Listing 13.10 Breast Cancer in 2026
Breast cancer is the most common cancer among American women. The American Cancer Society projects 316,950 new invasive breast cancer diagnoses in 2026 (plus 59,080 in situ), 2,800 male breast cancer diagnoses, and 42,170 breast cancer deaths in women plus 500 in men. The overall 5-year survival rate is 91% for all stages combined, but drops to 31% for metastatic disease (stage IV) and holds around 87% for regional (stage III).
SSA Listing 13.10 recognizes five separate ways breast cancer can meet the medical vocational disability rules. Some of them are automatic. Others require specific staging or recurrence documentation. This is a full walkthrough of each paragraph, the evidence you need, how the durational windows work, and how modern treatments (CDK 4/6 inhibitors, antibody-drug conjugates, immunotherapy) shape residuals for the Continuing Disability Review.
See If You Qualify
The five paragraphs of Listing 13.10
Paragraph A: Locally advanced cancer
Paragraph A covers what SSA calls "locally advanced" breast cancer. Three subtypes qualify automatically:
- Inflammatory carcinoma of the breast (IBC). A rare and aggressive form that accounts for 1 to 5% of all breast cancers. Diagnosis is clinical plus pathologic: rapid onset (weeks to months) of breast erythema, edema (peau d'orange), warmth, and tenderness, with skin biopsy showing dermal lymphatic invasion by tumor cells. IBC is always stage IIIB minimum at diagnosis (T4d). It qualifies under 13.10A regardless of node status.
- Stage IIIB disease. Any T (including T4a chest wall extension, T4b skin ulceration or satellite skin nodules, T4c both, T4d inflammatory) with N0-N3 disease. The T4 designation is what puts most cases in IIIB.
- Stage IIIC disease. Any T with N3 disease. N3a means 10 or more axillary lymph nodes. N3b means ipsilateral internal mammary node involvement PLUS axillary node involvement. N3c means ipsilateral supraclavicular node involvement.
These stages are set in the AJCC 8th edition Cancer Staging Manual, which SSA references directly. Pathologic staging (surgical specimen) governs when available. Clinical staging (imaging and physical exam) governs at diagnosis before surgery.
Paragraph B: Metastases beyond axillary lymph nodes I/II/III
Paragraph B covers regional metastases OUTSIDE the standard axillary drainage. It qualifies when tumor has spread to:
- Ipsilateral supraclavicular lymph nodes
- Ipsilateral infraclavicular lymph nodes
- Ipsilateral internal mammary lymph nodes
- Contralateral (opposite side) axillary or internal mammary nodes
Straight axillary nodal disease (level I, II, or III alone) does NOT qualify under 13.10B. That is what Paragraph C is for. The distinction matters because SSA treats these anatomic drainage routes as functionally equivalent to distant metastases for staging purposes even though AJCC still classifies them as regional (N3).
Evidence requirements: pathologic confirmation of tumor in the specified node basins via biopsy (fine-needle aspiration, core biopsy, or excisional biopsy), or radiographic confirmation via PET-CT with FDG avidity in the specified anatomic location plus clinical correlation.
Paragraph C: 10 or more positive axillary lymph nodes
Paragraph C covers heavy axillary nodal disease. It qualifies when the pathology report from axillary lymph node dissection or sentinel node biopsy plus completion dissection shows 10 or more axillary lymph nodes with metastatic tumor.
The count runs across levels I, II, and III combined. Levels below the pectoralis minor muscle are level I. Behind the muscle are level II. Above (near the neck) are level III. All count together toward the 10-node threshold.
Sentinel node biopsy without completion axillary dissection can still meet this listing IF the sentinel counts show 10 or more positive nodes. In practice, most 10+ node cases go to full axillary dissection.
Micrometastases (>0.2 mm but less than 2 mm, designated pN1mi) count toward the total. Isolated tumor cells (ITCs, ≤0.2 mm designated pN0(i+)) do NOT count as positive under 13.10C.
Paragraph D: Recurrence after therapy
Paragraph D covers recurrent breast cancer after anti-cancer therapy, EXCEPT for local recurrence within the breast (or ipsilateral chest wall following mastectomy) that is controlled with therapy.
