Cribriform breast cancer is a rare type of invasive breast cancer accounting for less than 4% of all breast cancers.
A pathologist (doctor who examines tissue removed during a biopsy or surgery) looks at the cancer cells under a microscope to see what type of breast cancer it is.
Cribriform breast cancer may be mixed with other types of breast cancer or it can be pure cribriform (not mixed with another type).
Cribriform cancer cells can also be found in ductal carcinoma in situ (DCIS), a non-invasive breast cancer.
Although each case is different, a person's prognosis (outlook) following treatment for cribriform breast cancer is generally good. This is because the cells are nearly always low grade and slow growing. Grade is the system used to classify cancer cells according to how different they are to normal breast cells and how quickly they’re growing.
The most common symptoms of cribriform breast cancer are a small lump or area that feels thicker than the rest of the breast.
However, it’s often found during routine breast screening, before there are any symptoms.
Cribriform breast cancer is diagnosed in the same way as other breast cancers. Cribriform breast cancer is diagnosed using a range of tests, which may include:
- mammogram – a breast x-ray
- ultrasound scan of the breast and under the arm (axilla) – uses high frequency sound waves to produce an image
- core biopsy of the breast and/or lymph nodes – uses a hollow needle to take a sample of breast tissue to be looked at under a microscope
- fine needle aspiration (FNA) of the breast and/or lymph nodes – uses a fine needle and syringe to take a sample of cells to be looked at under a microscope
Treatment aims to remove the cancer and reduce the risk of it coming back or spreading to other parts of the body.
Breast surgery is usually the first treatment for cribriform breast cancer.
This may be:
- breast-conserving surgery, also known as wide local excision or lumpectomy – the removal of the cancer with a margin (border) of normal breast tissue around it
- mastectomy – the removal of all the breast tissue including the nipple area
The type of surgery recommended depends on:
- where the cancer is in the breast
- the size of the cancer relative to the size of your breast
- whether more than one area in the breast is affected
Your breast surgeon will discuss this with you.
If you have breast-conserving surgery, it’s important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, sometimes a second operation is needed.
If you’re going to have a mastectomy, you’ll usually also be given the option to have breast reconstruction either at the same time as your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).
Surgery to the lymph nodes
If you have invasive cribriform breast cancer, your specialist team will want to check if any of the lymph nodes (glands) under the arm (the axilla) contain cancer cells. This, along with other information about your breast cancer, helps them decide whether or not you will benefit from additional treatment after surgery. To do this, your surgeon is likely to recommend an operation to remove either some of the lymph nodes (a lymph node sample or biopsy) or all of them (a lymph node clearance).
Sentinel lymph node biopsy is widely used if tests before surgery show no evidence of the lymph nodes containing cancer cells. It identifies whether the first lymph node (or nodes) is clear of cancer cells. If it is, this usually means the other nodes are clear too, so no more will need to be removed.
If the results of the sentinel lymph node biopsy show that the first node or nodes are affected, more surgery or radiotherapy to the remaining lymph nodes may be recommended.
However, spread to the lymph nodes under the arm is uncommon in pure cribriform breast cancer. Your surgeon will discuss whether or not this procedure is an option for you.
Find out more information about surgery to the lymph nodes.
Adjuvant (additional) treatment
After surgery, you may need other treatments. These are called adjuvant (additional) therapy and can include:
Sometimes chemotherapy or hormone therapy may be given before surgery. This is known as neo-adjuvant or primary therapy.
If you have breast-conserving surgery you will usually be offered radiotherapy to the breast to reduce the risk of the cancer coming back in the same breast. Sometimes you may be offered radiotherapy to the nodes under your arm.
Radiotherapy is sometimes given to the chest wall after a mastectomy, for example if some lymph nodes under the arm are affected.
The hormone oestrogen can stimulate some breast cancers to grow. A number of hormone therapies work in different ways to block the effect of oestrogen on cancer cells.
Invasive breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery. When oestrogen binds to these receptors, it can stimulate the cancer to grow.
If your cancer is oestrogen receptor positive, your specialist will discuss with you which hormone therapy they think is most appropriate. Most cribriform breast cancers are oestrogen receptor positive.
If oestrogen receptors are not found it is known as oestrogen receptor negative or ER-.
Tests may also be done for progesterone (another hormone) receptors.
The benefits of hormone therapy are less clear for people whose breast cancer is only progesterone receptor positive (PR+ and ER-). Very few breast cancers fall into this category. However, if this is the case for you your specialist will discuss with you whether hormone therapy is appropriate.
Chemotherapy destroys cancer cells using anti-cancer drugs, and is given to reduce the risk of breast cancer returning or spreading.
People diagnosed with cribriform breast cancer don’t usually have chemotherapy. This is because it’s less common for cribriform breast cancer to spread to the lymph nodes under the arm, and it’s more likely than other types of breast cancer to grow slowly.
Whether or not you’re offered chemotherapy depends on various features of the cancer including its size, its grade, hormone receptor status and HER2 status, and whether the lymph nodes are affected.
This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer to grow.
The most widely-used targeted therapy is trastuzumab (Herceptin). Only people whose cancer has high levels of HER2 (called HER2 positive) will benefit from having trastuzumab. HER2 is a protein that helps cancer cells grow.
There are various tests to measure HER2 levels that are done on breast tissue removed during a biopsy or surgery.
Cribriform breast cancer is likely to be HER2 negative. If your cancer is found to be HER2 negative, then trastuzumab will not help you.
Bisphosphonates are a group of drugs that can reduce the risk of breast cancer spreading in post-menopausal women. They can be used regardless of whether the menopause happened naturally or due to breast cancer treatment.
Bisphosphonates can also slow down or prevent bone damage. They’re often given to people who have, or are at risk of, osteoporosis (when bones lose their strength and become more likely to break).
Bisphosphonates can be given as a tablet or into a vein (intravenously).
Your specialist team can tell you if bisphosphonates would be suitable for you.
Being diagnosed with breast cancer can make you feel lonely and isolated.
Many people find it helps to talk to someone who has been through the same experience as them. Breast Cancer Now’s Someone Like Me service can put you in touch with someone who has had a diagnosis of breast cancer, so you can talk through your worries and share experiences over the phone or by email. You can also visit our confidential online Forum and join one of the ongoing discussions.
If you would like any further information and support about breast cancer or just want to talk things through, you can speak to one of our experts by calling our free Helpline on 0808 800 6000.