Screening and Diagnosis

Screening is looking for cancer before a person has any symptoms. This can help find     cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Signs of breast cancer include a lump or change in the breast.

These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

• A lump or thickening in or near the breast or in the underarm area
• A change in the size or shape of the breast
• A dimple or puckering in the skin of the breast
• A nipple turned inward into the breast
• Fluid, other than breast milk, from the nipple, especially if it’s bloody
• Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple)
• Dimples in the breast that look like the skin of an orange, called peau         d’orange

Tests that examine the breasts are used to detect and         diagnose breast cancer.

Check with your doctor if you notice any changes in your breasts. The following tests and procedures may be used:

• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
• Mammogram: An x-ray of the breast.  EnlargeMammography. The breast is pressed between two plates. X-rays are used to take pictures of breast tissue.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of both breasts. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
• Biopsy : The removal     of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.
• There are four types of biopsy used to check for breast cancer:
  • Excisional biopsy : The removal of an entire lump of tissue.
  • Incisional biopsy : The removal of part of a lump or a sample of tissue.
  • Core biopsy : The removal of tissue using a wide needle.
  • Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid, using a thin needle.

If cancer is found, tests are done to study the cancer cells.

Decisions about the best treatment are based on the results of these tests. The tests give information about:

• how quickly the cancer may grow
• how likely it is that the cancer will spread through the body
• how well certain treatments might work
• how likely the cancer is to recur (come back)

Tests include the following:

• Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
• Human epidermal growth factor type 2 receptor (HER2/neu) test : A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.
• Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
• There are many types of multigene tests. The following multigene tests have been studied in clinical trials:
  • Oncotype DX : This test helps predict whether stage I or stage II breast cancer that is estrogen receptor positive and node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
  • MammaPrint : This test helps predict whether stage I or stage II breast cancer that is node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.

Based on these tests, breast cancer is described as one of the following types:

• Hormone receptor positive (estrogen and/or progesterone receptor positive) or hormone receptor negative (estrogen and/or progesterone receptor negative).
• HER2/neu positive or HER2/neu negative.
• Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative).

This information helps the doctor decide which treatments will work best for your cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
• The type of breast cancer.
• Estrogen receptor and progesterone receptor levels in the tumor tissue.
• Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue.
• Whether the tumor tissue is triple negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu).
• How fast the tumor is growing.
• How likely the tumor is to recur (come back).
• A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
• Whether the cancer has just been diagnosed or has recurred (come back).

More Information for Patients

Breast Cancer Screening

Breast Changes and Conditions

Mammograms

Clinical Trials to Screen for Breast Cancer

More Information for Health Professionals

Breast Cancer Screening (PDQ®)–Health Professional Version