What counts under 13.10D:
- Regional nodal recurrence (any location) after prior nodal dissection or radiation
- Distant recurrence (bone, liver, lung, brain, distant lymph nodes)
- Contralateral breast recurrence in the same patient (rare, but counts)
- Chest wall recurrence after mastectomy that is not controlled by therapy within 12 months
What does NOT count under 13.10D:
- Local recurrence within the ipsilateral breast after lumpectomy, controlled with radiation or additional therapy
- DCIS recurrence at prior surgical site (managed as new primary if invasive component)
- Contralateral primary (separate primary in the opposite breast years later - staged as new primary, not recurrence)
The distinction of "recurrence" from "new primary" matters because a new primary in the opposite breast gets restaged from scratch under 13.10A-C. A true recurrence goes straight to 13.10D.
Paragraph E: Small-cell (oat cell) carcinoma of the breast
Paragraph E covers small-cell carcinoma of the breast, an extremely rare (less than 0.1% of all breast cancers) but highly aggressive neuroendocrine variant. Diagnosis requires pathology showing small-cell histology with neuroendocrine markers (chromogranin A, synaptophysin, CD56). Any confirmed small-cell breast cancer meets 13.10E regardless of stage.
Diagnostic evidence required
SSA requires objective medical evidence for every 13.10 approval:
- Pathology report confirming invasive breast carcinoma with histologic subtype (invasive ductal carcinoma is 70-80%, invasive lobular 10-15%, mixed 5-10%, tubular 2-3%, mucinous 2-3%, medullary 2%, inflammatory 1-5%, small-cell <0.1%)
- Receptor status: ER (estrogen receptor), PR (progesterone receptor), HER2 (human epidermal growth factor receptor 2). HER2 measured by IHC (immunohistochemistry) 0, 1+, 2+, 3+ scoring plus reflex FISH/CISH for equivocal 2+ cases. The new "HER2-low" category (IHC 1+ or 2+ FISH negative) matters for Enhertu eligibility.
- Ki-67 proliferation index when documented (>20% considered high, associated with more aggressive behavior)
- Grade: Nottingham grade 1 (well-differentiated), 2 (moderately differentiated), 3 (poorly differentiated)
- Staging workup: bilateral mammogram + breast MRI, chest CT, abdomen/pelvis CT, bone scan (or PET-CT for stage III+), brain MRI if symptomatic or in triple-negative/HER2+ high-risk
- Lymph node assessment: sentinel node biopsy for clinically node-negative, axillary dissection for clinically node-positive or after positive sentinel
- Genomic testing when indicated: Oncotype DX, MammaPrint, or Prosigna PAM50 for hormone-receptor-positive early-stage disease. Not required for 13.10 approval but often documented.
The Compassionate Allowance overlay
SSA maintains a list of about 280 conditions on the Compassionate Allowance (CAL) list. Three breast cancer categories are on the current 2026 CAL list:
- Inflammatory Breast Cancer (any stage)
- Metastatic Breast Cancer (stage IV)
- Paget disease of the breast (when associated with invasive carcinoma - the isolated in situ form does not qualify for CAL)
CAL cases get expedited processing (target 14-30 days for initial decision versus the 6-8 month national average). Every DDS office runs a CAL screen at intake. If the diagnosis matches, the case gets flagged and routed for expedited review.
Beyond CAL, breast cancer with distant metastases also qualifies as a Terminal Illness (TERI) case for expedited processing. If life expectancy is documented as under 6 months by a treating physician, the case moves faster still.
Modern treatment residuals for the CDR
The three-year remission rule under 13.00H1 (see our general Section 13.00 walkthrough) applies. After 3 years without evidence of active disease, SSA presumes medical improvement and shifts the analysis to residual side effects. Modern breast cancer treatments generate significant residuals:
CDK 4/6 inhibitors (palbociclib, ribociclib, abemaciclib)
Used for HR+/HER2- metastatic and high-risk early-stage disease. Common toxicities: neutropenia (60-70% grade 3+), fatigue (30-50%), diarrhea (30-40% with abemaciclib), pneumonitis (1-3% but potentially serious). These map to residual functional limitations under 7.00 hematologic or 5.00 digestive listings when severe.
Antibody-drug conjugates (trastuzumab deruxtecan, sacituzumab govitecan)
Enhertu (trastuzumab deruxtecan) for HER2+ and HER2-low disease. Trodelvy (sacituzumab govitecan) for triple-negative disease. Common toxicities: interstitial lung disease/pneumonitis (10-15% with Enhertu, 3-5% grade 3+, can be fatal), neutropenia (40-50% grade 3+), nausea/vomiting (70-80%), alopecia. ILD from Enhertu qualifies under 3.02 chronic respiratory disorders if PFTs meet the FEV1 or DLCO thresholds.
