Management of Invasive Ductal Carcinoma (IDC) of the Breast

Initial Evaluation and Staging

The American Cancer Society recommends initial comprehensive evaluation followed by either breast-conserving surgery with radiation or mastectomy, combined with appropriate systemic therapy based on tumor biology, with the specific approach determined by tumor extent, patient factors, and molecular characteristics 1, 2, 3
Document family history of breast/ovarian cancer with ages at diagnosis, prior therapeutic chest irradiation, collagen vascular disease presence, breast implant status, menstrual/pregnancy status, and hormone replacement therapy use 4, 5
Perform bilateral breast examination assessing tumor size and location, nipple discharge or retraction, breast-to-tumor size ratio, skin changes, axillary/supraclavicular lymphadenopathy, and contralateral breast appearance 4, 3

Breast-conserving surgery (BCS) with radiation therapy is appropriate for most patients with early-stage IDC when negative margins can be achieved with acceptable cosmesis 1, 2, 3
Mastectomy is indicated when breast conservation cannot achieve negative margins with acceptable cosmesis, for multicentric disease, or when radiation therapy is contraindicated 1, 3

Neoadjuvant chemotherapy is indicated for locally advanced disease, inflammatory breast cancer, or to downstage tumors for breast conservation 6, 7
Adjuvant systemic therapy, including endocrine therapy and/or chemotherapy, is based on tumor biology and stage 7

Radiation therapy is mandatory after breast-conserving surgery and reduces local recurrence by approximately two-thirds 1, 2, 7

Follow-up schedule: every 3-6 months for years 1-3, every 6-12 months for years 4-5, and annually after 5 years 7
Surveillance components include history and physical examination, annual mammography, and avoidance of routine imaging or tumor markers in asymptomatic patients 7