Diagnosis of Breast Cancer

Signs and Symptoms

Common breast cancer symptoms and signs of breast cancer include:

  • A lump or thickening inside the breast tissue or in the armpit area.
  • Change in shape or size of breast.
  • Change in appearance of skin in a part of the breast.
  • Inversion or turning in of the nipple.
  • Discharge from the nipple, particularly if blood stained

Cancer-Survivor-Story-San-Francisco

Detection and Diagnosis

Early detection of breast cancer, often found from breast cancer symptoms, improves the chances of successful treatment. New techniques are constantly being researched to improve the detection, diagnosis, and treatment of breast cancer.

Detections and diagnosis of breast cancer is achieved by the following techniques;

  • Clinical Breast Examination
  • Mammography
  • Other imaging tests such as ultrasound & MRI
  • Biopsy

Clinical Breast Examination (CBE)

During wellness checks, a health professional preforms a physical examination of the breast. The purpose of the exam is to find a lump or, any change in the breast, which may be an indication of breast cancer. CBE should be a part of regular health check-up. American Cancer Society recommends a CBE once every three years for women in their 20’s and 30’s and every year after 40.

Mammogram

Mammography

A Mammogram is an X-ray of the breast.  Screening mammogram is a key to early detection, even if women are asymptomatic. A diagnostic mammogram is for women who are having a problem such as a lump or unusual nipple discharge or pain. The diagnostic mammogram focuses in on a particular lump or area of abnormal tissue. It involves special techniques and more views than screening mammograms.

There have been recent advances in traditional mammography and now many women are getting access to Digital Breast Tomosynthesis. This new technology is delivering clearer pictures to help find breast cancer that would have likely gone undetected. You can read about a new 3D Mammography available through John Muir.

Potential abnormalities on a mammogram may include cysts, hematomas, calcifications, fibroadenomas or tumor.

Basic imaging tests

If a mammogram reveals abnormal findings, other imaging tests may be needed for further evaluation. These imaging tests include ultrasound and MRI of the breast.

Breast Ultrasound: Breast Ultrasound also known as sonography creates pictures using high frequency sound waves through the breast. The great advantage of breast ultrasound is that it requires no radiation, is non-invasive and can allow for a biopsy.

Advanced imaging tests

Breast MRI: Breast Magnetic Resonance Imaging (MRI) scans use radio waves and strong magnets. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue. Breast MRI is also helpful in detecting tumors even in dense breast tissue and distinguishing between benign and malignant tumors.

Bone Scan: A bone scan can help show whether a cancer has spread to the bones. For this test, a small amount of low-level radioactive material is injected intravenously. The substance settles in areas of bone changes throughout the entire skeleton. A scanner detects the radioactivity and creates pictures of the bones. The pictures may show cancer that has spread to the bones.

PET Scan: In this test a sugar molecule is bonded to a radioactive element (which releases positrons) and is injected into the body. The reason the PET scan is so successful is that cancer is, in general, more metabolically active than other body tissues, and so takes up more sugar. After the cancer takes up the sugar, the radioactive element is retained in the tissue and then positrons are released and visualized by the scanner.

CT Scan: In women with breast cancer, this test is most often used to look at the chest and abdomen to see if the cancer has spread to other organs. The CT scan uses a device that rotates around the body spreading the x-rays beams while it rotates. These images are then processed by a computer, resulting in cross-sectional images of the internal organs of the body. A blood vessel in your forearm or hand can be injected with contrast material which is used to highlight specific areas inside the body, which creates a clearer image.

Biopsies

A biopsy is the removal of tissue from the suspicious area to determine the presence or extent of the cancer cells. Following a clinical examination or mammography, a biopsy is the only definitive way of confirming or ruling out breast cancer in suspected cases. There are several kinds of breast biopsy techniques, some of them are:

  • Fine-needle aspiration— A fine needle aspiration (FNA) biopsy is an effective tool in evaluating and diagnosing suspected lumps or masses. It involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass. The sample is then sent to a pathology laboratory for analysis. The procedure is non-invasive and only slightly uncomfortable.
  • Core needle biopsy— Core biopsy is a more invasive procedure than FNA, as it involves making a small incision in the skin. A physician makes an incision and uses a large needle to collect several narrow samples of the tissue to be investigated.  This is the preferred way of diagnosing breast cancer.
  • A surgeon can remove a small portion of breast skin during a skin biopsy, if there are any changes to the skin.
  • Surgical Biopsy—surgical biopsy can be either incisional or excisional.
    • Incisional Biopsy— An incisional biopsy involves removal of only a portion of the tumor.
    • Excisional Biopsy– An excisional biopsy involves removal of the entire lump or suspicious area.

Other Lab Tests With Breast Tissue

The removed breast tissue has other lab tests done after a breast cancer diagnosis. These tests consist of:
Hormone receptor tests: These tests will show whether or not estrogen and progesterone hormones fuel the tumor. Cancer that is hormone-sensitive has a better chance of responding to hormone therapy. Hormone-negative cancer will respond to other kinds of treatment.

HER2/neu test: Knowing HER2/neu status or human epidermal growth factor receptor 2 is an important part of the diagnosis. HER2/neu is a gene that sends control signals to the cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2/neu gene. However, some breast cells contain more than 2 copies of that gene and start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly. If the breast tumor has too much HER2/neu, then targeted therapy is a treatment option.

A physician runs diagnostic tests to find out how widespread the cancer is. Staging helps the health care professional choose the best suitable treatment. Staging may involve other tests like bone scan, CT scan, lymph node biopsy and PET scans.


A Sentinel Lymph Node Biopsy (SLN biopsy)
 is surgical removal of the sentinel lymph node in the axilla. A surgeon injects the area near the breast tumor with blue dye and a radioactive substance. The surgeon uses a scanner to find the sentinel lymph node.  Examination under a microscope helps to determine whether there are cancer cells are present.

If you have breast cancer symptoms or a family history, contact us to request an appointment with one of our oncologists to begin diagnostic testing or to obtain a second opinion on a recent diagnosis.