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How Is Breast Cancer Diagnosed?

There are several imaging tests used to diagnose breast cancer. BMC’s Belkin Breast Imaging Center, designated a Breast Imaging Center of Excellence by the American College of Radiology, offers patients a full range of diagnostic services. A diagnostic work-up may include one or more of the following tests:

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If an abnormality is found, the only sure way to know if it is cancer is to examine the tissue directly. This is done by removing a sample of tissue from the breast and sending it to a pathology lab to have it examined under a microscope. The removal of cells or tissues for examination by a pathologist is called a biopsy. In all biopsy procedures, the area being biopsied is numbed and/or the patient is sedated to minimize any pain or discomfort. Types of biopsies include:

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Once removed, pathologists perform a thorough examination of the sample tissue. If the tissue is cancerous, it is given a grade from 1 to 3. A low grade (1) indicates the cancerous tissue has an appearance similar to that of regular tissue. Lower grade cancers tend not to grow as quickly as higher grade cancers. Grade is useful in predicting prognosis (outcome).

Pathologists also test cancerous tissue for hormone receptors: proteins in cells with the ability to attach themselves to hormones in the blood). Estrogen and progesterone are naturally occurring hormones in women’s bodies that can attach to receptors in some breast cancer cells and fuel their growth. If estrogen receptors are present in a tumor, it is called estrogen receptor-positive (ER-positive). If progesterone receptors are present, the tumor is progesterone receptor-positive (PR-positive). If both receptors are present, it is referred to simply as hormone receptor-positive. At least one of these receptors is present in approximately 2 out of 3 cases of breast cancer (American Cancer Society, 2015b). Hormone receptor-positive cancers tend to be slower growing and generally respond well to hormone therapy.

Cancerous tissue is also tested for too much of a protein called HER2/neu. Cancers with high levels of HER2/neu are called HER2-positive. Approximately 1 out of 5 breast cancers are HER2-positive (American Cancer Society, 2015b). These cancers tend to grow and spread quickly and are treated with drugs specifically targeting the HER2/neu protein.

Certain cancers, when tested, are neither hormone receptor-positive nor HER2 receptor-positive. In other words, the cancer cells do not possess estrogen receptors or progesterone receptors, and they do not have high levels of HER2/neu. These cancers account for approximately 15 out of 100 cases of breast cancer and are called triple-negative breast cancers (National Cancer Institute, 2012).

Once a woman has been diagnosed with breast cancer, there are several ways to find out if the cancer has spread. These include:

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Based on the findings of a patient’s diagnostic work-up, he or she may meet with BMC experts in a variety of specialties including internal medicine, medical oncology, pathology, radiation oncology, radiology/mammography, and surgical oncology.

The results of these consultations and procedures are reviewed in the Cancer Care Center’s weekly multidisciplinary Breast Tumor Board meeting. Each patient receives a comprehensive, individualized care plan, designed to meet their specific needs. Following this review, the patient’s BMC physician will discuss the Tumor Board’s recommendations with the patient and her family, and together they will develop a comprehensive treatment plan.