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Diagnosis of Breast Cancer

Imaging, Pathology, Hormone Status, Staging

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Updated June 02, 2014

Diagnosis: Identification of a disease, based on signs and symptoms

Breast cancer isn't always detected with the naked eye. Its early signs are often hidden within your breast tissues. Changes to your breasts that you do see may not be the result of breast cancer at all. Lumps and bumps may come and go, as your hormones ebb and flow, and as you age. Breast skin may change texture due to sunburn, radiation treatments, or infections that cause rashes. So how would you know for sure whether or not a lump, skin rash, or skin dimpling is benign or cancerous? You will need help from your medical professionals to get a clear diagnosis.

Hands-on Screening

Clinical Breast Exam (CBE)
Women who are between 20 and 30 years old should have a clinical breast exam during their annual physical. If irregularities are found, a mammogram and ultrasound can help clarify the nature of the problem.

Getting the Right Picture: Imaging Studies

Mammograms
A mammogram is the gold standard for breast cancer screening and early detection. The American Cancer Society recommends that women 40 years old and up have an annual mammogram, though some other medical associations push that recommendation to age 50. Mammograms can help detect 85 to 90 percent of all breast cancers, even before you can feel a lump. Breast Magnetic Resonance Imaging (MRI)
A breast MRI reveals different details of your breast health than a mammogram, so it can be used as a complementary test. MRIs don’t use compression, like mammograms, but are much more expensive and not as widely available. Learn more about how mammograms and MRIs are different.

Elastography - Staying in Touch With Breast Cancer Detection and Diagnosis
Elastography is a new, though still investigational, technology for imaging breast tissue. It may be better than mammography, ultrasound, and MRI at distinguishing between benign and cancerous growths. Elastograms can find a cancerous lump without a biopsy.

Getting Inside the Problem: Pathology Tests

If a breast lump is suspicious, a sample of tissue or fluid must be taken and tested by a pathologist.

Fluid Tests:

Ductal Lavage: Screening for pre-cancerous and cancerous breast cells
Ductal lavage has been referred to as the "Pap smear for the breast." A tiny tube is inserted into the breast to draw fluid from the breast ducts, which is then examined under a microscope or screened for cancer cells. This is also an investigational screening technique.

Aspiration: During an aspiration, your doctor will use a fine needle to suction a sample of fluid from a lump, such as a cyst, to be screened.

Tissue Tests:

Breast Biopsy: A surgeon can remove a very small tissue sample from your breast. The tissue will be tested and examined under a microscope for cancer. There are three types of breast biopsy:

Discovering What Fuels the Cancer

Hormone Status
Breast cancers are divided into two main types: estrogen receptor positive, and estrogen receptor negative. If you test positive for breast cancer, estrogen and progesterone biomarker test results appearing on your pathology report will help your physician determine which type of the disease you have. This information affects your treatment as well as your follow-up care.

HER2 Status
HER2 (human epidermal growth factor receptor 2) protein can fuel the uncontrolled growth of a breast cancer tumor. Herceptin is used to treat this kind of breast cancer, in combination with other chemotherapy drugs. Lapatanib is also available for those who are HER2 positive. Knowing your HER2 status affects your diagnosis and treatment.

Getting the Overall Diagnosis

Breast Cancer Staging
Once all the test results are in, your doctor will summarize the diagnosis for you. Your cancer will be ranked in stages, once by your oncologist, and again by your radiologist. Knowing the stage of your breast cancer is critical to deciding on a course of treatment.
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