Understanding Breast Cancer -- Diagnosis & Treatment
How Is Breast Cancer Diagnosed?
Breast cancer responds to treatment best when it is detected early. The most effective way to detect breast cancer is by mammography.
A clinical -- or physical -- breast exam can complement mammography screening. Medical organizations don't agree on the recommendation for breast self-exams, which is an option for women starting in their 20s. Patients should discuss the benefits and limitations of breast self-exams with their doctors.
If you decide to do breast self-exam, make sure to go over how to perform it with your health care provider. Premenstrual changes can cause temporary thickening that disappears after your period, so it may be better to check your breasts three to five days after your period ends. If a breast self-exam makes you anxious or you have questions about how to perform it, consult your health care provider.
Look for dimpling or changes in shape or symmetry. This may be best done by looking in a mirror. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. Using light pressure, you should check for lumps near the surface. Use firm pressure to explore deeper tissues. Pinch all segments of the nipple and areola (the pigment area around the nipple) gently. If there is any discharge from the nipple -- especially if it is bloody -- see your doctor.
Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done.
The American Cancer Society recommends yearly screening mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) does not recommend screening for women in their 40s. For women between the ages of 50 and 74, USPSTF experts say women should have mammograms every two years. They also say that there is not enough data to recommend screening after age 74. When you need a mammogram is a personal decision between you and your doctor. If you're over 40, talk to you doctor about when you should begin mammogram screening. Breast lumps can be identified on a mammogram up to two years before they can be felt.
Several tests can help distinguish a benign lump from a cancerous tumor. Because malignant and benign lumps tend to have different physical features, imaging tests such as mammography and ultrasonography can often rule out cancer. The only way to confirm cancer is to perform a needle aspiration or a biopsy and to test the tissue sample for cancer cells.
An MRI of the breast is performed before surgery to look for other hidden tumors and to decide on the proper surgical technique. Other imaging tests like CT scans, PET scans, bone scans, or X-rays are not recommended to be done routinely in operable breast cancers unless clinical signs or symptoms of possible metastasis are present.
Cancer cells are analyzed for the presence or absence of endocrine (estrogen and progesterone) receptors to find out if the cancer is likely to respond well to hormone therapy. Other tests, such as the her-2-neu oncogene test, can help predict the likelihood of metastasis and the potential for recurrence after treatment as well as help decide on treatment programs.