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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 done:

General Tests

Mammogram

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.

Ultrasonography

During 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 masses

Ultrasound 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
Further Testing

Your doctor will use these tests to help determine the next step. Your doctor may simply continue to monitor you for any future breast changes. Your doctor may also decide to do further testing. In some cases, your doctor may decide to remove a sample of tissue. The sample will be sent to a 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 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).

Keep in mind that your doctor 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.

Staging

If cancer is found, your prognosis and treatments depend on the location, size, and stage of the cancer.

The following tests may be done to determine the stage and look for spreading of the cancer:

To determine the stage, the doctor uses the following classification system:

  • 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.

In addition to staging, other factors play a role in your prognosis, including your general health and age. In a large study, for example, younger women (less than age 40), who were initially diagnosed with Stage I or II breast cancer, had lower survival rates compared to older women. Researchers are investigating what may account for this unexpected result.

Tumor Markers

Tumor markers are proteins that are produced in both cancerous and healthy cells. There are several types of tumor markers present that can be detected in various bodily fluids and tissues. Tumor markers are elevated in the presence of cancer and can be used to detect its presence. Once cancer is diagnosed, tumor marker levels can assist your doctor in determining the stage of your cancer and help guide appropriate treatment. During the course of treatment, tumor markers help determine if the cancer treatment is working.

At this time, there are about 20 tumor markers in use.

Revision Information

  • Breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed January 6, 2014.

  • Breast cancer in men. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003091-pdf.pdf. Accessed January 6, 2014.

  • Breast cancer in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 1, 2012. Accessed January 6, 2014.

  • Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 3, 2014. Accessed January 6, 2014.

  • Tumor markers. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Detection/tumor-markers. Updated December 7, 2011. Accessed January 6, 2014.

  • 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.