Diagnosis of Breast Cancer
Related Media: Breast BiopsyYour doctor will discuss your medical history, including any family history of breast cancer. Your breasts will be examined for characteristic symptoms, including lumps or thickening, nipple discharge or inversion, redness or changes in the skin or contour of the breast. If breast cancer is suspected, the following tests will be done:
General TestsMammogram A mammogram is an x-ray of the breast. It can often find tumors that are too small for you or your doctor to feel. The accuracy of a mammogram to detect cancer will depend on several factors. It may be affected by the size of the tumor, your age, breast density, and the skill of the radiologist. Although mammograms are the most sensitive test currently used to evaluate the breast, they will miss 10%-15% of breast cancers. An MRI scan may have better accuracy in detecting some tumor types. It may be more accurate in cases where the breast tissue is more dense than usual or when breast cancer of both breasts is suspected. MRI scans can also be used if there are conflicting results from other tests, such as a mammogram and ultrasound. UltrasonographyDuring ultrasonography, sound waves (called ultrasound) are bounced off tissues. The echoes are converted into a picture. Ultrasound is used to evaluate lumps that have been identified through breast self-exam, clinical breast exam, or mammography. They help to see if a mass is solid or has liquid in it. Solid masses are generally more concerning than cystic or liquid-filled massesUltrasound may also be used to:
- Determine where the cancer has spread
- Detect any cancer cells that are in the ducts
- Determine if cancer has spread to the lymph nodes in the armpit
- Fine needle aspiration —A thin needle is used to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not be checked by a lab.
- Large needle (or core) biopsy—tissue from a suspicious area is removed with a special needle.
- Surgical biopsy —During a surgical biopsy, all or part of a breast lump is removed for lab examination. An incisional biopsy removes a small portion of a large lump, while an excisional biopsy removes the entire lump (usually a small one).
- CT scan of the chest and abdomen
- MRI scan of the chest, abdomen , and bones
- Bone scan —to see if cancer has spread to the bones
- Sentinel lymph node biopsy —to help detect cancer in the lymph nodes and determine how many are affected
- Positron emission tomography–CT (PET/CT) —to help detect distant spread of tumor, especially for locally advanced disease
- Stage 0—Called in situ, meaning within the site of origin, the cancer remains in the breast and has not spread.
- Stage I—Cancer has spread beyond the lobe or duct and invaded nearby tissue. At this stage, the tumor is no larger than two centimeters in size and has not spread beyond the breast.
- Stage II—Stage II means one of the following:
- Tumor in the breast is less than two centimeters in size and the cancer has spread to the lymph nodes under the arm, or
- Tumor is between two and five centimeters in size (with or without spread to the lymph nodes under the arm) or
- Tumor is larger than five centimeters but has not spread to the lymph nodes under the arm
- Stage III—The tumor is large (more than five centimeters in size) and the cancer has spread to the lymph nodes. Additionally, the tumor could invade the skin, the chest wall, the nipple, or spread to the lymph nodes in the neck or chest wall (called internal mammary nodes).
- Stage IV—Cancer has spread beyond the breast and lymph nodes to other parts of the body.
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5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Gnerlich JL, Deshpande AD, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg. 2009;208:341-347.
- Reviewer: Mohei Abouzied, MD, FACP
- Review Date: 12/2014
- Update Date: 12/20/2014