Immunotherapy (pembrolizumab, atezolizumab)
Used for PD-L1 positive triple-negative disease and high-risk early TNBC (KEYNOTE-522 regimen). Immune-related adverse events include hypothyroidism (10-15%), adrenal insufficiency (2-5%), pneumonitis (3-5%), colitis (2-4%), hepatitis (2-3%), type 1 diabetes (<1% but permanent). These qualify under 9.00 endocrine, 5.00 digestive, or 3.00 respiratory listings depending on which organ is affected.
Chemotherapy-induced peripheral neuropathy (CIPN)
Taxanes (paclitaxel, docetaxel) cause CIPN in 30-70% of patients, with 15-30% having persistent symptoms at 2+ years post-treatment. Platinum agents (carboplatin) add to the effect. Grade 3 CIPN (interfering with activities of daily living) can qualify under 11.14 peripheral neuropathy at the CDR.
Cardiotoxicity
Anthracyclines (doxorubicin, epirubicin) cause LVEF decline in 5-10% of patients. Trastuzumab (Herceptin) adds 2-5% LVEF drop, usually reversible after treatment stops. Combined with radiation to the left chest wall, cumulative cardiotoxicity can qualify under 4.02 chronic heart failure at the CDR when LVEF drops below 30% or NYHA class III/IV symptoms develop.
Radiation lymphedema
Post-radiation lymphedema of the arm occurs in 20-40% of breast cancer survivors who had axillary radiation or dissection. Severe cases (arm circumference difference >4 cm, functional impairment) can support residual disability findings even after 3-year remission.
Worked case examples
Case 1: Marisol, 51, Texas, inflammatory breast cancer
Marisol presented in February 2026 with 3 weeks of right breast erythema, edema, and warmth. Physical exam showed peau d'orange over the entire right breast. Ultrasound-guided skin punch biopsy showed dermal lymphatic invasion by high-grade invasive ductal carcinoma, ER+/PR-/HER2+. Core biopsy of breast mass confirmed invasive ductal carcinoma with the same profile. Staging PET-CT showed T4dN2M0 (right axillary + right internal mammary node uptake), clinical stage IIIB.
SSDI application filed March 15, 2026. CAL flag triggered on IBC diagnosis. Approval March 30, 2026 (15 days), meeting Texas DDS turnaround target. Listing 13.10A met on inflammatory histology. Backdated onset to first symptom date (February 2, 2026).
Marisol completed neoadjuvant TCHP (docetaxel + carboplatin + trastuzumab + pertuzumab) x 6 cycles, then modified radical mastectomy with axillary dissection (14 positive nodes), then adjuvant Kadcyla (T-DM1) x 14 cycles, then chest wall + supraclavicular radiation, then continued Herceptin + pertuzumab maintenance. At 3-year CDR (2029), no evidence of disease. Residuals: grade 2 CIPN from taxane, moderate right arm lymphedema (5 cm circumference difference), reduced LVEF at 45% from anthracycline + trastuzumab + left chest radiation exposure. Residuals continue to support functional disability under 4.02 (heart failure with NYHA class II-III) plus 11.14 (peripheral neuropathy).
Case 2: David, 47, Georgia, HR+/HER2- with 12 positive axillary nodes
David presented with a right breast mass on self-exam January 2026. Diagnostic mammogram + ultrasound showed 4.2 cm mass with multiple enlarged axillary nodes. Core biopsy: invasive ductal carcinoma, grade 3, ER+ 95%/PR+ 60%/HER2 0 by IHC. Ki-67 45%. Staging showed T2N3aM0, clinical stage IIIC.
David underwent right total mastectomy with level I-III axillary dissection: pathology showed 12 of 22 axillary nodes positive with metastatic carcinoma, largest deposit 3.5 cm with extranodal extension. Adjuvant AC-T chemotherapy (4 cycles doxorubicin/cyclophosphamide + 12 weekly paclitaxel), then chest wall + supraclavicular radiation, then endocrine therapy (aromatase inhibitor + ovarian suppression given he is male, monthly leuprolide + anastrozole is off-label but supported), then adjuvant abemaciclib for 2 years for high-risk HR+.
SSDI application filed April 2026. Listing 13.10A (stage IIIC) AND 13.10C (12 positive axillary nodes) both met. Approval May 2026 (30 days, expedited under CAL despite not being IBC/metastatic because Georgia DDS flagged the 12-node count as a high-severity presentation). Backdated onset to biopsy date January 15, 2026.
