Multifocal Breast Cancer: What You Need to Know

Table of Contents
View All
Table of Contents

There are several different kinds of breast cancer, including multifocal, multicentric, and unifocal. Multifocal breast cancer is a type of breast cancer in which there is more than one tumor, and all of the tumors originated from the same primary tumor. The multiple tumors are usually in the same section, or quadrant, of the breast. 

There are also multiple tumors in multicentric breast cancer, but they did not originate from the primary one. They are likely in different areas of the breast. In unifocal breast cancer, there is a single tumor. This article will describe how multifocal breast cancer is diagnosed and treated. It will also discuss other types of breast cancer. 

A woman with cancer is next to her daughter. A girl is hugging a woman happy - stock photo

KARRASTOCK / Getty Images

What is Multifocal Breast Cancer?

Multifocal breast cancer is a type of breast cancer in which two or more tumors are present in the breast. These tumors originate from the primary tumor and are usually located in the same region of the same breast. 

Multifocal vs. Multicentric Breast Cancer

The research estimates that multifocal and multicentric breast cancers represent about 10%–60% of all breast cancer cases. This wide range is due to there being different definitions of the disease, as well as different diagnostic tools used.

Type Overview

  • Multifocal: Two or more tumors originating from the primary tumor
  • Multicentric: Two or more tumors developing separately, often in different areas of the breast
  • Unifocal: One tumor present in the breast

Research has shown that individuals with multifocal or multicentric breast cancer are at a higher risk of metastasis than those with unifocal breast cancer. This means that cancer cells are more likely to spread beyond the breast tissue into surrounding lymph nodes and other areas of the body. 

A 2015 study found that multifocal and multicentric breast cancers are also more likely to recur than unifocal breast cancers. Multifocal and multicentric breast cancers have been associated with a younger age at diagnosis, a larger tumor size, and a higher incidence of lymph node involvement.

Types of Breast Cancer

Breast cancer usually begins in the lobules or ducts in the breast. The lobules are milk-producing glands, and the ducts are the passages that drain milk from the lobule to the nipple. Part of the diagnostic process for breast cancer is to determine if cancer cells have spread beyond these tissues, including:

  • Noninvasive: These cancers are contained within the lobules or ducts and do not spread to the rest of the breast. 
  • Invasive: These cancers grow into normal, healthy tissues. This is the case for most breast cancers. 

Common types of breast cancer include:

  • Ductal carcinoma in situ (DCIS): DCIS is noninvasive cancer that stays inside the duct. 
  • Lobular carcinoma in situ (LCIS): Not cancer, but rather an overgrowth of cells that stay inside the lobule, LCIS is considered a warning sign that you may develop invasive cancer in the future. 
  • Invasive ductal carcinoma (IDC): This is the most common type of breast cancer and begins in the duct before spreading to surrounding tissues. There are several subtypes that behave differently.
  • Invasive lobular carcinoma (ILC): This invasive cancer starts inside the lobule and grows into the surrounding tissue. 

Less common types of breast cancer:

  • Inflammatory breast cancer: This is a fast-growing form of breast cancer that causes reddening and swelling of the breast. A distinct lump is not usually present. 
  • Paget’s disease: This is a rare form of breast cancer in which cancer cells are present in the nipple. 
  • Phyllodes tumors: These are rare breast tumors that start in the connective tissue in the breast known as the stroma. These cancers tend to grow rapidly in a leaf-like pattern. These tumors are usually not cancerous but may contain cancer cells.
  • Male breast cancer: Breast cancer is rare in men, and it usually starts as ductal carcinoma. 

Diagnosis and Staging of Multifocal Breast Cancer

If your physician suspects that you have developed breast cancer, they will recommend several tests to both diagnose and stage the disease. The diagnostic tests determine if you have breast cancer, and the staging tests determine how advanced the disease is. 

Diagnosing Multifocal Breast Cancer

There are several tests used to diagnose breast cancer, including:

  • Clinical breast exam: A breast exam performed by your physician to detect any lumps in the breast
  • Mammogram: An X-ray of the breast that is performed for either screening or diagnosis 
  • Breast magnetic resonance imaging (MRI): An MRI that produces detailed pictures of areas in the breast using a magnet linked to a computer
  • Ultrasound: A machine that uses sound waves to produce pictures of areas in the breast
  • Biopsy: Tissue or fluid from the breast that is removed and examined under a microscope

Staging Multifocal Breast Cancer

Once breast cancer is diagnosed, additional tests are performed to stage cancer. This tells the medical team how advanced the cancer is and whether it has begun to spread to other areas of the body. Understanding the stage of cancer is an important factor when determining the appropriate treatment plan. 

