How Is Invasive Lobular Breast Cancer Different from Invasive Ductal Breast Cancer?
Invasive lobular breast cancer differs from the more common form of breast cancer, invasive ductal breast cancer, in multiple ways:
- Invasive lobular breast cancer forms in lines, not as lumps, as ductal breast cancer does. This can make invasive lobular breast cancer harder to detect.
- It recurs and spreads differently. It tends to recur (come back) longer after initial treatment and spread to different places in the body, such as the lining of the gastrointestinal and urinary tracts.
- It shows up on imaging scans differently. Invasive lobular breast cancer is more difficult to see on breast imaging scans of all types and therefore may be diagnosed later or require additional imaging, such as MRI scans. When monitoring metastatic lobular breast cancer, PET/CT scans may not be very effective, so other imaging technologies may be better. There is ongoing research in this area.
Our Unique Approach to Treating Invasive Lobular Breast Cancer
The Invasive Lobular Breast Cancer Program at Dana-Farber Brigham Cancer Center is one of the only programs in the country to combine clinical care with in-depth research for this difficult-to-diagnose type of breast cancer. Our specialized team of medical oncologists, surgical oncologists, radiologists, nuclear medicine experts, and pathologists has deep expertise in invasive lobular breast cancer. This multidisciplinary team works together and with you to create a personalized treatment plan tailored to your unique medical needs, beginning with your very first appointment.
Knowledge about invasive lobular breast cancer has improved in recent years, but there are still misconceptions and misunderstandings about this disease. Our physician-scientists lead research efforts that are improving the understanding of and treatments for invasive lobular breast cancer and leading to better outcomes for patients. They can provide you with the most up-to-date information so that you can make the best decisions about your care.
Learn more about how our team is leading research for invasive lobular breast cancer.
Supportive Resources
To address your physical and emotional needs, we provide a comprehensive range of support services, including a variety of integrative therapies, through the Leonard P. Zakim Center for Integrative Therapies and Healthy Living. Among our many services, we offer individual and family counseling, genetic counseling, physical therapy, social work, nutrition services, acupuncture, and massage.
Diagnosis and Treatment for Invasive Lobular Breast Cancer
Signs of Invasive Lobular Breast Cancer May Include:
- Hard or thickened area in the breast or underarm
- New pain in one spot on the breast that does not go away
- Change in the size or shape of the breast
- Dimpling or puckering in the skin of the breast
- New changes to the nipple – inverted (pointing inside) or pulling to one side
- In some cases, a lump or hard knot inside the breast might occur
Many of these symptoms can also indicate medical issues that are not cancer. Some of these symptoms, like an inverted nipple, are also similar to other types of breast cancer such as inflammatory breast cancer. Talk to your doctor any time you notice a change in your breasts.
Risk Factors for Invasive Lobular Breast Cancer Include:
- Being assigned female at birth: Women and people assigned female at birth (AFAB) are most likely to develop invasive lobular breast cancer, but men and people assigned male at birth (AMAB) can develop it, too.
- Being age 55 or older: Unlike ductal breast cancer, invasive lobular breast cancer usually affects people later in life. Many people with invasive lobular breast cancer are over 60 when they are diagnosed.
Diagnosing Invasive Lobular Breast Cancer
Invasive lobular breast cancer does not often form a lump and therefore can be hard to detect through a breast exam and can even be difficult to see in a mammogram. For this reason, if your doctor thinks you might have invasive lobular breast cancer, they may recommend additional breast imaging tests.
Tests and procedures to diagnose invasive lobular breast cancer include:
- Mammogram: X-ray images of the breast. At our center, we use digital mammograms, which provide a clear, two-dimensional image highlighting unusual structures such as calcifications or masses, which may need further evaluation. Three-dimensional imaging is an FDA-approved advanced technology that takes multiple images, or X-rays of breast tissue, to create a 3D picture of the breast. You may also hear it called breast tomosynthesis. Unlike a traditional mammogram, which only takes one single image, breast tomosynthesis takes multiple images. These multiple images of breast tissue slices give doctors a clearer image of breast masses and make it easier to detect breast cancer.
- Ultrasound: Imaging that can capture the size and structure of a potential tumor. In conjunction with mammography, it is a highly useful tool for diagnosis. For example, ultrasound can provide doctors with more information about an abnormality seen on a mammogram or help guide the needle during a breast biopsy.
- Biopsy: Procedure to remove a sample of breast tissue for testing. Tissue samples collected during a biopsy procedure are examined by pathologists who specialize exclusively in breast cancer. Pathologists' findings are critical to determining the best treatment for your cancer, and they are key members of your medical team, providing consultation to clinicians and, at times, working side by side with surgeons. Our pathologists not only evaluate tissues in order to characterize your cancer, but they also investigate any unusual or unexpected findings, using microscopes and analysis to observe and test tissue. Pathologists in our program see hundreds of invasive lobular breast cancer biopsies per year and are very skilled at identifying this less-common form of breast cancer.
Treating Invasive Lobular Breast Cancer
Invasive lobular breast cancer is currently treated in much the same way as other forms of breast cancer. Our physicians are leaders in the field of invasive lobular breast cancer who can provide detailed education and the most up-to-date treatment information. Treatment options include:
- Surgery: Most patients first undergo surgery to remove the tumor. Depending on the size of the tumor, surgical options may include a lumpectomy (removing just the tumor and a margin of surrounding tissue) or a mastectomy (removing the whole breast). It is also important to determine whether cancer cells have spread from the breast to the lymph nodes under the arm. As invasive lobular breast cancer tends to present in lines, rather than as a lump, our specialized surgeons may use additional imaging to target the tumor for surgery.
- Radiation therapy: Following surgery, treatment may involve radiation therapy to eliminate any remaining microscopic cancer cells at the site of the tumor.
- Systemic therapy: Chemotherapy may be given to kill cancer cells that may have escaped into the bloodstream or lymph system; however, not all patients with invasive lobular breast cancer benefit from chemotherapy. Invasive lobular breast cancer is usually estrogen receptor-positive, so our medical oncologists may recommend that some patients receive endocrine (hormone) therapy to reduce the amount of estrogen in the body or block its effect. CDK4/6 inhibitors such as abemaciclib and ribociclib may also be recommended.
Learn more about our approach to caring for patients with breast cancer.
Additional Resources
Additional resources, including information about breast self-exams, questions to ask your doctor, frequently asked questions, fact sheets, information about research and advocacy for invasive lobular breast cancer, and more are available through the Lobular Breast Cancer Alliance.