What is Comedocarcinoma?
Comedocarcinoma is a type of breast cancer that is considered a very early stage or precancerous condition(1).
According to the American Cancer Society, comedocarcinoma is also considered a subtype of ductal carcinoma in situ, which accounts for 1 in 5 new diagnoses of breast cancer(2). It is non-invasive breast cancer and affects only the milk ducts. It does not spread to nearby tissues.
Comedocarcinoma involves small plugs and growths that are seen while regular breast cancer screening.
Causes and Risk Factors of Comedocarcinoma
There are no common causes of comedocarcinoma, but there are a few factors that may increase the risk. These include:
- Family history
- Genetic mutations, which include BRCA1 and BRCA2
- Undergoing hormone replacement therapy for long term
- Having a history of benign breast condition
- Age
- Obesity increases the chances of suffering from comedocarcinoma
A study done in 2020 found the risk factor for estrogen receptor-positive ductal carcinoma in situ in African American women include(3):
- Early menstruation
- Having a late first birth
- First-degree family history of ductal carcinoma in situ
- Using birth control pills
Different Grades of Comedocarcinoma
Comedocarcinoma is a high-grade subtype of ductal carcinoma in situ, containing dead cells inside the lesions.
Ductal carcinoma in situ is rated from grade I to III.
- Grade I: This includes the low risk of recurrence. In this, the cancer cells look similar to the healthy ones under a microscope.
- Grade II: This is also known as a moderate grade. In it, the cancer cells grow faster and there are higher chances of recurrence
- Grade III: This is high-grade ductal carcinoma in situ, in which there are good chances of recurrence of cancer
Comedocarcinoma is considered the highest grade and therefore the most aggressive form of ductal cell carcinoma in situ.
Symptoms of Comedocarcinoma
A person with comedocarcinoma does not always experience symptoms. There may be breast pain and in some, it may also cause clear nipple discharge, unlike other breast cancer in which the discharge is bloody.
Ductal carcinoma can lead to lumps in the breast and breast swelling, dimpled skin resembling an orange peel, inward-turned nipples, swollen lymph nodes, and flaky, red, or thickened nipples of breast skin.
A doctor should be consulted for any kind of breast discomfort.
How is Comedocarcinoma Diagnosed?
Comedocarcinoa is mostly detected in a routine mammogram. 70% to 90% of the ductal carcinoma in situ are detected as abnormal calcifications during the imaging tests(4). These may be visible as small white spots on a mammogram.
Along with mammography, the following tests can also be used for determining comedocarcinoma:
- Breast examination
- Breast ultrasound
- Magnetic resonance imaging
- Breast biopsy
Once the condition is diagnosed, the stages of comedocarcinoma are determined by the pathologist. The stages describe how far it has spread and can be helpful for the doctors to determine the treatment and outlook.
Treatment of Comedocarcinoma
Comedocarcinoma is considered a precancer but if left untreated has the potential to become invasive cancer(5).
This is why ductal carcinoma in situ is treated with mastectomy or breast-conserving surgery to remove the cancer cells. Also, in some, the surgery may be followed by radiation therapy.
If the ductal carcinoma in situ is hormone receptor-positive, hormone therapies are recommended by the doctors, which include aromatase inhibitors or estrogen modulators.
The extent of treatment for ductal carcinoma in situ depends on the grading. As comedocarcinoma is a grade III cancer, a combination of treatment are given by the doctor.
Outlook for Comedocarcinoma
Comedocarcinoma is considered stage 0, which is early in cancer staging scales. It can still spread to other areas of the body. It is important to prevent ductal carcinoma in its early stages to prevent it.
The risk of death is low in ductal carcinoma in situ(6).
Comedocarcinoma is a subtype of ductal cell carcinoma in situ and is a non-invasive type of breast cancer. The risk of death is low but there are chances of the spread of cancer to outside the breast ducts. This is why preventive treatment such as surgery and hormone therapies are recommended by doctors.
