| Breast cancer | Diagnosing breast cancer | Treatment for breast cancer |
| Deciding on treatment | Looking after yourself | Breast prostheses |
| Breast reconstruction | List of Breast Care Nurses |
See also our genetics and breast cancer, breast cancer trials and breast health pages.
On this page: Signs to look for | Doctors and other health professionals you may see | How breast cancer is diagnosed | Further tests | Staging breast cancer | Prognosis
You may notice a change in your breast or your doctor may find an unusual breast change during a physical examination.
Signs to look for include:
These changes don't necessarily mean you have breast cancer, but if you have any of these symptoms you should have them checked by your doctor without delay.
Men's symptoms are similar to women's.
Some women have no symptoms and their breast cancer may be found on a screening mammogram. See our Common Breast Problems page for more on self examination.
Your doctor will examine you and refer you for tests to find the cause of your symptoms. This can be a worrying and tiring time, especially if you need several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist who'll advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major disciplines. Ideally, your hospital will have all means of diagnosis and treatment. This may not be possible in regional centres.
Specialists and other health professionals who care for people with breast cancer include:
Your general practitioner (GP) is also an important member of your treatment team. GPs can explain information provided by your specialists, help you with treatment decisions and help you get practical and emotional support.
‘In the time between the diagnosis and going in to hospital I was in an absolute dream.
The night before the surgery all of the family visited me in hospital and only then did the realisation that I had breast cancer come to me.'
Several tests are usually used to find out if your breast change is due to breast cancer.
Your doctor will feel your breasts and the lymph nodes under your arms, take a full medical history and ask about your family history.
This is a low-dose x-ray of the breast. A mammogram can find changes that are too small to be felt through physical examination.
Both breasts are checked. Your breast is pressed between 2 x-ray plates, which spread the breast tissue out so clear pictures can be taken. Many women find this procedure uncomfortable, but it's over in about 20 seconds.
Sometimes, a lump that can be felt isn't seen on a mammogram and other tests will need to be done.
Ultrasound uses soundwaves to make a picture of your breast.
A gel is spread on the breast and a small device called a transducer is moved over the area. It sends out soundwaves that echo when they meet something dense like an organ or tumour. A computer creates a picture from these echoes. This test is painless and takes 15 to 20 minutes.
Your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast. You may need one or more biopsies. A biopsy removes a small amount of breast tissue. There are a few ways of doing this. After a biopsy a pathologist examines the removed tissue.
A thin needle is used to take some cells from the breast lump or abnormal area. Sometimes an ultrasound is used to help guide the needle. The test is a bit uncomfortable, similar to having blood taken for a blood test. It's usually done in a specialist's rooms, a hospital outpatient department or at a radiology practice.
A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area. It's usually done under local anaesthetic. A mammogram or ultrasound is used to help guide the needle. A core biopsy may be uncomfortable and you may experience some pain.
If the lump is too small to be biopsied using the method above, a surgical biopsy is needed. To help the surgeon find the abnormal tissue, a needle and wire may be put into the breast under local anaesthetic before the biopsy. The biopsy is then done in a separate operation using a general anaesthetic. The lump and a small area of normal breast tissue around the lump are removed, along with the wire. This operation is usually done as day surgery but may mean an overnight stay in hospital. If the surgical biopsy removes all the cancer, further surgery may not be needed.
There is a hormonal factor in some breast cancers. The ovaries produce 2 hormones, oestrogen and progesterone, which can help cancer cells grow.
The pathologist will test breast tissue for proteins found inside some cancer cells. These proteins are called receptors. In breast cancer they're called hormone receptors because they allow oestrogen and progesterone to attach to the cancer cell.
A cancer cell that has oestrogen receptors is called oestrogen receptor positive (ER+). A cell that binds progesterone is called progesterone receptor positive (PR+). Breast cells that do not have receptors are called negative for these hormones (ER- or PR-).
Knowing whether a breast cancer contains oestrogen receptors helps your doctors decide on treatment. Breast cancers that are either ER+ or PR+ are more likely to respond to hormone therapy, which reduces oestrogen in the body. A tumour that's oestrogen receptor negative (ER-) is unlikely to benefit from hormone therapy but other treatments are available.
HER2 (human epidermal-growth-factor receptor 2) is a protein found on the surface of some cancer cells. Tumours that have high levels of these receptors are known as HER2-postive. These tend to divide and grow more rapidly than other types of breast cancer.
