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.

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    You do need a mammogram if you have small breasts. Breast cancer can occur in small breasts. The mammogram is a test used to help detect breast cancer at an early stage, and women with breasts of any size are at risk for breast cancer.
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    A Administration, answered on behalf of
    Paget's disease is a rare type of breast cancer that begins in the milk ducts right near the nipple and areola and then spreads to the skin of the nipple and the areola.

    To diagnose any breast abnormality, your doctor may perform any of the following tests:
    • Mammogram - This is an image of the inside of your breast captured either on film like an X-ray or as a computerized digital image.
    • Ultrasound - In a breast ultrasound, high frequency sound waves exposed to breast area produce pictures of the inside of the breast, similar to an X-ray. This allows your radiologist to distinguish between a solid mass (benign or malignant tumors) and a liquid mass (cyst).
    • MRI - MRI stands for magnetic resonance imaging. An MRI uses a magnetic field and radio frequency waves to project a very detailed picture of the inside of your breast onto a computer.
    • Biopsy - For a biopsy, your doctor removes tissue from the inside of your breast to examine under a microscope. There are a variety of methods your doctor can use to obtain this tissue sample.
    • Pathology - After your doctor draws a sample of your affected breast tissue, a pathologist examines the tissue under a microscope, classifies your tissue sample, and makes make a diagnosis.
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    A Clinical Pathology, answered on behalf of
    Dr. Tom Ortmeier - Cancer Biopsies
    There are different types of breast cancer biopsies -- and the kind you get can affect your long-term care. In this video, Dr. Tom Ortmeier discusses the different ways a breast biopsy can be done.
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    The initial radiologic evaluation of nipple discharge includes a mammogram. If no abnormality is visible, a galactogram may be indicated. The duct must be discharging on the day of the study in order to identify the correct orifice to be cannulated. A tiny blunt-tipped catheter (called a cannula) is inserted into the discharging duct and a small (approximately 1 ml) amount of contrast agent is injected. Additional mammographic images are obtained. Some patients report a sensation of "fullness" during the examination, but no sharp pain or burning should be experienced. If an abnormality is detected on the galactogram, surgical excision is recommended.
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    A Internal Medicine, answered on behalf of
    why is breast cancer screening important
    Early breast cancer screenings can often contribute to positive outcomes. In this video, watch Tejas Raiyani, MD, explain the benefits of early breast cancer screenings.
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    A , Pharmacy, answered
    Testing for HER2-positive breast cancer begins with testing for breast cancer in general. If you have a suspicious lump, mass or other lesion in your breast your doctor will take a sample of the tissue by doing a fine needle aspiration, a needle biopsy or surgical biopsy.

    If the initial biopsy shows that the tissue is cancerous, the sample should be tested further for HER2 -- a protein, produced by HER2 genes, that is present in high amounts in people who have HER2-positive breast cancer. HER2 protein causes cancer cells to grow and spread more quickly, which makes HER2-positive breast cancer an aggressive form of breast cancer.

    Tests that are used for examining breast tissue for HER2 include:
    • IHC (Immunohistochemistry) measures the amount of HER2 protein in a tissue sample. IHC is the most commonly used initial test for HER2 in breast cancer samples. However, it sometimes doesn't give a definite answer.
    • FISH (Fluorescent in situ hybridization) is a test that flags HER2 genes with fluorescent pieces of DNA so that the genes can easily be counted under a special microscope. FISH is often done as a follow-up after an IHC test.
    • CISH (chromogenic in situ hybridization) works similarly to FISH to count the HER2 genes, but looks at color changes in the cells rather than fluorescence and doesn't require a special microscope. 
    • Dual ISH (in situ hybridization) uses a special stain to cause a color change in HER2 proteins in a tissue sample. The sample can then be examined under a regular microscope. Research shows it can be more precise than the IHC test and less costly and simpler to use than the FISH test.
    If one of these tests determines that you have HER2-positive breast cancer, your doctor can prescribe medication that treats this kind of breast cancer more specifically and more successfully than drugs used for other types of breast cancer.
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    HER2/neu status: About 1 of 5 breast cancers have too much of a growth-promoting protein called HER2/neu (often just shortened to HER2). The HER2/neu gene instructs the cells to make this protein. Tumors with increased levels of HER2/neu are referred to as HER2-positive.

    Women with HER2-positive breast cancers have too many copies of the HER2/neu gene, resulting in greater than normal amounts of the HER2/neu protein. These cancers tend to grow and spread more aggressively than other breast cancers.

    All newly diagnosed breast cancers should be tested for HER2/neu because HER2-positive cancers are much more likely to benefit from treatment with drugs that target the HER2/neu protein, such as trastuzumab (Herceptin®) and lapatinib (Tykerb®).

    Testing of the biopsy or surgery sample is usually done in one of two ways:
    • Immunohistochemistry (IHC): In this test, special antibodies that identify the HER2/neu protein are applied to the sample, which cause cells to change color if many copies are present. This color change can be seen under a microscope. The test results are reported as 0, 1+, 2+, or 3+.
    • Fluorescent in situ hybridization (FISH): This test uses fluorescent pieces of DNA that specifically stick to copies of the HER2/neu gene in cells, which can then be counted under a special microscope.
    Many breast cancer specialists feel the FISH test is more accurate than IHC. However, it is more expensive and takes longer to get the results. Often the IHC test is used first. If the results are 1+ (or 0), the cancer is considered HER2-negative. People with HER2-negative tumors are not treated with drugs (like trastuzumab) that target HER2. If the test comes back 3+, the cancer is HER2-positive. Patients with HER2-positive tumors may be treated with drugs like trastuzumab. When the result is 2+, the HER2 status of the tumor is not clear. This often leads to testing the tumor with FISH. Newer test methods are now becoming available as well.

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    A , Health Education, answered

    Don’t forget to ask your doctor, “How sure are you of the results?” Comprehensive breast care centers are more likely than other facilities to do what pathologist Dr. J. B. Askew calls the “triple test,” making sure the results of your biopsy report, the mammographic images (the mammogram and/or ultrasound), and the physical exam all concur. Remember that reading a pathology report is not an exact science. Even the very best pathologist has to take a visual tissue sample and describe it in words. By definition, words and language are subjective and don’t have exactly the same meanings every time or for everyone.

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    Male breast cancer is typically found through a clinical breast exam. If your doctor feels any lumps, a mammogram or ultrasound may then be used to look for any abnormalities within the breast. If you have nipple discharge, your doctor can examine the fluid to look for cancerous cells. A biopsy is used to make a definitive diagnosis of breast cancer, including the type and stage.
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    A answered
    Medullary carcinoma accounts for 3-5% of all breast cancers and involves a distinct boundary between tumor tissue and normal tissue. It also differs from other forms of invasive ductal cancers in that it contains large cancer cells and immune system cells throughout the tumor. The prognosis for this type of breast cancer is generally better than for other invasive forms.