Invasive Ductal Carcinoma (IDC) Symptoms and Prognosis

Infiltrating ductal carcinoma (IDC) is the most common type of breast cancer. With IDC, cancer cells start growing in the milk ducts of the breast. As the tumor grows, it may spread beyond the ducts into surrounding tissues.

The term "invasive" means cancer cells have spread beyond the duct system into other parts of the breast. This does not always mean IDC has spread beyond the breasts, or even that it has invaded the lymph nodes or blood vessels. 

This article will discuss the prevalence and symptoms of invasive ductal carcinoma. It will also cover causes, risk factors, diagnosis, and treatment.

Types of Invasive Ductal Carcinoma

Most invasive ductal carcinomas are the general type. There are also four additional sub-types, and they are much less common:

• Medullary ductal carcinoma: The tumor cells of this type look aggressive when examined with a microscope, but they are often slow-growing. They are named because they look similar to a part of the brain called the medulla. This tumor type is most common in women who are in their late 40s to early 50s. The BRCA1 gene raises the risk for this kind of tumor.
• Mucinous ductal carcinoma: This is a less aggressive tumor where cancer cells are surrounded by a puddle of mucin (the main component of mucous). This cancer most often develops in women in their 60s and beyond.  
• Papillary carcinoma: These are very rare kinds of IDC that have a tumor with “fingers” that grow out and reach toward nearby healthy cells. They most often occur in people after menopause. Sometimes the cells are abnormal and grow very quickly.
• Tubular ductal carcinoma: This less aggressive, slow-growing tumor grows in very small tube shapes. It generally affects women in their early 50s. 

How Common Is Invasive Ductal Carcinoma?

According to the American Cancer Society, about 80% of all breast cancers are IDC. This type of breast cancer can occur at any age, but many people are over the age of 55 at the time of diagnosis. The National Cancer Institute reports that a woman’s risk of breast cancer increases with age.

IDC is also the main cause of male breast cancers. The American Cancer Society estimates that about 1 in 833 men will be diagnosed with breast cancer.

Invasive Ductal Carcinoma Symptoms

According to the American Cancer Society, a new lump or mass is the most common symptom of breast cancer.

The American College of Physicians recommends mammograms as the best screening tool for breast cancer. Most importantly, get any routine screening recommended by your healthcare provider.

Your provider may also do a clinical breast exam or may recommend you complete a monthly breast self-examination (BSE). Medical guidelines are changing and BSE is not often recommended for cancer screening. However, self-examination of your breast can be helpful in other ways.   

A monthly BSE helps you to know what is normal for your breast tissue. Over time, you will become familiar with your breast health. This helps you recognize changes to the breast and identify breast cancer early. 

Some signs of breast cancer that may be found during a breast self-examination include:

• Swelling in all or part of the breast
• Skin irritation
• Dimpling (having the bumpy texture of an orange peel)
• Breast and/or nipple pain
• Nipple retraction (pulled in rather than sticking out)
• Red, scaly, and/or thick skin in the breast and/or nipple
• Nipple discharge, other than milk
• Lump near the nipple, beneath the areola, in the breast tissue, or in the underarm 

If you find changes to your breast or if you develop any of the issues listed, reach out to your healthcare provider for further evaluation.

Causes and Risk Factors for IDC

The underlying causes of IDC are not fully known. Scientists continue to study what makes a person more or less likely to develop breast cancer. There are some risk factors you can change, and some you cannot. 

Researchers think certain hormonal, environmental, and lifestyle factors increase a person’s risk for breast cancer. These may include:

• Smoking
• Drinking alcohol
• Use of birth control pills or hormone replacement
• Obesity
• Lack of exercise
• Not having children
• Not breastfeeding
• Prior radiation to the chest

Other times, people develop breast cancer without such known risk factors.

Some breast cancer risk factors are not changeable. They are things you are born with or inherit from your parents.

These include:

• Being female: Breast cancer is more common in women
• Being older: Breast cancer risk increases with age
• Certain breast cancer genes: Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are inherited tumor suppressor genes.
• A family history of breast cancer

Your healthcare provider will review your risk factors with you and help you make decisions about your health choices and cancer screening.

Diagnosing Invasive Ductal Carcinoma

If you find a breast lump during your breast self-exam or a clinical exam, you need to have it properly checked out. Fortunately, 80% of all breast lumps are not cancer. Instead, they are often benign issues that may mimic cancer. For the other 20%, if breast cancer is caught early, your chances of survival are generally very good. 

