Table of ContentsView All
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Table of Contents
Overview
Classification
Treatment
Survival Rates
Coping
FAQ
Breast cancer, like other cancers, is staged. This is a determination of how much cancer has spread. The stages help guide treatment and prognosis.
Stage 1 breast cancer is confined to where abnormal cell division began. It has not spread yet to anywhere else in the breast or body. Therefore, it is further subdivided into Stages 1A and 1B. When detected at this early stage, treatment is usually very effective and the prognosis is good.
This article discusses what stage 1 breast cancer is, whattreatment optionsyou have, as well as your chances of surviving this type of cancer.
Overview of Stage 1 Breast Cancer
Stage 1 breast cancer is the earliest stage of what’s considered invasive breast cancer. “Invasive” does not mean cancer has invaded other areas of your body. Instead, it means that the cells in your tumor have infiltrated the area past what’s called the basement membrane.
When a tumor begins, it has not yet grown past this membrane and isn’t considered cancer butcarcinoma in situ.These tumors are referred to asstage 0tumors. Carcinoma in situ is 100% curable with surgery since the cells are completely contained.
Stage 1 tumors are the earliest stage of invasive breast cancer. These tumors are small, and if they have spread tolymph nodes, the spread is only microscopic.
Staging of Breast Cancer
To understand how your healthcare provider determines the stage of your cancer and if you have a stage 1A or stage 1B tumor, it’s helpful to know a little about theTNM system of classification.
Thus, using the TNM system, stage 1 cancers are defined as follows:
Stages of Breast Cancer: Understanding the Classification System
It can be confusing and a little alarming if you read your pathology report, and it says cancer has “metastasized to lymph nodes.” This does not mean you havemetastatic breast cancer(stage 4 breast cancer). You can have lymph node metastases even with early-stage disease.
Tumor Grade
Tumor gradeis a number that describes the aggressiveness of a tumor. Pathologists look at the cancer cells from a biopsy and/or surgery under a microscope to determine things such as how actively cells are dividing. Tumors are then given a grade of 1, 2, or 3, with 1 being the least aggressive and 3 being the most aggressive.
Your tumor grade doesn’t necessarily tell you what your prognosis will be, but it does help you and your healthcare provider choose the most appropriate treatments.
Receptor Status
You’ll also need to know your tumor’s receptor status.Receptors are proteins found on the surface of cancer cells that can tell what fuels the cell’s growth and division. The three types include:
Once your tumor cells are tested, you’ll be told whether it’s:
Hormone Receptor Status in Breast Cancer
Treatment of Stage 1 Breast Cancer
Treatment options for stage 1 breast cancer fall into two main categories:
If a tumor is very small, local treatments are usually all that’s required.If the tumor is larger, more aggressive (has a higher tumor grade), has spread to lymph nodes, or has a molecular profile that indicates it’s more likely to spread, systemic treatments are usually recommended.
With stage 1 breast cancers, the use of systemic therapy is considered adjuvant (add-on) therapy.The goal is to eliminate any cancer cells that may have spread beyond the breast but are too small to be detected.
Work with your healthcare provider to weigh the pros and cons of each option for your situation.
Does Stage 1 Breast Cancer Need Chemo?Treatment for stage 1 breast cancer depends on several factors. However, if the tumor is large, more aggressive, or has spread to lymph nodes, systemic treatment such as chemotherapy may be recommended.
Does Stage 1 Breast Cancer Need Chemo?
Treatment for stage 1 breast cancer depends on several factors. However, if the tumor is large, more aggressive, or has spread to lymph nodes, systemic treatment such as chemotherapy may be recommended.
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Surgery
Surgery is recommended for the majority of stage 1 cancers.Options include either alumpectomy(removal of only part of the breast) or amastectomy(removal of the entire breast). People choose one over the other for several reasons, and it can be a very personal choice.
If you choose a lumpectomy, following up with radiation therapy is usually recommended.
If you opt for a mastectomy, your healthcare provider will talk to you about the option ofbreast reconstruction. Skin-sparing surgery is becoming more common. In this procedure, an implant or anexpanderis often placed at the same time as your mastectomy. In addition, depending on your risk factors, you may need to weigh therisks and benefits of having a single vs. double mastectomy.
In addition to discussing the efficacy of these options with your healthcare provider, be sure to also talk about what you can expect cosmetically with each procedure.
Sentinel Node BiopsyAsentinel node biopsymay be done before your surgery. In the past, several lymph nodes were usually removed and then examined under the microscope, but it’s now possible to determine which lymph nodes cancer will spread to first and sample only those nodes.If yourlymph nodesare positive, it means the tumor has a higher chance of spreading to other organs or distant parts of the body. Often, chemotherapy is recommended to get rid of any cells that have spread.
Sentinel Node Biopsy
Asentinel node biopsymay be done before your surgery. In the past, several lymph nodes were usually removed and then examined under the microscope, but it’s now possible to determine which lymph nodes cancer will spread to first and sample only those nodes.If yourlymph nodesare positive, it means the tumor has a higher chance of spreading to other organs or distant parts of the body. Often, chemotherapy is recommended to get rid of any cells that have spread.
Asentinel node biopsymay be done before your surgery. In the past, several lymph nodes were usually removed and then examined under the microscope, but it’s now possible to determine which lymph nodes cancer will spread to first and sample only those nodes.
If yourlymph nodesare positive, it means the tumor has a higher chance of spreading to other organs or distant parts of the body. Often, chemotherapy is recommended to get rid of any cells that have spread.
