Cribriform breast cancer is a rare type of invasive breast cancer accounting for less than 4% of all breast cancers.
It’s common to see cribriform breast cancer mixed with another type of breast cancer called tubular breast cancer.
Cribriform cancer cells can also be found in ductal carcinoma in situ (DCIS), a non-invasive breast cancer.
Cribriform breast cancer is usually a low-grade (well-differentiated), slow-growing breast cancer. Although each case is different, the outlook for cribriform breast cancer is generally better than many other types of invasive breast cancer.
The most likely symptoms of cribriform breast cancer are a small lump or thickening in the breast tissue. However, it’s more often found after a routine mammogram (breast x-ray) through breast screening, before there are any symptoms.
Cribriform breast cancer is diagnosed in the same way as other breast cancers. A range of tests will be done to make the diagnosis. They include a mammogram (breast x-ray), ultrasound scan, fine needle aspiration and/or needle core biopsy.
The features of your cribriform breast cancer will affect what treatments you are offered.
Breast surgery is usually the first treatment for cribriform breast cancer.
This may be:
- breast-conserving surgery, usually referred to as wide local excision or lumpectomy, which is the removal of the cancer with a margin (border) of normal breast tissue around it
- a mastectomy, which is the removal of all the breast tissue including the nipple area.
The type of surgery recommended depends on the area of the breast affected, the size of the cancer relative to the size of your breast and whether more than one area in the breast is affected. Your breast surgeon will discuss this with you.
If you have breast-conserving surgery, it’s important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, sometimes a second operation is needed.
If you’re going to have a mastectomy, you’ll usually be able to have breast reconstruction either at the same time as your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).
Surgery to the lymph nodes
If you have invasive cribriform breast cancer, your specialist team will want to check if any of the lymph nodes (glands) under the arm (the axilla) contain cancer cells. This helps them decide whether or not you will benefit from additional treatment after surgery.
To do this, your surgeon is likely to recommend an operation to remove either some (a lymph node sample or biopsy) or all of the lymph nodes (a lymph node clearance).
Sentinel lymph node biopsy is widely used for people whose tests before surgery show no evidence of the lymph nodes containing cancer cells. It identifies whether the first lymph node (or nodes) is clear of cancer cells. If it is, this usually means the other nodes are clear too, so no more will need to be removed. If the results of the sentinel lymph node biopsy show that the first node or nodes are affected, you may be recommended to have further surgery or radiotherapy to the remaining lymph nodes. However, spread to the lymph nodes under the arm is uncommon in cribriform-only breast cancer (not mixed with tubular breast cancer).Your surgeon will discuss whether or not this procedure is an option for you.
Find out more information about surgery to the lymph nodes.
Adjuvant (additional) treatment
After surgery, you may need further treatment. This is called adjuvant (additional) therapy and can include:
- hormone therapy
- targeted therapy.
The aim of these treatments is to reduce the risk of breast cancer returning in the same breast or developing in the other breast, or spreading somewhere else in the body.
If you have breast-conserving surgery you will usually be offered radiotherapy to the breast to reduce the risk of the cancer coming back in the same breast. Sometimes you may be offered radiotherapy to the nodes under your arm.
In some circumstances, you may be recommended to have radiotherapy to the chest wall after a mastectomy, for example if some lymph nodes under the arm are affected.
Hormone (endocrine) therapy
Hormone therapy will only be prescribed if your breast cancer has receptors within the cell that bind to the female hormone oestrogen and stimulate the cancer to grow (known as oestrogen receptor positive or ER+ breast cancer).
All breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery. Most cribriform breast cancers are oestrogen receptor positive.
Find out more about when hormone therapy is given.
Depending on various features of the cancer, chemotherapy may be recommended for some people. Because it’s less common for invasive cribriform breast cancer to spread to the lymph nodes under the arm, and it’s more likely than other types of breast cancer to grow slowly, chemotherapy is not often used.
Targeted therapies (sometimes called biological therapies)
This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that cause cancer to grow.
The most widely used targeted therapy is trastuzumab (Herceptin). Only people whose cancer has high levels of HER2 (HER2 positive), a protein that makes cancer cells grow, will benefit from having trastuzumab.
There are various tests to measure HER2 levels which are done on breast tissue removed during a biopsy or surgery. Invasive cribriform breast cancer is usually HER2 negative, meaning that trastuzumab will not be of any benefit.