How to Stage Multifocal Breast Cancer

To stage multifocal breast cancer, your medical team will order several tests to determine how advanced the disease is. These include imaging studies, blood tests, and a biopsy. For multifocal breast cancer, the medical team focuses on the size and growth of the primary tumor. 

A common way to stage breast cancer is to use the TNM system. This system is based on these three important factors:

  • "T" is for tumor: How far has the primary tumor grown into nearby tissues?
  • "N" is for nodes: Have cancer cells spread to the lymph nodes near the breasts?
  • "M" is for metastasis: Has the cancer spread (metastasized) to distant sites in the body such as the lungs or liver?

Stages

Staging for breast cancer is based on the size and location of the primary tumor, as well as the nearby lymph nodes. Multifocal breast cancer stages include:

Stage 0: This is noninvasive breast cancer in which there are no cancer cells detected beyond the primary tumor–also called ductal carcinoma in situ (DCIS) or Paget's disease of the breast.

Stage 1: This is invasive breast cancer that typically has started to grow into surrounding breast tissues.

  • Stage 1A: The tumor measures up to 2 centimeters, and there is no lymph node involvement.
  • Stage 1B: There may be small collections of cancer cells in the nearby lymph nodes. 

Stage 2: Invasive breast cancer typically indicates a larger primary tumor or that cancer has spread to more lymph nodes.

  • Stage 2A: Cancer is found in one to three of the nearby lymph nodes, or the primary tumor measures 2–5 centimeters. 
  • Stage 2B: The primary tumor is 2–5 centimeters and there is lymph node involvement, or the primary tumor is greater than 5 centimeters. 

Stage 3: This is invasive breast cancer in which cancer has spread farther than stage 2 but has not metastasized beyond the local tissues and organs near the breast.

  • Stage 3A: Cancer is found in four to nine lymph nodes, or the primary tumor is larger than 5 centimeters and has spread to at least one lymph node. 
  • Stage 3B: Cancer has spread to the chest wall, as well as the surrounding lymph nodes. 
  • Stage 3C: Cancer has spread to at least 10 axillary lymph nodes, either below or above the collar bone on the same side as the tumor, or in the breastbone lymph nodes on the same side as the tumor. Or it can be in more than three axillary lymph nodes and in breastbone lymph nodes.

Stage 4: Invasive breast cancer; cancer has spread beyond the breast to other organs such as the lungs, bones, liver, or brain. 

What Else Determines Prognosis?

In addition to the stage, other factors that affect breast cancer prognosis include the type of cancer, how fast the tumor is growing, your age, your overall health, and your menopausal status. 

Knowing the stage of your cancer allows your medical team to develop the most effective treatment plan for you. It also helps them to determine your prognosis and five-year survival rate. This rate is used to describe the likelihood of your treatment plan being effective. The five-year survival rates for all types of breast cancer are:

  • Localized (stage 0): 99%
  • Regional (stages 1–3): 86%
  • Distant (stage 4): 28%

It’s important to note that the prognoses for unifocal and multifocal breast cancers are different. A 2017 study found that multifocal breast cancer tended to be more aggressive and have a poorer prognosis than unifocal breast cancer. 

Multifocal Breast Cancer: Treatment and Recurrence

Once your medical team has determined your diagnosis and cancer stage, the next step is to develop a comprehensive treatment plan. 

Treatment

Treatment options for multifocal breast cancer vary based on factors like age, stage, and spread of cancer, and may include:

  • Radiation therapy: Radiation therapy involves using high doses of radiation to kill cancer cells. This is often recommended after a lumpectomy to kill any remaining cancer cells after surgery. Possible side effects include pain, swelling, redness, flaking skin, fatigue, sore throat, and lymphedema (swelling in soft tissues). 
  • Chemotherapy: Chemotherapy uses medications to kill fast-growing cells in the body, including cancer cells, which tend to grow and divide rapidly. Possible side effects include fatigue, mouth sores, hair loss, loss of appetite, nausea and vomiting, diarrhea, increased risk of infections, and bleeding.
  • Surgery: Surgery is often the first step in treating multifocal breast cancer. Possible side effects include a changed appearance, pain, scarring, infection, and swelling. 

