Diagnosis

Breast self-exams (BSEs), clinical breast exams, and imaging techniques (such as mammogram, MRI, or ultrasound) may detect abnormalities or changes in the breast that may suggest cancer. They do not provide exact information to tell what those abnormalities or changes are. In order to diagnose or confirm the presence of cancer, a sample of cells must be taken from the tumor. Additional tests will be needed to determine specific tumor characteristics and if the cancer has spread to other parts of your body. You may need to undergo one or more of these tests. Talk to your doctor about which tests are appropriate for you.

• Biopsies and tumor marker testing
• Physical exam
• Blood tests
• Chest x-ray
• Bone scan
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan

Biopsies and tumor marker testing

Biopsies

A biopsy is the removal and examination of a tissue sample from the tumor to determine if it is cancerous. Biopsies can be done in several ways depending on the size and location of the tumor.

• Surgical biopsy. A surgical biopsy is a short procedure that lasts about an hour. Using a local or general anesthetic, the physician makes an incision into the breast and removes all of the tumor or irregular tissue (excisional biopsy) or just a part of the lump or tissue (incisional biopsy).
• Needle biopsy. A needle biopsy is less involved than a surgical biopsy and may be done in the doctor's office. A local anesthetic may be used to numb the breast tissue. A needle is inserted into the tumor in the breast. A fine needle aspiration uses a small needle to remove a sample of cells, whereas a core needle biopsy uses a larger needle to remove a piece of tissue.

The biopsy tissue is sent to a pathologist who examines it under a microscope to determine if there are cancer cells present. If the tissue contains cancer cells, the pathologist will also determine what type of breast cancer it is and the grade, or how much the cancer cells differ from normal cells. A report will be sent to your doctor, who will discuss the results with you. This report is called the pathology report. It may take several days until the results are made available to your doctor.

Once breast cancer is detected, tests are performed to determine the clinical stage of your cancer. Below is a short description of some of the more common tests that may be performed.

Tumor marker testing

The tissue that was taken for the biopsy (which was used to diagnose breast cancer) will be examined for the presence of certain "tumor markers." Tumor markers are special proteins that may be on the surface or inside cancer cells. In breast cancer, tumors are tested for hormone receptors and HER2/neu. It is important to determine the status of these tumor markers because they can help predict how the cancer will respond to certain treatments.

• Hormone receptor (HR) testing checks for the presence or absence of estrogen and/or progesterone receptors on the cancer cells. Some breast cancers have estrogen receptors and are called estrogen receptor-positive (ER+). Cancers that are ER+ use estrogen to grow and may respond to hormonal treatment that blocks or decreases estrogen. Some breast cancers have progesterone receptors and are referred to as progesterone receptor-positive (PR+ or PgR+). PgR+ cancers use progesterone to grow, and these too may respond to hormonal treatment. The majority of breast cancers are ER+ and PgR+, but some are ER- and/or PgR-.
• HER2/neu is a protein (receptor) on breast cancer cells. Some breast cancer cells overproduce the HER2/neu protein. HER2/neu-positive cancers may respond to therapy that targets the HER2/neu protein and may respond better to certain types of chemotherapy.

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Physical exam

Your doctor will perform a complete physical exam to determine your general health and to look for signs that cancer has not spread to other parts of your body. This includes examination of lymph nodes, lungs, liver, and skin.

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Blood tests

Blood tests are commonly performed to check that cancer has not spread to the liver and bones. Blood tests may also be performed to assess your overall health.

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Chest x-ray

A chest x-ray uses small amounts of radiation to take a picture of the inside of your chest. It may be used to see if the breast cancer has spread to your ribs or lungs.

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Bone scan

A bone scan is used to check the bones for metastases. If breast cancer has spread to the bones, it would be likely detected on a bone scan.

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Computed tomography (CT) scan

Computed tomography, also known as a CAT or CT scan, is similar to an x-ray, but it gives a more detailed picture. It can detect extremely small tumors that may not be seen on an x-ray. It may also help your doctor determine whether or not the breast cancer has spread into the surrounding lymph nodes, liver, lung, or bones.

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Positron emission tomography (PET) scan

Positron emission tomography, or PET scan, determines the way the body's cells act in the presence of sugar. Normal cells take in sugar and use it to make energy. Cancer cells usually take in more sugar than normal cells. You will be given a special type of sugar before the test. The PET scan will detect the presence of tumors by detecting hot spots, which are brightly colored areas on the picture where the sugar has been absorbed by cells. The more sugar the tumor takes in, the more likely it is a cancer. A PET scan is useful in detecting cancer that has spread outside of the breast.

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