Breast Cancer Diagnosis

Breast Cancer Diagnosis

Breast Cancer Diagnosis
Beyond a breast exam or mammogram, there are various tests and methods for doctors to diagnose and track progress of breast cancer. The process involves imaging and lab tests, including ultrasounds, MRIs, a breast biopsy and even bones scans to locate tumors and stage the cancer. A medical oncologist or breast surgeon help explain a breast cancer diagnosis and provide treatment options. Learn more about diagnosing breast cancer with expert advice from Sharecare.

Recently Answered

  • 1 Answer
    A
    A Surgery, answered on behalf of
    After intake of a patient’s history and a physical exam, a diagnostic mammogram is the next tool for patients aged 35 and older who have found a lump. If less than 35 years of age, the accuracy of a diagnostic mammogram significantly decreases due to the natural breast density of a young woman, as breast density naturally decreases with age. For those under 35, a solid lesion can best be diagnosed with an ultrasound-guided needle biopsy. At this young age, the high percentage diagnosis is a benign fibro-adenoma.

    For those over 35, the diagnostic mammogram will yield important information concerning the nature of the mass. Is it smooth or are the borders irregular? Does it create architectural distortion? Are there any other lesions present that are too small to be palpated? The recent introduction of 3D tomosynthesis with mammography adds detection sensitivity. Needle biopsy using mammogram imaging is called a stereotactic biopsy. Imaging with breast magnetic resonance imaging (MRI) is very sensitive in detecting breast abnormalities and is especially helpful in patients with dense breasts. If a lesion is not visualized on mammography, 3D tomosynthesis or ultrasound, then a needle biopsy using MRI image guidance is the preferred diagnostic option.

    Multiple well-controlled, large, randomized studies document that annual screening mammography saves lives. As a cancer is evolving, mammography leads to early detection. If the malignant process is diagnosed earlier in its natural history, there are higher cure rates and less severe treatments. Despite some controversy, mammography lowers the risk of dying from breast cancer and should be a mandatory component of every woman’s healthcare plan.

    This content originally appeared on the HCA Virginia Physicians blog.
  • 1 Answer
    A
    A answered
    There are many available options to pursue if unfavorable results are found after mammography or other screening activities. If a malignant tumor is found, and the breast cancer was one of several types (early onset, two separate breast cancers, male breast cancer, ovarian cancer or multi-generational), a doctor will consider whether there is an inherited mutation in the family. Although this is present in only five to 10 percent of individuals, the breast and ovarian cancer risk is as high as 87 percent and 44 percent, respectively, in the patient’s lifetime, depending on many factors.

    Fortunately, there are many options for treatment and future preventive activity. Preventive mastectomy and removal of ovaries is the choice of many, but not all, women. This reduces the risk of breast and ovarian cancer, but not to zero. This prevention, one form of risk management, was chosen by Angelina Jolie after she discovered she carries a mutated copy of the BRCA1 gene, with wide media coverage after the announcement. This is a personal decision, to be made with all facts in place and with information from a healthcare provider with extensive knowledge in this area. For those at a lesser risk, at the opposite end of the continuum, one would start with lifestyle changes and medication.

    This content originally appeared on the HCA Virginia Physicians blog.
  • 1 Answer
    A
    A Surgery, answered on behalf of
    A detailed personal risk assessment will not necessarily dictate treatment of the newly discovered lump but can add perspective. Risk analysis is helpful in planning a long-term approach to breast health and a screening strategy.

    The salient risk factors, in order of importance, are: 1) personal history of familial genetic mutations (Angelina Jolie’s BRCA1 and BRCA2 mutation, for example); 2) personal history of previous breast cancer; 3) personal history of non-malignant proliferative benign disorders (sclerosing adenosis, ductal hyperplasia or atypical ductal hyperplasia, for example); 4) breast density on mammography; 5) family history of breast cancer and 6) previous radiation therapy to the chest (for example, Hodgkin’s disease treatment).

    The risk factor generating the greatest misconception is a positive family history of breast cancer, with women automatically suspecting doom when they feel a breast lump. Conversely, women with a negative family history tend to feel bullet proof. Both concepts are incorrect, as the status of the family history is an important factor, but breast cancer is multifactorial and family history is only one of many risk components. Ultimately, most breast cancer patients have a negative family history of breast disease and the majority of patients with breast cancer (60 percent) have no identifiable risk factors.