Case 3: Rosa, 62, California, metastatic recurrence 5 years after initial treatment
Rosa had stage IIA (T2N0M0) invasive lobular carcinoma diagnosed 2021, treated with lumpectomy + sentinel node biopsy (negative) + whole breast radiation + 5 years of adjuvant letrozole. Completed treatment 2026. In June 2026 she developed new lower back pain. MRI spine showed multiple T3-L2 vertebral lesions. Bone biopsy: metastatic lobular carcinoma, ER+/PR+/HER2 0. Restaging showed multiple bone metastases plus liver lesions.
Recurrent metastatic disease 5 years after initial treatment. Listing 13.10D met on recurrence with distant metastases. Also qualifies as Metastatic Breast Cancer CAL. SSDI application June 20, 2026 filed with California DDS. Approval July 5, 2026 (15 days). Started palbociclib + fulvestrant first-line therapy.
What to file with your application
The strongest 13.10 applications include:
- Pathology report from initial diagnostic biopsy with receptor status
- Operative report from lumpectomy or mastectomy
- Final pathology from surgical specimen with node count
- Staging imaging: mammogram, breast MRI, chest CT, bone scan or PET-CT, brain MRI if applicable
- Oncology consultation notes documenting stage assignment and treatment plan
- Any hospital admission records related to treatment complications
- Current medication list and treatment schedule
Pediatric 113.10
Section 113.10 pediatric breast cancer is exceedingly rare but exists in the childhood listings. Any confirmed pediatric breast cancer (typically secretory carcinoma) qualifies under 113.10 due to the extreme rarity and the different biology in the pediatric population.
Related reading
Full section walkthrough: Section 13.00 cancer basics. Other cancer listings covered: 13.05 lymphoma, 13.06 leukemia. Companion prostate cancer piece: 13.24 prostate cancer.
Frequently asked questions
Does every breast cancer diagnosis qualify for SSDI?
No. Only breast cancer meeting one of the five paragraphs of Listing 13.10 qualifies automatically. Early-stage disease (stage I, II, IIIA) does not meet the listing on staging alone and would need to qualify through the residual functional capacity analysis (unable to sustain full-time work due to treatment side effects, fatigue, or other limitations).
How long does the SSDI process take for breast cancer?
CAL cases (inflammatory breast cancer, metastatic breast cancer, Paget disease with invasive component) target 14-30 days. Non-CAL 13.10 cases average 3-4 months at DDS, faster than the 6-8 month general SSDI average because oncology cases are prioritized.
What is the difference between IIIB, IIIC, and Paragraph B/C?
Stage IIIB is any T4 (skin or chest wall involvement, or inflammatory). Stage IIIC is any T with N3 nodal disease. Paragraph B covers metastases to specific nodal basins outside standard axillary levels (supraclavicular, infraclavicular, internal mammary, contralateral). Paragraph C covers 10 or more positive axillary nodes specifically.
Can I get SSDI while still working during treatment?
SSDI requires that you are not engaging in Substantial Gainful Activity (SGA, $1,620/month in 2026 for non-blind). If your earnings are below SGA, you can still be approved. Some patients continue reduced hours or accommodations during chemo and still qualify.
Do I need to be finished with treatment to qualify?
No. Listing 13.10 is met at diagnosis when the staging criteria are satisfied. You do not need to have completed surgery, chemo, or radiation. Filing early is better because SSDI has a 5-month waiting period and the sooner you file, the sooner your entitlement clock starts.
What happens to my benefits after 3 years of remission?
SSA does a Continuing Disability Review at 3 years post-active-disease-clearance. If no evidence of disease and no significant treatment residuals, benefits can be terminated. Residuals like chemo-induced neuropathy, cardiomyopathy from anthracyclines, lymphedema, cognitive impairment (chemo brain), or fatigue can support ongoing disability past the 3-year mark.
Does male breast cancer qualify?
Yes. Listing 13.10 applies to any breast cancer regardless of patient gender. The 2,800 annual male breast cancer diagnoses go through the same five-paragraph analysis. Male cases tend to present at later stages due to lower awareness, so many meet 13.10A or 13.10C at diagnosis.
Next steps
If you were just diagnosed with breast cancer, apply for SSDI as soon as you have your pathology and staging in hand. Do not wait until after surgery or chemo. The 5-month waiting period starts from your established onset date, so filing early puts money in your pocket faster.