Surgery Types

Types of breast cancer surgery include:

  • Lumpectomy: The surgeon removes the cancerous tumor while sparing as much breast tissue as possible. This may be an option when the tumors are located in the same quadrant of the breast.
  • Mastectomy: The surgeon removes the entire breast and surrounding lymph nodes.

Recurrence

Recurrence is a concern for those with multifocal breast cancer. Recurrence refers to cancer coming back after being successfully treated. A 2015 study found that 8.3% of patients with multifocal breast cancer who underwent a lumpectomy experienced disease recurrence. Of the individuals who underwent a mastectomy, 7.7% experienced recurrence.

Support and Coping

Multifocal breast cancer is an overwhelming diagnosis and finding support resources is essential. Talk with your oncologist about your concerns, and lean on friends and family who offer help. Joining a cancer support group or online community may be helpful as well. 

Summary 

Multifocal breast cancer occurs when two or more tumors that originated from one primary tumor are found in the breast. These tumors are usually located in the same region of the breast. Multifocal breast cancer can be diagnosed with a clinical breast exam, mammogram, breast MRI, breast ultrasound, and biopsy. There are several treatment options including surgery, radiation therapy, and chemotherapy. 

A Word From Verywell

If you have recently been diagnosed with multifocal breast cancer, you have likely been experiencing a range of emotions. This is an incredibly overwhelming time, and finding support is important. Talk with your doctor and medical team about your concerns. Consider joining a support group or online community to connect with others who understand what you are going through. 

Frequently Asked Questions

  • Is multifocal breast cancer worse than unifocal?

    Research shows that multifocal breast cancer is likely more aggressive and more likely to spread than unifocal (single tumor) breast cancer. Talk with your oncologist about your individual prognosis and treatment options. 

  • Is multifocal breast cancer rare?

    Multifocal breast cancer is considered rare cancer, but it is difficult to determine the exact number of cases. This is because there are different definitions of and diagnostic criteria for multifocal breast cancer. The research estimates that multifocal and multicentric breast cancers represent about 10%–60% of all breast cancer cases.

  • What is the most aggressive form of breast cancer?

    Multifocal and multicentric breast cancers are considered more aggressive than unifocal breast cancer because they are more likely to spread to the lymph nodes. Metastatic breast cancer occurs when cancer cells spread to distant areas of the body such as the brain or bones. Metastatic breast cancer is the most aggressive form of breast cancer. Talk with your oncologist about treatment options. 

Was this page helpful?
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Cancer Institute. Definition of multifocal breast cancer

  2. Ustaalioglu BO, Bilici A, Kefeli U, Şeker M, Oncel M, Gezen C, Gumus M, Demirelli F. The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients: single center experience. Am J Clin Oncol. 2012 Dec;35(6):580-6. doi: 10.1097/COC.0b013e31822d9cd6

  3. Neri A, Marrelli D, Megha T, Bettarini F, Tacchini D, De Franco L, Roviello F. Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases. BMC Surg. 2015 Jan 14;15(1):1. doi:10.1186/1471-2482-15-1

  4. Lang Z, Wu Y, Li C, Li X, Wang X, Qu G. Multifocal and multicentric breast carcinoma: A significantly more aggressive tumor than unifocal breast cancer. Anticancer Res. 2017 Aug;37(8):4593-4598. doi:10.21873/anticanres.11858

  5. Breastcancer.org. Non-invasive or invasive breast cancer. Updated September 21, 2020. 

  6. Centers for Disease Control and Prevention. How is breast cancer diagnosed? Updated September 22, 2021. 

  7. Coombs NJ, Boyages J. Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol. 2005 Oct 20;23(30):7497-502. doi:10.1200/JCO.2005.02.1147

  8. Breastcancer.org. Breast cancer stages: 0 through IV. Updated May 11, 2021. 

  9. National Cancer Institute. Breast cancer treatment. Updated October 4, 2021.

  10. American Cancer Society. Survival rates for breast cancer. Updated January 27, 2021. 

  11. Ghamrini YE, Salama TMS, Hassan MI, Nasser HM. Mapping of multifocal breast cancer to achieve negative margins: A new step in the evolution of conservative breast surgery(A cohort study). Ann Med Surg (Lond). 2020 Jun 4;56:28-33. doi:10.1016/j.amsu.2020.05.030

  12. Nijenhuis MV, Rutgers EJ. Conservative surgery for multifocal/multicentric breast cancer. Breast. 2015 Nov;24 Suppl 2:S96-9. doi:10.1016/j.breast.2015.07.023