    This content originally appeared on the HCA Virginia Physicians blog.
  • 1 Answer
    A
    A Surgical Oncology, answered on behalf of
    The majority of breast cancers found by screening mammography are small and non-palpable. In contrast, breast cancers that are not detected by screening mammography tend to be much larger and usually are palpable. Breast cancer on mammography usually appears as a suspicious microcalcifications, a super-density with irregular borders, or an asymmetrical density compared with the other breast or the previous annual mammogram. On an ultrasound, breast cancer appears as a solid mass that is taller than wide with irregular borders or an angular or lobular borders. There is frequently increased vascularity within the solid mass and a shadow cast behind the mass.
     
    Magnetic resonance imaging (MRI) is another modality for breast imaging. Breast cancer usually presents on MRI as a contrast-enhanced lesion. Breast MRI probably gives the best three-dimensional assessment of the tumor mass and also allows doctors to evaluate whether there are satellite lesions. MRI is significantly better than mammography for evaluating the lymph nodes in the armpit, behind the muscle and along the internal mammary chain. And MRI screening usually is restricted to women with high risk conditions for developing breast cancer.
  • 2 Answers
    A
    A Surgery, answered on behalf of
    Breast cancer doesn’t distinguish between size, shape or even gender. Even men can get breast cancer. No matter what the size of your breasts, annual mammograms help detect issues early and decrease the chance of death due to breast cancer. 
    See All 2 Answers
  • 2 Answers
    A
    The digital breast tomosynthesis (3D mammography) system has benefits for technicians as well as patients. An enhanced control center includes an oversize monitor that swivels out and around for easy viewing, as well as advanced filters and magnification view capabilities that enable the technician to easily switch back-and-forth between images.

    The added features and controls make it easier for doctors to see the images on the screen and separate slices of the image to get a better, clearer picture of breast tissue. With the enhanced system, the machine and monitor are easier to maneuver when positioning for different mammography views.
    See All 2 Answers
  • 2 Answers
    A
    A Diagnostic Radiology, answered on behalf of
    The images from digital breast tomosynthesis (3D mammography) are reconstructed into one-millimeter-thick slices of breast tissue that have been stacked up into a volume. Doctors can then go through them one by one to get better visualization of fine mammographic detail that can potentially uncover a mass that might be hidden by overlapping tissue above or below it. Tomosynthesis therefore allows doctors to look through the tissue layer by layer and potentially uncover a breast cancer.
    See All 2 Answers
  • 1 Answer
    A
    A Oncology, answered on behalf of
    The primary area for breast cancer to spread to is the lymph nodes in the breast (around 90% of breast tumors drain into the axilla). Traditionally, all these lymph nodes were removed during surgery. In the 1990s, a technique for sentinel lymph node biopsy was developed in which a dye is injected in the tumor, and the migration of the dye is then observed as it goes to the lymph nodes, if it migrates at all. If there’s no breast cancer in the sentinel lymph nodes, which are the first nodes that receive the dye, you can be confident it won’t be in any other lymph nodes.
     
  • 1 Answer
    A
    A Oncology, answered on behalf of
    In the 1800s, Rudolph Virchow, a doctor and pathologist, described a whole slew of various tumors based on their appearance under a microscope. Until very recently, the appearance of the breast cancer under the microscope was the most important information doctors had to determine the type of tumor. The two most common types of tumors are infiltrating ductal cancer, which has a frequency of 70% to 80%, and invasive lobular cancer, which has a frequency of 5% to 10%.

    In the 21st century, there are new methods of classifying breast cancers. Doctors extract the nucleic acids from the breast cancer cells and look at the proteins expressed by the cancers in a DNA array. Thousands of genes have been observed, and breast cancers can be classified based on their gene expression. Doctors are learning more and more about the genes that drive the breast cancer and cause it to behave the way it does. This is leading to a shift in how cancers are classified. While in the past only chemotherapy was used, now tumors are classified by their molecular profiles and there are therapies that can target the molecular defect and leave the normal cells alone.
  • 1 Answer
    A
    A Nursing, answered on behalf of
    Most people diagnosed with breast or ovarian cancer do not need genetic susceptibility testing. Only 5% to 10% of all breast and ovarian cancers are hereditary -- 90% are not. If you meet the criteria, you can have the test and learn if you are a carrier.