The American College of Physicians (ACP) published clinical guidelines for people with an average risk for breast cancer without symptoms. Overall, the recommendation is for regular mammograms to screen for breast cancer.

In people considered at average risk who do not have symptoms of breast cancer, the recommendations change with age:

• 40-49 years old: Current guidelines recommend starting annual screening mammograms at age 40.
•  50-74 years old: Providers should offer screening mammograms every one to two years.
• Age 75 and older: Stop screening if life expectancy is less than or equal to 10 years.

Clinical breast exam, breast ultrasound, and magnetic resonance imaging (MRI) are not recommended as initial screening tests. 

If your mammogram shows an area of concern, your healthcare provider may recommend that you have a breast biopsy. A biopsy is a procedure that involves obtaining a sample of the growth. There are several ways to obtain a biopsy sample, and your healthcare team will let you know which is recommended for you based on size, location, and other factors. 

The sample is examined with a microscope by a specialized doctor called a pathologist. 

A biopsy will help determine if the suspicious area is malignant (cancerous) or benign. Grading (aggressiveness of cancer) is based on how different the cells are from normal breast cells. The biopsy examination can identify the type of cells to determine the type of breast cancer. The biopsy can also be used to help guide treatment by identifying features of the tumor that may make it treatable with certain medications—such as hormone receptors or specific genes.

Stages of IDC

Healthcare providers use a staging system to describe how far cancer has spread within the body. For breast cancer, the stages are numbered from 0 to 4. Higher numbers indicate more extensive spread. Stage 0 breast cancer (carcinoma in situ) is the only non-invasive stage. All breast cancers from stages 1 to 4 are invasive. 

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What Is the Treatment for Invasive Ductal Carcinoma?

The goal of treating any breast cancer is to get rid of cancer cells and prevent any cancer from coming back. The return of cancer is called recurrence. 

There are multiple kinds of treatment for breast cancer, and they can be used in different combinations. Researchers are continuing to study what combination of treatments for IDC is most effective.

Breast cancer treatments may include: 

• Surgery: A lumpectomy involves the removal of cancer and a small area of healthy tissue around it. A mastectomy removes the entire breast. 
• Chemotherapy: Chemotherapy drugs may be used before surgery to shrink the tumor. It may also be given after surgery to prevent cancer cells from returning.
• Radiation: Radiation therapy for breast cancer usually uses external X-ray beams to kill cancer cells. Radiation can be used before surgery, after surgery, or as the only treatment.
• Hormone therapy: Certain medicines may be given if cancer cells have specific hormone receptors. For example, HER2 cancer cells are treated with targeted therapy drugs, such as Herceptin (trastuzumab). In addition, many drugs treat different kinds of hormone-sensitive breast cancers.

The goal of treatment is to give you the best possible outcome, so treatment plans are adjusted for each individual person.  

Follow-Up

Even after you have completed primary treatments for breast cancer, you will still see your oncologist for several years for check-ups. You may need to take hormone therapy for up to 10 years if the tumor was estrogen- or progesterone-sensitive.

You will continue to have mammograms on any breast tissue that you still have.

Bone density scans are usually recommended once you reach menopause to check for signs of bone loss. Osteopenia (thinning bone) and osteoporosis (weak bone) are more common when women have changes in estrogen—a common side effect of some breast cancer treatments.

Prognosis of Invasive Ductal Carcinoma

Healthcare providers use the term "prognosis" to talk about your future outlook and survival. Different factors influence a person’s prognosis with IDC, including:

• Whether IDC is a new diagnosis or a recurrence
• The stage of the cancer and whether it is confined to the breast or has spread to lymph nodes, other tissue, or organs
• Hormone-receptor status
• Treatment responses
• Your age, overall health, and menopausal status (if female)

Your healthcare team will be able to give you more information about how treatable they expect your cancer to be. You will also likely have more tests along the way to see how your cancer is responding to the treatment.

Summary

Invasive ductal carcinoma is a very common type of breast cancer. Regular mammograms are the recommended way to screen for this kind of cancer. If you are diagnosed with IDC, your healthcare team will work together with you to make a plan to treat your cancer based on the size and location of the tumor, the extent of spread, and your overall health.