby lymph nodes): 86%
• Distant (cancer has spread to distant parts of the body such as the lungs, liver, or bones): 27%

There is no single way to prevent all cases of breast cancer but people can take steps to lower the risk. 

• Lose weight or maintain a healthy weight
• Exercise regularly 
• Avoid or limit alcohol
• Breastfeed for at least several months 
• Use non-hormonal options to treat menopausal symptoms
  • For women at increased risk of breast cancer (a strong family history of breast cancer, a known gene mutation that increases breast cancer risk, such as in the BRCA1 or BRCA2 gene, or have had DCIS or LCIS):
    • Genetic counseling and testing for breast cancer risk 
    • Close observation to look for early signs of breast cancer
      • More frequent doctor visits (such as every 6 to 12 months) for breast exams and ongoing risk assessment
      • Start breast cancer screening with yearly mammograms at an earlier age
      • Other screening tests, such as breast MRI
    • Medicines to lower breast cancer risk
      • Tamoxifen and raloxifene
      • Aromatase inhibitors for women past menopause
    • Preventive surgery for women who have a very high risk for breast cancer, such as from a BRCA gene mutation
      • Prophylactic mastectomy to remove the breasts
      • Removal of the ovaries to reduce estrogen in the body