What to know about multifocal breast cancer

multifocal breast cancer

By Jamie Eske    

Reviewed by Yamini Ranchod, PhD, MS

About | Prevalence | Classifications | Staging | Diagnosis | Recurrence statistics | Prognosis | Treatment | Treatment side effects | Coping mechanisms | Summary

Multifocal breast cancer is a
form of breast cancer in which multiple tumors arise in the same area of the
There are many types of breast
cancer. The type and characteristics, including the number of tumors and where
they are, can affect a person’s treatment and long-term outlook.
This article covers
information about multifocal breast cancer, including how doctors diagnose and
treat the condition, its prognosis, and recurrence rates.

What is multifocal breast

A person who has received a
diagnosis of multifocal breast cancer has more than one invasive tumor in one
area of their breast.
Experts classify breast
cancers into different categories, depending on their characteristics. A person
can receive one of the following diagnoses:

  • Unifocal breast cancer, where
    there is only one tumor in the breast.
  • Multifocal breast cancer, when
    at least two invasive tumors develop in the same quadrant, or area, of the
    breast. All tumors arise from one original tumor.
  • Multicentric breast cancer,
    where at least two tumors develop separately, often in different areas of the
Multifocal breast cancer is
not necessarily more advanced or aggressive than single tumor breast cancer.
Staging multifocal breast cancer depends primarily upon the characteristics of
the primary, or largest, tumor.
However, there is more risk of
larger tumors or cancer spreading to the lymph nodes, so that the prognosis may
be less favorable for some people with multifocal compared with unifocal breast

How common is it?

As a result of differences in
definitions and diagnostic techniques, anywhere from 4 to 75 percent of breast
tumors are multifocal or multicentric.
One study involving 1,158
people with breast cancer of stages 1, 2, and 3 found multifocal breast cancer
in 131 of the participants, or 11.3 percent. They found multicentric breast
cancer in 60 cases, or 5.2 percent of participants.

Other classifications of
breast cancer

Doctors classify different
types of breast cancers based on the type of cells in which cancer develops.
Most breast cancers are carcinomas, which means they grow in the cells that
line the organs and body tissues.
Breast cancer is either
invasive or noninvasive:

  • Noninvasive breast cancers
    develop inside the milk-producing glands, or lobules, or inside the milk ducts
    and do not spread outside these areas.
  • Invasive breast cancers grow
    beyond the lobules or ducts and spread into other areas of the breast or parts
    of the body.
The main types of breast
cancer include the following:

  • Ductal carcinoma in situ
    initially develops in the milk ducts, and doctors consider it
    noninvasive. Having DCIS increases a person’s risk of developing cancer again
    compared with someone who has never had breast cancer. The chance of a
    recurrence is less than 30 percent.
  • Lobular carcinoma in situ
    is another form of noninvasive breast cancer that initially develops in
    the lobules. LCIS can increase someone’s risks of developing invasive breast
    cancer later in life. LCIS usually does not show up on a mammogram.
  • Invasive ductal carcinoma
    is a form of breast cancer that has spread beyond the ducts and into the
    surrounding breast tissue. IDCs are the most common type of breast cancer,
    accounting for 80 percent of all breast cancer diagnoses.
  • Invasive lobular carcinoma
    is a form of breast cancer that has spread beyond the lobules and into
    the surrounding breast tissue. ILCs make up a small percentage of all breast
    cancer diagnoses.
How to stage multifocal breast

Staging for multifocal breast
cancer varies with doctors basing this on the characteristics of the primary
tumor and whether or not cancer is present in other areas of the body.
Treatment plans and long-term outlook depend on the cancer stage.
There are five stages,
starting from zero, that indicate if, and how far, a tumor has spread.
Stages range from noninvasive
cancer that has not spread to surrounding tissue (stage 0) to metastatic cancer
that has spread to other parts of the body (stage IV).
A doctor will be able to work
out a person’s cancer stage by looking at the tumor, node, and metastasis (TNM)
factors. These vary between individuals:

  • Tumor (T): Size and location
    of the largest tumor and whether or not it has spread to surrounding tissue.
  • Node (N): Whether or not the
    tumor has spread to the lymph nodes and how many lymph nodes are affected.
  • Metastasis (M): Whether or not
    cancer has spread to other parts of the body, where they are, and how far from
    the original site.
The TNM system does not
include whether a tumor is multifocal or unifocal.


