What Is Early Breast Cancer? Symptoms, Causes, Diagnosis, and Treatment

One way to think about early versus late-stage breast cancer is in terms of its potential to be cured with treatment. “Stage 1 through 3 breast cancers are generally considered curable. Stage 4 is a more advanced stage,” says Lynn Symonds, MD, a breast oncologist at Fred Hutch Cancer Center and an assistant professor in the division of hematology and oncology at the University of Washington School of Medicine in Seattle.

Doctors assign breast cancer a stage number that ranges from 0 to 4. The stage is based on how large the cancer is, and whether it has spread to lymph nodes or to other parts of the body.

Early breast cancer includes the following stages.

Stage 0 or Ductal Carcinoma In Situ

At this stage the cancer is noninvasive, meaning that it hasn’t spread from the place which it started — such as the lobules or milk ducts. “In situ” means “in the original place.”

Stage 1

Stage 1A The tumor in the breast is no bigger than 2 centimeters (cm) across and it isn’t in any lymph nodes.

Stage 1B

• The tumor in the breast is no bigger than 2 cm and there are small groups of cells in the lymph nodes, or
• There is no tumor in the breast, but small groups of cancer cells are in the lymph nodes.

Stage 2

The tumor is larger and there may be cancer in the axillary lymph nodes (lymph nodes under the arm). There are two substages.

Stage 2A

• There is no tumor in the breast, but cancer is in one to three axillary lymph nodes or in lymph nodes near the breastbone, or
• The tumor is 2 cm or smaller and it has spread to axillary lymph nodes, or
• The tumor measures 2 cm to 5 cm and it has not spread to axillary lymph nodes.

Stage 2B

• The tumor measures 2 to 5 cm and small groups of cancer cells are in lymph nodes, or
• The tumor measures 2 to 5 cm and cancer has spread to one to three axillary lymph nodes or to lymph nodes near the breastbone, or
• The tumor is 5 cm or larger, but it has not spread to axillary lymph nodes.

Stage 3

Only stage 3A is considered early breast cancer because it has not spread to the chest wall, the skin of the breast, or other organs.

• No tumor is found in the breast, or there is a tumor of any size, and cancer is found in four to nine axillary lymph nodes or in lymph nodes near the breastbone, or
• The tumor is larger than 5 cm and small groups of breast cancer cells are found in the lymph nodes, or
• The tumor is larger than 5 cm and cancer has spread to one to three axillary lymph nodes or to lymph nodes near the breastbone.

Along with assigning a number, your doctor will consider these factors when staging your cancer:

• The grade: How different the cancer cells look from healthy cells.
• The estrogen- and progesterone-receptor status: Whether the cancer grows in response to these hormones.
• The HER2 status: Do the cancer cells make too much of a protein called human epidermal growth factor receptor 2?

In its early stages, breast cancer may not show any symptoms. Many early-stage breast cancers are picked up during a screening mammogram.

• A lump in the breast or in the armpit
• Clear fluid or bloody discharge from the nipple
• Breast pain
• A nipple that turns inward (inverted nipple)
• Changes to the size or shape of the breast
• Dimpling or other texture changes in the breast skin
• Redness and swelling of the breast

“It’s important to remember that these symptoms can also be related to a noncancerous condition,” says Jennifer Tseng, MD, the medical director of breast surgery and a double board-certified surgical oncologist specializing in breast cancer at City of Hope Orange County in Irvine, California. Even so, let your doctor know if you have symptoms like these so that if it does turn out to be cancer, you can get prompt treatment.

Screening mammograms help find breast cancer before symptoms appear. A mammogram uses low-dose X-rays to detect cancer.

• Diagnostic Mammogram A diagnostic mammogram is a more detailed version of the same test used to screen for early-stage breast cancer.
• Breast Ultrasound This test uses sound waves to detect abnormal areas inside the breast.
• Breast Magnetic Resonance Imaging (MRI) It’s a scan that uses X-rays and strong magnetic fields to take detailed images from inside the breast.
• Biopsy This is how doctors confirm a breast cancer diagnosis. During a biopsy, the doctor removes a piece of tissue from the suspicious growth using a needle.

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   “The biopsy will provide your medical team with information about whether or not this is breast cancer, and what type of breast cancer it is,” says Dr. Symonds.

After an early-stage breast cancer diagnosis, your team of doctors will recommend a treatment plan based on your type of breast cancer, its stage, and your health. Treatments can include a combination of surgery, radiation therapy, and systemic (body-wide) treatments like chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

“Cancer with a higher stage, like stage 3, is more likely to require intensive treatment to give the patient the best chance of a cure,” says Symonds.

Surgery

Hormone Therapy

Chemotherapy

Targeted Therapy

Immunotherapy

Can breast cancer be cured at an early stage? The answer is yes. Breast cancer that hasn’t spread beyond the breast is potentially curable. The lower the stage, the better the survival odds.

When you look at survival numbers, remember that they’re based on research that was done a few years ago in large groups of people. Statistics can’t necessarily predict what will happen to you today. Your doctor can give you a better idea of your prognosis.

• You had a larger cancer.
• Cancer was in your lymph nodes.
• Your cancer is a more aggressive type, such as HER2-positive or triple-negative.
• You were young (under age 35) when you were diagnosed.

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Regular follow-up visits after treatment will help ensure that if your cancer does come back, your doctor can catch it early. “If you still have breast tissue, your provider will do breast imaging, normally a mammogram. That’s typically done yearly, though some patients may need more screening depending on their history,” says Symonds. “Your provider will also do a physical exam and symptom review when they see you at visits.”

Surgery, radiation, and medication aren’t the only ways to improve your outcome. “For anyone who has received breast cancer treatment, staying healthy is important because studies show that doing so may reduce the chance of a recurrence,” says Dr. Tseng.

• Avoid excess weight gain. Most breast cancer patients gain some weight during and after treatment. Try to keep your body mass index (BMI) within the healthy range of 18.5 to 24.9. “We know that fat cells can impact hormone levels, and so maintaining a healthy BMI can be an important factor in preventing breast cancer recurrence,” says Symonds.
• Stay active. Research finds that exercise is the most effective of all lifestyle interventions for reducing the risk of a recurrence, in part because it reduces hormone levels and inflammation. Try to do at least 30 minutes of moderate intensity exercise (like a brisk walk or bike ride) five days a week. If you haven’t been active in the past, start slowly and work your way up to 30 minutes.
• Follow a balanced diet. Eat more fruit, vegetables, whole grains, and lean proteins, and less saturated fat, for good nutrition.
• Don’t drink alcohol, or at least cut back. Because there’s a link between alcohol and breast cancer risk, it’s safest not to drink at all. If you do, limit yourself to one drink a day or less.

Breast cancer isn’t a journey you want to take alone. “Having a support network to help you during treatment is so important for your overall health and emotional well-being,” Symonds says.

You can find that support from friends, family, and other people in your network. Or you might join a support group at your cancer hospital or through an organization like Susan G. Komen or the American Cancer Society. Ask your medical team to connect you with resources such as social workers and mental health professionals in your community.

The Takeaway

A diagnosis of early breast cancer means the cancer hasn’t spread beyond the breast and lymph nodes, and is considered curable. Some people with early-stage breast cancer may have no symptoms at all, so it’s important to stay on top of your yearly screening mammograms. In addition to the many treatment options available, lifestyle changes such as exercising, eating well, and cutting out alcohol can help you achieve the best outcome and reduce your risk of recurrence.