Diagnosis of Breast Cancer

Your 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 performed:

General Tests

Mammogram

A mammogram is an x-ray of the breast that 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 such factors as 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.

Other x-rays, including MRIs , are being studied to see if they are more sensitive than mammograms.

Ultrasonography

During ultrasonography, sound waves (called ultrasound) are bounced off tissues, and the echoes are converted into a sonogram, or a picture. Ultrasound is used to evaluate lumps that have been identified via breast self-examination, clinical breast examination, 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 masses.

Further Testing

Depending on the outcome of these tests, your doctor may simply continue to monitor subsequent breast changes, or may decide to do further testing. In some cases, your doctor may decide to remove a sample of tissue to be examined in the lab. This sample may be taken by one of the following methods:

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 need to be checked by a lab.

Large needle (or core) biopsy—In this procedure, tissue is removed with a large-bore needle from an area that looks suspicious on a mammogram, but cannot be felt.

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 small).

Keep in mind that your physician may recommend proceeding directly to biopsy if the lump is clinically suspicious. The only way to absolutely confirm the diagnosis of breast cancer is by tissue examination. After biopsy is taken or surgery is performed, the cancer is analyzed for the presence of estrogen and progesterone receptors (ER and PR tests) and Her-2-Neu content, which will aid your physician in determining the best course of treatment for you.

Staging

If cancer is found, your prognosis and treatments depend on the location, size, and stage of the cancer and your general health. Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected.

The following stages are used to classify breast cancer:

Stage 0—Called "in situ" (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: 1) the tumor in the breast is less than two centimeters in size and the cancer has spread to the lymph nodes under the arm, or 2) the tumor is between two and five centimeters in size (with or without spread to the lymph nodes under the arm), or 3) the 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.

References:

National Breast Cancer Coalition website. Available at: http://www.natlbcc.org . Accessed January 27, 2006.

National Cancer Institute website. Available at: http://www.cancer.gov . Accessed January 27, 2006.

The National Women’s Health Information Center website. Available at: http://www.4woman.gov . Accessed January 27, 2006.



Last reviewed April 2007 by Jondavid Pollock, MD, PhD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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