Senior Consultant, Medical Oncology, BLK-Max Super Speciality Hospital, New Delhi
Part 4 of 9 in Diagnosis and Management of Breast Cancer
Breast Cancer Types: Invasive, Non-Invasive and Receptor Subtypes
March 2, 2025
Breast cancer is classified first as non-invasive or invasive, and then further by subtype and stage.
Non-invasive versus invasive disease
Non-invasive breast cancers are limited to early or precancerous stages. Ductal carcinoma in situ (DCIS) involves abnormal cells confined to the breast ducts, and lobular carcinoma in situ (LCIS) involves abnormal cells confined to the milk glands; in both, the disease has not spread beyond that structure.
Invasive breast cancer is definite breast cancer: invasive ductal or invasive lobular carcinoma, depending on whether the duct or the gland is involved, and inflammatory breast cancer, in which cancer cells block the lymph vessels of the skin and cause the breast to appear inflamed. About 80% of all breast cancers are invasive ductal carcinomas, arising in the cells lining the milk ducts. Other, less common types include angiosarcoma, phyllodes tumour, and Paget's disease of the breast.
How the receptor profile decides treatment
Subtyping depends on which receptors are present on the cancer cells, identified through immunohistochemistry of the biopsy sample. The three receptors tested are the oestrogen receptor, the progesterone receptor and HER2; when all three come back negative, the disease is called triple-negative breast cancer. This receptor profile, more than the tissue type alone, is what actually decides which treatments will work for a given patient.
How the disease spreads
An abnormal cell typically starts growing within the ducts or glands, becoming atypical while still confined within that layer, the stage described as DCIS or LCIS. Invasion means the cells have breached the duct wall; once cancer cells reach the blood vessels or the lymphatics, the disease can travel to other parts of the body and becomes metastatic.
This article is based on a Jivo Masterclass session conducted by Dr. Sahil Bambroo, Senior Consultant, Medical Oncology, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a breast cancer or medical oncology consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Sahil Bambroo taught doctors across Africa on March 2, 2025.
FROM THE LIVE Q&A
Dr. Morris Kumwama
Speaking of biopsy, from which specific region should the tissue sample be taken, and what is the sampling technique?
Dr. Sahil Bambroo
In early breast cancer, biopsy is usually a guided procedure taken directly from the lesion itself, using a simple technique: fixation of the tissue followed by histopathology, then immunohistochemistry to determine oestrogen receptor, progesterone receptor and HER2 status. If HER2 comes back equivocal on immunohistochemistry, a FISH test confirms it. In metastatic disease involving organs such as the lung, bone or liver, the biopsy is taken from whichever site is most accessible and least risky for the patient, often the liver or the lung. In patients too unwell for any other biopsy, such as those presenting with severe anaemia, a bone marrow biopsy can confirm metastatic breast cancer directly, including its subtype through immunohistochemistry on that same sample, allowing treatment to proceed with good results.
Book a Consultation with Dr. Sahil Bambroo
Book on WhatsAppOr message us on WhatsApp: +91 98182 98669
Frequently Asked Questions
What are the causes and major signs of breast cancer?▼
The most common cause is advancing age; risk rises with it. Other contributing factors include early menarche, late menopause, never having children, having a first child after age 35, reduced breastfeeding, smoking, and alcohol consumption of any quantity. Genetic factors matter too: a first-degree relative with breast or ovarian cancer, or a positive result for high-penetrance genes such as BRCA1, BRCA2 or PTEN, raises risk. Chest radiation received for an earlier childhood lymphoma also raises the risk of a thoracic malignancy later in life.
Does an effective curative treatment for breast cancer really exist? If so, what is the therapeutic protocol, and if not, why are anti-cancer drugs used?▼
Definitive, curative treatment absolutely exists for early breast cancer: stage one and stage two patients see close to 100% results with protocols matched to the tumour's subtype, adjusted further for the patient's comorbidities and financial circumstances. For metastatic breast cancer, a cure isn't currently possible, but survival and quality of life have improved substantially compared with a few years ago. Breast cancer is the most common cancer among women, but most cancer deaths are actually from lung cancer, not breast cancer, which is part of why even stage four disease now sees meaningfully better survival than before. There is no single protocol; treatment has to be customised to the patient's age, subtype and disease status in each case.
Speaking of biopsy, from which specific region should the tissue sample be taken, and what is the sampling technique?▼
In early breast cancer, biopsy is usually a guided procedure taken directly from the lesion itself, using a simple technique: fixation of the tissue followed by histopathology, then immunohistochemistry to determine oestrogen receptor, progesterone receptor and HER2 status. If HER2 comes back equivocal on immunohistochemistry, a FISH test confirms it. In metastatic disease involving organs such as the lung, bone or liver, the biopsy is taken from whichever site is most accessible and least risky for the patient, often the liver or the lung. In patients too unwell for any other biopsy, such as those presenting with severe anaemia, a bone marrow biopsy can confirm metastatic breast cancer directly, including its subtype through immunohistochemistry on that same sample, allowing treatment to proceed with good results.
What is the difference between invasive and non-invasive breast cancer?▼
Non-invasive disease (DCIS or LCIS) is confined within the ducts or glands. Invasive disease, including invasive ductal, invasive lobular and inflammatory breast cancer, has spread beyond that structure into surrounding breast tissue.
What is triple-negative breast cancer?▼
Breast cancer in which the oestrogen receptor, progesterone receptor and HER2 are all negative on immunohistochemistry testing of the biopsy.
In This Series: Diagnosis and Management of Breast Cancer
- 1.Diagnosis and Management of Breast Cancer
- 2.Breast Cancer Warning Signs and How to Perform a Breast Self-Examination
- 3.Diagnosing a Breast Lump: Imaging, Biopsy and Why a Guided Biopsy Is Safe
- 4.Breast Cancer Types: Invasive, Non-Invasive and Receptor Subtypes
- 5.Staging Breast Cancer and What Each Stage Means for Prognosis
- 6.Treating Breast Cancer by Subtype: Surgery, Hormone Therapy, Chemotherapy and Immunotherapy
- 7.Breast Cancer in Younger Women: Rising Incidence and Genetic Risk
- 8.When Chemotherapy Can Be Avoided: Genomic Testing in Early Breast Cancer
- 9.Life After Breast Cancer: Menopause, Bone Health, Fertility and Reconstruction