Diagnosing multifocal breast
cancer involves multiple examinations and, in some cases, minor procedures:

  • Breast exam. A healthcare
    provider will examine the breasts and chest area for signs of lumps or other
  • Mammogram. This is a regular
    breast cancer screening procedure that captures X-ray images of the breasts. A
    healthcare provider examines these images for early signs of breast cancer.
  • Ultrasound. An ultrasound
    machine creates detailed images of the body’s internal structures in real time.
  • MRI scan. An MRI detects
    multifocal breast cancers more accurately than ultrasounds and mammograms.
  • Biopsy. A biopsy is a
    minimally invasive procedure where a doctor removes a small sample of breast
    tissue or part of a lymph node, which goes to a lab for testing.
Recurrence statistics

Recurrence is a significant
concern for multifocal breast cancer treatment. Recurrence refers to cancers
that come back after treatment. Recurrent cancers can develop in the same place
as the original tumor, or they can develop in a new location in the body.
When doctors compare
multifocal breast cancer with unifocal breast cancer, the former may carry a
higher risk of recurrence. However, not all studies show that this is the case,
so more research is needed.
One retrospective study
followed a group of 152 people with either unifocal or multifocal breast
cancer. The research team found no differences in recurrence or mortality rates
between the two groups after 7 years, though doctors had given those with
multifocal cancer more aggressive treatment.

The prognosis for someone with
breast cancer will depend on the stage of the cancer. Experts calculate a
person’s outlook by using average 5-year survival rates. However, these
parameters are just a guide, and many people live much longer than these might
The 5-year survival rates for
women with breast cancer are as follows:

  • Stage 0 and 1 is close to 100
  • Stage 2, about 93 percent.
  • Stage 3, about 72 percent, and
    treatment is often successful.
  • Stage 4, or metastatic breast
    cancer, about 22 percent. There are still many treatment options at this stage.
In one study, the researchers
associated multifocal breast cancer with higher mortality rates and lower 5-
and 10-year survival rates, but the only independent predictors of survival
were tumor size and lymph node metastases.
Compared with single tumor
breast cancers, multifocal breast cancers have a higher risk of spreading to
the lymph nodes.
There is a wide variation
between individuals, and scientists need to complete more research before they
know how multiple tumors affect a person’s prognosis.
Overall survival rates for multifocal
breast cancer depend on various factors, such as

  • age
  • overall health status
  • tumor size
  • how the cancer reacts to
  • if the cancer has spread
    beyond the original site

The appropriate treatment
option can vary, depending on many factors, such as the person’s age, the stage
of cancer, and whether or not cancer has spread to the lymph nodes or other
areas of the body.
Treatments for multifocal
breast cancer include:
During a lumpectomy, a surgeon
removes the cancerous cells while saving as much of the surrounding healthy
breast tissue as possible. This procedure is especially promising if the cancer
is only present in one quadrant of the breast.
A mastectomy is a surgical
procedure that involves removing the entire breast and the surrounding lymph
nodes. Unless a tumor is larger than 5 centimeters (or 2 inches) in diameter,
or large relative to the breast, doctors usually favor breast-conserving
surgery, such as a lumpectomy.
Radiation therapy
Doctors often recommend
radiation therapy in combination with a lumpectomy. After removing as much of
the cancer as possible, they may use radiation therapy to destroy any remaining
cancer cells. Radiation therapy is an effective method of preventing later
breast cancer recurrence.
Chemotherapy is a systemic, or
body-wide, treatment that uses one or more cytotoxic medications that prevent
cancer cells from multiplying. When treating multifocal breast cancer,
chemotherapy may be used either before or after the primary treatment.

Treatment side effects

Breast cancer treatments can
significantly increase a person’s long-term survival rate, but they can cause
side effects.
Side effects of breast
surgery, including lumpectomy and mastectomy, may be:

  • tenderness or pain in the
  • scarring
  • swelling of the breast
  • changes in the shape and
    appearance of the breast
  • infection
Radiation therapy side effects
may include

  • pain in the breast
  • swelling of the breast
  • change in shape or appearance
    of the breast
  • fatigue
  • redness of the skin
  • flaking or peeling of the skin
  • sore throat
  • lymphedema, which is swelling
    in a specific area due to a buildup of fluid
Chemotherapy side effects are:

  • fatigue
  • hair loss
  • mouth sores
  • loss of appetite
  • weight loss
  • nausea or vomiting
  • diarrhea or constipation
  • easy bruising or bleeding
  • lowering of the body’s immune
  • ïncreased risk of infections
Coping with multifocal breast

People recently diagnosed with
multifocal breast cancer may experience a range of emotions and have many
questions. A person and their family or friends can speak to a doctor about all
stages of the process, including how and where to get psychological support.
Joining a support group is a
good idea for people who want to discuss their feelings and concerns with
others going through similar experiences. People can join support groups in
person and online.
Building and maintaining
strong relationships with family and friends can make it easier to have honest
and open discussions with loved ones. These connections can help people cope
with any difficulties that may arise throughout their journey through
diagnosis, treatment, and recovery.

Multifocal breast cancer
occurs when at least two invasive tumors are present in the same quadrant of
the breast. There are conflicting clinical definitions, so the exact number of
people who have multifocal breast cancer and the risk of developing it remains
There are several treatment
options available for multifocal breast cancer. These include lumpectomy,
mastectomy, radiation therapy, hormonal therapy, and chemotherapy.
The appropriate treatment plan
will vary from person to person, so it is vital that people speak honestly and
openly with their doctor about their treatment preferences and concerns.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.