Metaplastic breast cancer

Metaplastic breast cancer is a very rare type of invasive breast cancer that accounts for around 1% to 2% of all breast cancers.

Breast cancers can be grouped into different types. Rare breast cancers, such as metaplastic, may also be referred to as “special type”. This means the cancer cells have certain features, visible under a microscope, that identify them as a particular type of breast cancer.

Metaplastic breast cancer is often triple negative.

It’s more common in post-menopausal women and black women.

As with most types of breast cancer, the symptoms of metaplastic breast cancer can include:

• A lump or swelling in the breast
• A change to the skin, such as puckering or dimpling
• Changes to the nipple, for example it may become pulled in (inverted)
• Changes in size or shape of the breast

Routine breast screening can often pick up cancer before there are any symptoms. So some women will be diagnosed with metaplastic breast cancer after attending breast screening, without having any of the symptoms described above.

Find out more about the signs and symptoms of breast cancer and how to check your breasts.

Metaplastic breast cancer is diagnosed using a range of tests. These may include:

• A mammogram
• An ultrasound scan
• A core biopsyof the breast and sometimes lymph nodes

The treatments you’re offered will depend on the features of your metaplastic breast cancer (such as size, grade, hormone receptor status and HER2 status).

Metaplastic breast cancer can be treated with a combination of:

• Surgery
• Chemotherapy
• Radiotherapy
• Hormone (endocrine) therapy
• Targeted therapies
• Bisphosphonates

Surgery

If you have primary breast cancer, you will usually have surgery to remove the cancer.

The 2 main types of surgery are:

• Breast-conserving surgery (wide local excision or lumpectomy) – removal of the cancer with a margin (border) of normal breast tissue around it
• Mastectomy – removal of all the breast tissue, including the nipple area

The type of surgery recommended will depend on:

• The area of the breast affected
• The size of the cancer relative to the size of your breast
• Whether more than 1 area in the breast is affected 

If you have breast-conserving surgery, it’s important the cancer is removed with a margin of healthy breast tissue around it. This is to reduce the risk of any cancer cells being left behind. If there are cancer cells at the margin, you may need further surgery to remove more tissue, which may be a mastectomy.

Most women who have a mastectomy will have the option to have breast reconstruction.

Surgery to the lymph nodes

Metaplastic breast cancer is less likely to spread to the lymph nodes under the arm than other invasive breast cancers.

However, your treatment team will still want to check if your lymph nodes contain any cancer cells. This, along with other information about your breast cancer, helps them decide whether you will benefit from any other treatment after surgery.

You can find out more about surgery to the lymph nodes on our surgery page.

Chemotherapy

You may have chemotherapy to treat metaplastic breast cancer.

Chemotherapy destroys cancer cells by affecting their ability to divide and grow.

In primary breast cancer, it’s given to reduce the risk of breast cancer returning or spreading.

Chemotherapy may be given on its own or alongside other treatments.

You may have chemotherapy before or after surgery.

Before surgery

Chemotherapy given before surgery is called primary or neo-adjuvant chemotherapy. You may have it to:

• Slow the growth of breast cancer that’s growing quickly
• Shrink a larger breast cancer before surgery, which may mean you can have breast-conserving surgery rather than a mastectomy
• Destroy any cancer cells that may have spread elsewhere in the body

After surgery

Chemotherapy given after surgery is called adjuvant chemotherapy. You may have it after surgery for primary breast cancer to reduce the risk of cancer returning or spreading.

Secondary breast cancer

Chemotherapy can be used to treat secondary metaplastic breast cancer that has spread from the breast to other parts of the body. You may have it to:

• Control or slow the growth of secondary breast cancer
• Relieve symptoms

Radiotherapy

Radiotherapy uses high energy x-rays to destroy cancer cells.

If you have breast-conserving surgery you will usually be offered radiotherapy to the breast. This is to reduce the risk of the cancer coming back in the same breast.

You may also have radiotherapy to the lymph nodes under the arm or above the collarbone.

Radiotherapy is sometimes given to the chest wall after a mastectomy, for example if cancer cells have spread to the lymph nodes under the arm.

Hormone (endocrine) therapy

Some breast cancers use oestrogen in the body to help them to grow. These are known as oestrogen receptor positive or ER-positive breast cancers.

Hormone therapies block or stop the effect of oestrogen on breast cancer cells. Different hormone therapy drugs do this in different ways.

Hormone therapy will only be prescribed if your breast cancer is ER-positive. 

Metaplastic breast cancers are more likely to be ER-negative. However, some may be ER-positive.

Targeted therapies

Targeted therapies can be used to treat metaplastic breast cancer.

They are a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.

The type of targeted therapy you are given will depend on the features of your breast cancer.

Targeted therapies are usually given in combination with chemotherapy or hormone therapy.

Your treatment team will discuss if you will be offered a targeted therapy as part of your treatment.

Bisphosphonates

Bisphosphonates are a group of drugs that can slow down or prevent loss of bone tissue and reduce the risk of breast cancer spreading in women who have been through the menopause. They can be used if the menopause happened naturally or because of breast cancer treatment.

Bisphosphonates can be given as a tablet or into a vein (intravenously).

Your treatment team can tell you if bisphosphonates would be suitable for you.

Follow-up after treatment

You'll continue to be monitored after your hospital-based treatments (such as surgery, chemotherapy or radiotherapy) finish. This is known as follow-up.

Whether you had breast-conserving surgery or a mastectomy (with or without reconstruction), it's important to be aware of any changes to the breast, chest or surrounding area.

The area around your scar may feel lumpy, numb or sensitive. This means that you'll need to get to know how it looks and feels so you know what’s normal for you. This will help you feel more confident about noticing changes and reporting them early to your breast care nurse, treatment team or GP.

Research has shown that the risk of metaplastic breast cancer spreading or coming back is higher than in other types of breast cancer.

Your treatment team will be able to help you with any questions or worries you have about the outlook for your cancer.

Being diagnosed with breast cancer can be a difficult time, especially if you’ve been diagnosed with a rare type of breast cancer.

Our information on coping emotionally with your diagnosis might help you through this time.

If you’d like any further information and support or just want to talk things through, speak to one of our nurses by calling our free helpline. See below for ways to get in touch.

Our Someone Like Me service can also 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 online forum and join 1 of the ongoing discussions.