Lymph Node-Positive Breast Cancer
Radiation Therapy
If you have a lumpectomy,radiation therapyis usually used to treat your remaining breast tissue.
Radiation can be done after both lumpectomy and mastectomy. Even with a mastectomy, the surgeon cannot get every cancer cell. Radiation helps kill cancer cells that may have been left behind or those that are too small to be seen.
Chemotherapy
Chemotherapyis sometimes used as an adjuvant treatment for stage 1 breast cancer.
The purpose of chemotherapy is to treat any cancer cells that may have strayed from your breast before they can grow into metastases.
The use of chemotherapy is also very dependent on the receptor status of the tumor. In a person who is HER-2 positive or triple-negative, chemotherapy is often used even if the lymph nodes are completely negative.
However, it’s traditionally been difficult to determine who will benefit from chemotherapy, and it’s especially difficult with node-negative stage 1 breast tumors that are positive for hormone receptors and negative for HER-2.
TheOncotype DxRecurrence Score or MammaPrint are genomic tests that can be helpful in determining who should undergo chemotherapy.Those who score higher on the test are at higher risk for recurrence, and chemotherapy can increase their survival rates. Those with low scores, meanwhile, are not likely to benefit from chemotherapy.
However, these tests are only used in people with estrogen and/or progesterone-positive tumors that are also HER-2 negative. They are not used in peoplewith triple-negative or HER-2 positive breast cancer.
Since some of the long-term potential side effects of chemotherapy can be severe—such as heart damage or failure and secondary leukemia—it’s important to weigh the possible risks and benefits. Talk with your healthcare provider about the risks of each recommended chemotherapy drug and what it may mean for you.
Hormone Therapies
If your tumor is estrogen receptor-positive,hormonal therapyis usually recommended following primary treatment with surgery, chemotherapy, and radiation.The purpose is to reduce the risk of cancer coming back.
Estrogen receptor-positive tumors are more likely to have a late recurrence (more than five years after diagnosis). The drug tamoxifen is often used for premenopausal women. For postmenopausal women, treatment is usually anaromatase inhibitorsuch as Aromasin (exemestane), Arimidex (anastrozole), or Femara (letrozole).In some high-risk premenopausal women, an aromatase inhibitor is sometimes used with drugs to suppress ovarian function.
HER2 Targeted Therapies
If your tumor is HER2 positive, aHER2-targeted medicationsuch as Herceptin (trastuzumab) is usually started after primary treatment.
Clinical TrialsThe only way progress is made in the treatment of breast cancer is through studying new drugs and procedures in clinical trials. Many myths aboutclinical trialsabound, but the truth is that every treatment being used today was once studied in a clinical trial. If other treatments have failed, this may be an avenue to explore.
Clinical Trials
The only way progress is made in the treatment of breast cancer is through studying new drugs and procedures in clinical trials. Many myths aboutclinical trialsabound, but the truth is that every treatment being used today was once studied in a clinical trial. If other treatments have failed, this may be an avenue to explore.
It is important to choose the treatments that are best for you, no matter what someone else may choose. It’s also very important tobe your own advocate for your cancer care. People living with cancer and healthcare providers are working together much more closely than in the past, and you are a vital member of your cancer team.
Is Stage 1 Breast Cancer Curable?
For those with localized, early-stage breast cancer who receive treatment with surgery and chemotherapy or radiation therapy, if recommended, the five-year survival rate is close to 100%.
Even so, going through treatment for stage 1 breast cancer can be challenging. Side effects are common, especially with chemotherapy, andfatigueis almost universal.
After your initial breast cancer treatment is over, expect follow-up care to last another five years or possibly more.Ongoing treatments depend on multiple factors and may include:
You need to know the signs and symptoms of arecurrenceso you can alert your healthcare provider immediately if you suspect cancer has come back.
Coping with Stage 1 Breast Cancer
When you have stage 1 breast cancer, your emotions may span the spectrum from fear and worry to confusion and panic. It’s important to have an outlet for your feelings and to remember that it’s OK (and understandable) to have a bad day.
One of the best things you can do for yourself is to gather a support network. Consider the people in your life you can lean on, both emotionally and practically. Even if you are feeling good through your treatment, it can be exhausting. Ask for help and allow people to give it to you.
Getting involved in a support group or online support community can be priceless. There is something special about talking to others who are facing the same challenges you are. These communities also offer a chance to learn about the latest research on breast cancer, as nobody is as motivated as those living with the disease.
Summary
Stage 1 breast cancer is very treatable with surgery, radiation, chemotherapy, or targeted therapies. It is considered early-stage breast cancer and the prognosis is good. Talk with your treatment team about what your diagnosis means and what treatment options may be best for you. Ask any questions you have—your treatment team is there for that reason!
Frequently Asked Questions
Breast cancer can recur and metastasize years to decades after the original diagnosis and treatment. Approximately 30% of women with early-stage breast cancer will eventually experience metastatic disease.
It is not possible to determine exactly how long it will take for newly diagnosed breast cancer to progress from stage 1 to stage 2. It can happen within months if it is an aggressive high-grade tumor, or it can take longer. It’s important to know that stage 1 breast cancer could have already been present for a while before being detected, so it may progress quickly.
If stage 1 cancer is treated comprehensively, the risk is fairly low. It can depend on characteristics of your breast cancer like hormone receptor status and size of the tumor. Local recurrence is more common, and about 7% to 11% of women with early-stage breast cancer have a local recurrence within the first five years.Your healthcare provider will recommend a surveillance schedule for you so that new breast cancer or a recurrence can be identified and treated as quickly as possible.
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