This receptor test can help determine which treatment options are more likely to be effective. About 1 in 5 women have HER2-positive cancer cells.
‘After the shock, my initial feeling was an overwhelming sense of helplessness; I thought, "I'm going to die". I couldn't believe it, I was too young ... Then I started to read the literature, and ask more questions of my medical team. I felt better, more in control, as I became more informed.'
If the tests described above show you have breast cancer, some more tests may be done to see if the cancer has spread to other parts of the body. You may have one or more of these tests. The results will be written in a pathology report. You can ask for a copy of your pathology report.
Blood samples may be taken to check your general health.
A chest x-ray may be taken to check the lungs for signs of cancer.
A CT (computerised tomography) scan is a type of x-ray that takes pictures of the inside of the body. It can assess if the cancer has spread to the lymph nodes or to other organs.
This painless test takes about 30-40 minutes. To make the scan pictures clearer and easier to read you may have an injection of a dye into a vein in your arm. You may also be asked to drink a special liquid. It may make you feel hot all over for a few minutes. You'll lie flat on a table while the CT scanner, which is large and round like a doughnut, takes pictures.
A bone scan may be done to see if the breast cancer has spread to your bones.
A small amount of radioactive material is injected into a vein, usually in your arm. This material is attracted to areas of bone where there's cancer. After a few hours, the area of your body is viewed with a scanning machine, which sends pictures to a computer. A bone scan is painless and will not make you radioactive.
A PET (positron emission tomography) scan takes detailed pictures of the body to detect abnormalities in the tissues. A small amount of radioactive material is injected into a vein, usually in the arm. You'll lie on a table, which moves through a machine containing sensors for the signals from the radioactive material.
PET and MRI are not routine tests but may be used if other types of scans can't give doctors all the information they need.
An MRI (magnetic resonance imaging) scan uses both magnetism and radiowaves to build up detailed cross-section pictures of the body. This test involves lying on a table in a metal cylinder - a large magnet - that's open at both ends. A dye may be injected into your veins before a scan.
Some people feel anxious lying in the narrow metal cylinder. Talk to your health care team before the scan if you're anxious. It may be helpful to have a mild sedative or talk to the person operating the scan through an intercom. An MRI is painless and is usually over in an hour.
The tests described above show whether you have cancer. They can also show if the cancer has spread to other parts of your body. Working out how far the cancer has spread is called staging. This helps your doctor recommend the best treatment for you.
Stages of breast cancer are numbered from I to IV. Early breast cancer may be called stage IA, stage IIA and stage IIB (early).
| Stage I | The tumour is small, less than 2 cm in diameter, and has not spread to the lymph nodes. |
| Stage IIA | The tumour is less than 2 cm and has spread to the lymph nodes or it is larger (2-5 cm) and has not spread to the lymph nodes. |
| Stage IIB | (early) - The tumour is between 2-5 cm and has spread to the lymph nodes. |
| Stages IIB | (advanced), Stage III and Stage IV refer to advanced cancer. For more information about these stages call the Cancer Council Helpline on 13 11 20 or visit www.nbocc.org.au. |
Your cancer will also be given a grade. The grade shows how fast the cancer is growing.
| Grade 1 | Low grade: cells look abnormal and grow faster than normal cells but not as fast as grade 2. |
| Grade 2 | Intermediate grade: cells look abnormal and grow faster than grade 1 but not as fast as grade 3. |
| Grade 3 | High grade: a faster-growing cancer. |
The higher the grade, the more likely it is that you'll have chemotherapy or hormone therapy after the surgery.
Prognosis means the expected outcome of a disease.
The earlier breast cancer is found and treated, the better the prognosis. Most people with early breast cancer can be treated successfully.
For some people with more advanced cancer, a cure may still be possible. For other people, treatment can reduce symptoms and improve quality of life.
You'll need to discuss your prognosis with your doctor, but it's not possible for any doctor to predict the exact course of your illness. Test results, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as your age, fitness and medical history are all important in assessing your prognosis.
Reviewed by:
Assoc. Prof. John Boyages, Exec. Director NSW Breast Cancer Institute, Westmead Hospital
Lynn Buglar, Breast Physician, BreastScreen NSW
Sally Crossing AM, Breast Cancer Action Group NSW
Cynthia Murphy, Breast Cancer Action Group NSW
Esperance Coelho, Cancer Council NSW
Dr Amanda Hordern, Cancer Council Victoria
