The diagnosis and confirmation of breast cancer involve a series of pathology tests and imaging procedures.

After your breast cancer is diagnosed, it becomes necessary to diagnose the stage and the grade of cancer.

Besides, your doctor would also want to know if there is metastasis, meaning if your cancer has spread to the neighboring lymph nodes and further, to other parts of the body.

Some tests, such as genetic tests are done to identify the risk of breast cancer, and still, others are done to guide the doctor to a more appropriate treatment option.

All this helps your doctor to outline a treatment approach and to predict the outcome and prognosis of the disease and its treatment.

There are various ways in which breast cancer can present. It can present as a lump or swelling of the breast or some skin changes.

Being sure of the presence of breast cancer is important before exposing the patient to cancer treatment. Treating cancer comes with various options. Each of these treatment options can be long, expensive, and present with various types of side effects. Confirmation of the diagnosis is, therefore, important.

Female breast cancer is mostly diagnosed in women between the age of 65 to 74. The average age at diagnosis is 63 years.

Differential Diagnosis of Breast Cancer

There are other conditions of the breast that can be mistaken for breast cancer. These conditions are all benign and mentioned in descending order of frequency:

  • Fibrocystic disease of the breast is called mammary dysplasia which is characterized by benign or nonmalignant breast lumps.
  • Fibroadenoma is a nonmalignant lump in the breast made of fibrous and glandular tissue.
  • Intraductal papilloma is a noncancerous tumor that grows inside the milk ducts.
  • Lipoma is a nonmalignant growth made of fat or adipose tissue. It is soft and encapsulated.
  • Fat necrosis is a rare nonmalignant inflammatory lesion in the breast. It may present as a lump with skin changes and usually is a result of trauma due to surgical procedures such as a biopsy or lumpectomy.

Tests and procedures for breast cancer

A breast cancer diagnosis is confirmed by a series of tests and procedures, which comprise not only breast screening but also tests to confirm the diagnosis of breast cancer, its stage, and grade.

Breast Exam

breast self-exam is an inspection and palpation of your breasts that you do on your own. You do the breast examination yourself at monthly intervals following a particular technique.

You also undergo a clinical breast exam, which is done by the clinician in a more precise manner.

The health care provider carefully inspects and feels your breasts, underarm, and the area just below your clavicle for any changes in the breast tissue for any abnormalities, such as a lump.

You should have a clinical breast exam every one to two years from the age of 20 and every year starting at age 40.

A more frequent clinical breast exam may be necessary if you have risk factors such as a strong family history of breast cancer.

Mammogram

A mammogram is used in breast cancer screening to detect its presence. The screening mammogram is a routine imaging procedure. You may have it every year depending on what your doctor recommends.

The screening mammogram is done in people who do not have symptoms. The purpose is to detect cancer early and treat it promptly with good results.

A diagnostic mammogram is advised when a woman is experiencing symptoms, such as a new lump or nipple discharge. It is also done when any abnormality is detected on screening.

A diagnostic mammogram usually takes more pictures of the breast than a screening mammogram. Sometimes, your doctor may order a digital mammogram.

Breast Ultrasound

The ultrasound of the breast is a safe non-invasive procedure, which uses sound waves to produce pictures of the breast tissue on a computer. It helps to diagnose any abnormality found during a physical exam, or on a mammogram or breast MRI.

Breast MRI (Magnetic Resonance Imaging)

Magnetic resonance imaging (MRI) of the breast is a noninvasive test, which uses a powerful magnetic field and radiofrequency pulses, and produces detailed images of the breast tissue on a computer.

MRI of the breast offers important information about abnormalities in the breast tissue that may not be obtained by mammography or ultrasound.

It is indicated in the following conditions:

  • In breast screening of women who are at high risk for breast cancer
  • To determine the extent of breast cancer after it has been newly diagnosed
  • To further investigate abnormalities seen on mammography
  • To monitor breasts during the following years after lumpectomy

Breast Biopsy

A breast biopsy is a simple surgical procedure in which the surgeon removes a sample of abnormal breast tissue and sends it to a pathological laboratory for testing.

A breast biopsy is the most confirmatory method to know if the lump in your breast is malignant. You should know that 80% of the breast lumps examined are benign.

Blood Tests for Breast Cancer

Blood tests for breast cancer include the complete blood count, blood chemistry tests to evaluate liver function, calcium levels, and blood sugar levels.

Read the full note on these blood tests

HER2/neu Test

A HER2/neu test is done on the sample of breast tumor tissue obtained through a breast biopsy. This test checks if the cancer gene HER/neu protein is present in the cancer cells.

If this cancerous protein is found present, the chemotherapeutic drug Herceptin is used to block this protein receptor to inhibit the growth of the tumor.

Hormone receptor test

A hormone receptor test is done on the breast tissue that has been removed by a biopsy to determine if hormone therapy for that breast cancer can be applied or not.

A test called an immunohistochemistry (IHC) test is used to determine if cancer cells have estrogen and progesterone receptors.

If the biopsied material contains certain proteins, which are receptors of the hormones, estrogen or progesterone, then these hormones stimulate the cancer to grow.

The cancer is then labeled as hormone receptor-positive or hormone receptor-negative based on whether or not the cancer cells have these receptors.

If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to lower these hormone levels and stop the cancer cells from growing.

Hormone therapy is helpful for hormone receptor-positive breast cancers.  It does not work on tumors that are hormone receptor-negative.

Staging and grading your breast cancer after diagnosis

Once your breast cancer has been confirmed, your doctor will work further to identify the stage of your cancer and its grade. This helps to determine the right treatment option for you and the prognosis.

The entire information about your cancer’s stage can become available only after you undergo breast cancer surgery.

The following investigations will help to identify the stage of your breast cancer. You may not be subjected to all these tests. Your doctor will conduct those he finds necessary.

  • Blood tests, such as a complete blood count
  • Mammogram of both the breasts
  • Breast MRI
  • Bone scan is done to look for any metastasis to the bone from the breast cancer. It could be to the bones of the spine, arms, and legs.
  • CT scan
  • Positron emission tomography (PET) scan is not used routinely in breast cancer screening due to its limitations. PET scans can be useful to determine whether the cancer has spread to the nearby lymph nodes.

Breast cancer is staged from 0 to IV. Stage 0 indicates a noninvasive or localized cancer while Stage IV breast cancer indicates metastasis and the cancer has spread to other areas of the body.

While examining the microscopic slide prepared from the breast biopsy, the pathologist looks for the distinct features that tell him the grade of breast cancer.

How long from breast cancer diagnosis to surgery?

Most women with breast cancer undergo surgery. Common types of breast surgery are lumpectomy, mastectomy, and removal of the axillary and supraclavicular lymph nodes.

Some women who have breast surgery may also decide to have the breast reconstructed either at the same time or later on. The optional time for surgery after diagnosis is less than 90 days.


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