Is there indeed a stage 1a and 1b?

There is indeed a stage 1a and 1b.  My MO told me I was stage 1a.  I can't tell you if there was  a change in the staging process since 2008.  I have read through some of the threads myself and there does seem to be some confusion.  Your right, in the grand scheme of things, it really makes no difference. The standard of care is pretty much the same for all MOs.

I was staged 1b due to a micromet in one node. I  tried to find staging info and it is confusing to say the least but my doctor told me 1b so that's good enough for me.

My doctors at Mayo Clinic said I was Stage 1C.

I didn't know there were A-C on Stage I.  I guess by what Val wrote I would be a Stage Ib. Is stage 1c 1 cm to 2 cm?  But that can't be right, I didn't have micromets, so I must be Stage 1a.

Bren

I think there is some confusion between tumor size and stage differences.  

Stage I tumors can range in size from less than 1mm to 2cm.  The tumor size ("T" within the TNM classification) divisions are:

• T1mic - a tumor that is ≤1 mm in greatest dimension.
• T1a - a tumor that is >1 mm but ≤5 mm in greatest dimension.
• T1b - a tumor that is >5 mm but ≤10 mm in greatest dimension.
• T1c - a tumor that is >10 mm but ≤20 mm in greatest dimension. 

All these tumor sizes can be either Stage IA or Stage IB.  All these tumor sizes can also be Stage IIA, IIIA, IIIC, or IV.  The other factors that determines the stage are nodal status and mets, and for Stage I, it's actually nodal status - not tumor size - that determines if you are Stage IA or Stage IB.

Breaking Stage I into A and B is new.  This change first came about in the Fall 2010 update of the AJCC Staging manual.  It's interesting to note that the NCCN Treatment Guidelines still don't include this change in their explanation of staging, which suggests that acceptance might not yet be widespread. 

In any case, it appears that while previously any presence of cancer cells in the nodes automatically moved someone up to Stage II, with this change, they are keeping those with micromets (i.e. nodal mets of no more than 0.2mm in size in no more than 3 nodes) in Stage I. For those with micromets to the nodes, they've created the new Stage IB classification.

What this means is that if you were Stage I before, you are Stage IA now.  If you were Stage II previously with a tumor that was 2cm or less in size but had micromets in your nodes (N1mi), now you are Stage IB.  There is no Stage IC. 

Here how this is explained in the AJCC Staging Manual, in their section on Summary of Changes:

Stage I breast tumors have been subdivided into Stage IA and Stage IB; Stage
IB includes small tumors (T1) with exclusively micrometastases in lymph
nodes (N1mi) 

You can access the latest AJCC Breast Cancer Staging Manual from this website:  AJCC Staging Manual    Just click on "Chapter 32 Breast" in the right hand column.  

You're welcome!

minxie, yes, it appears that the reason why micromets in the nodes for those with tumors 2cm or smaller have been reclassified as Stage IB, vs. the previous classification as Stage IIA, is because the long term prognosis is only minimally affected by micromets.

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Here is an excerpt from pages 20-21 of Chapter 32,  Breast Cancer Staging (or pages 364-365 within the total AJCC Staging Manual):

Should nodal micrometastases be considered different from
nodal macrometastases for purposes of overall stage grouping?
The AJCC Cancer Staging Manual has traditionally grouped breast cancer cases with exclusively nodal micrometastases (pN1mi) as having the same prognostic significance as macrometastases with respect to assigning an overall stage grouping based on T, N, and M categorical classifications. A recent analysis of data in the United States Surveillance, Epidemiology, and End Results (SEER) national cancer database has demonstrated that when nodal tumor deposits no larger than 2.0 mm are the only finding in lymph nodes and the primary tumor is less than or equal to 2 cm (pT1) the incremental decrease in survival at 5 and 10 years was only 1% compared to patients with no nodal metastases detected. Patients with tumors no larger than 2.0 cm (T1) represented 70% of the total population in the analysis, and in this subset calculated 10-year survival decreased from 78% to 77% to 73% for pN0, pN1mi, and pN1a, respectively. This does not justify classifying pN1mi cases with Stage II tumors. This analysis included data from 1992 to 2003 spanning the introduction and widespread adoption of sentinel lymph node biopsy. In this edition of the manual, T1 tumors with nodal micrometastases (pN1mi) will be classified as Stage IB to indicate the better prognosis for the subset of breast cancer patients and to facilitate further investigation. 

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Intersting...I remember before my final path my surgeon thought I would be a 1B but I ended up a 2A.

Valgirl, to my understanding, up until this 7th version of the Staging Manual, officially there was only Stage I - with no IA or IB or IC. That's still how the NCCN Guidelines show it.  But when you think about it, there can be a lot of difference between someone who has a 1mm invasive tumor (as I do) and someone who has a 8mm invasive tumor (as you do) and someone who has a 1.9cm invasive tumor (which would also be Stage I).  The significance of being HER2+++ or triple negative - and therefore the presentation of different treatment options - kicks in when a tumor is only 6mm in size (or even smaller).  And until the NCCN Treatment guidelines were changed this year to incorporate the use of the Oncotype test, the guidelines used to suggest the consideration of chemo for any tumor that was 1cm in size or greater.  So within Stage I, there can be a lot of differences in treatment. For this reason I think that many doctors logically have wanted to distinguish between these different Stage I diagnoses so they would use the tumor "T" classification as a way to also classify and differentiate Stage I diagnoses. I think that's why so many of the women posting here were told that they were Stage IA or IB or IC, based on the tumor size.

The problem now is that these unofficial Stage I classifications are inconsistent with the new "official" description of Stage IA and Stage IB.  That's probably going to cause quite a bit of confusion for quite some time.  And by the way, I noticed that although the 7th Edition of the Staging Manual was issued on August 10th 2010, they state the following:  "All of the TNM Staging information included in the Seventh Edition, taking effect for all new cases diagnosed after January 1, 2010, is uniform between the AJCC and the UICC (International Union Against Cancer)."  So I guess that means that if you were diagnosed and staged before January 1st 2010, don't worry about these changes but if you were diagnosed and staged afterwards, these changes do apply.  It also means that although the source of this information is the American Joint Committee on Cancer (AJCC), the staging info that they provide is consistent internationally. That's very important to know - this isn't just an American thing (for all of us on this board who are not in the U.S.!).

Erica, I'm not sure who or what you were referring to, but the only link that I included in my posts was to the AJCC Staging Manual, 7th Edition, which was issued in August 2010.  The quotes that I included are directly from that version of the manual....if your comment referred to any of these quotes, obviously I can't control what data or studies these doctors/experts used in 2010 to make their decisions about staging changes. 

I agree with Valgirl.  That's exactly what I read.

Stages of Breast Cancer
National Cancer Institute

http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2 

Thanks Beesie and Lago. There definitely seems to have been some confusion between Staging and T size and you've now cleared that up.

Lago - congratulations on being done with chemo!!! Hope you're feeling well this weekend!

Huh - my radiation oncologist told me I was 1b, but that was almost 5 years ago.  I guess I am a 1a.  Thanks Bessie.