Diagnosing breast cancer

Monday 31 October, 2011

This information is about early breast cancer, for other types of breast cancer, visit Cancer Australia's website, or call 13 11 20. See also our genetics and breast cancer, breast reconstruction and prosthesis, breast cancer trials or breast health pages.

On this page: Physical examination | Mammogram | Hormones and breast cancer | HER2 receptor | Ultrasound | Biopsy | Further tests | Amanda's story | Staging breast cancer | Grading breast cancer | Prognosis | Which health professionals will I see? | Information reviewed by


Several tests are usually used to find out if your breast change is due to breast cancer.

Physical examination

Your doctor will feel your breasts and the lymph nodes under your arms. They will also take a full medical history and ask about your family history.

Mammogram

A mammogram is a low-dose x-ray of the breast tissue. This scan can find changes that are too small to be felt through a physical examination.

Your breast is pressed between two x-ray plates, which spread the breast tissue out so clear pictures can be taken. Both breasts are checked. Many women find this procedure uncomfortable, but it's over in about 20 seconds.

Sometimes, the doctor will feel a lump that is not shown on a mammogram and other tests will need to be done.

'The mammogram was a little uncomfortable, but it didn't hurt. I certainly don't look forward to it every year, but it's only a few minutes of discomfort. It's good to do it regularly for peace of mind.' — Patient

Hormones and breast cancer

Some types of breast cancer are sensitive to hormones. Hormones are chemical messengers in the body that transfer information. The ovaries produce the hormones oestrogen and progesterone, which can cause cancer to grow.

The pathologist will test breast tissue for proteins found inside some cancer cells. These proteins are called receptors. In breast cancer they are 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 has progesterone receptors is called progesterone receptor positive (PR+).
  • Cells without receptors are hormone receptor negative.

Knowing whether a breast cancer contains hormone receptors helps your doctors decide on treatment. Breast cancers that are ER+ or PR+ are more likely to respond to hormonal treatments, which reduce oestrogen in the body.

A tumour that is oestrogen receptor negative (ER-) will not benefit from hormonal treatment, but other treatments are available.

HER2 receptor

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 HER2-postive (HER2+). These tumours tend to divide and grow more rapidly than other types of cancer.

About one in five women have HER2+ cancer cells. They usually have treatment tailored to their situation, such as Herceptin®.

Ultrasound

An ultrasound is a painless scan that uses soundwaves to create a picture of your body. A gel is spread on your breast and a small device called a transducer is moved over the area. This sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. The scan takes about 15-20 minutes.

Biopsy

Your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast. During a biopsy, a small amount of tissue is removed from your breast. A pathologist examines the removed tissue and checks for cancer cells under a microscope. You may need to have more than one biopsy.

There are a few ways of doing a biopsy:

Fine needle aspiration - 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 - it can feel similar to having blood taken. It is usually done in a specialist's rooms, a hospital outpatient department or at a radiology practice.

Core biopsy - A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area. It is usually done under local anaesthetic, so your breast is numb. A mammogram or ultrasound is used to help guide the needle. This type of biopsy may be uncomfortable or painful.

Surgical biopsy - If the lump is too small to be biopsied using the methods above, a surgical biopsy is done. Before the biopsy, a needle and wire may be put into the breast to help the surgeon find the abnormal tissue. You will be given local anaesthetic, and the doctor may use an ultrasound scanner to guide the needle.

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 some women have an overnight stay in hospital.

If the surgical biopsy removes all the cancer, you won't need further surgery. You may have other treatment, such as radiotherapy.

Further tests

If the tests described above show you have breast cancer, one or more tests may be done to see if the cancer has spread to other parts of your body.

The test and scan results will be written in a report (sometimes called a pathology or radiology report).

There are extra costs associated with some tests and scans, depending on if you are treated in a public or private hospital. Talk to your medical team for information about how much you will be charged.

Blood tests

Blood samples may be taken to check your general health.

Chest x-ray

Your doctor may take a painless x-ray of your chest to check your lungs for signs of cancer.

CT scan

A CT (computerised tomography) scan is a type of x-ray procedure that takes pictures of the inside of the body. Unlike a standard x-ray, which takes a single picture, a CT scan uses a computer to compile many pictures of the body. It can show if the cancer has spread to the lymph nodes or other organs.

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 liquid. This can make you feel hot all over for a few minutes.

You will lie flat on a table while the CT scanner, which is large and round like a doughnut, takes pictures. This painless test takes about 30 to 40 minutes.

PET scan

A PET (positron emission tomography) scan is a specialised test. It takes pictures of the body to detect tissue abnormalities. A small amount of radioactive material is injected into a vein, usually in your arm. You will need to wait for about an hour for the fluid to flow through your body.

You will then lie on a treatment table that moves through a scanning machine. This body scan will show ‘hot spots' where the fluid has accumulated - this happens where there are active cells, like cancer cells.

MRI scan

An MRI (magnetic resonance imaging) scan uses magnetism and radio waves to build up detailed cross-section pictures of the body. The scan involves lying on a treatment table in a metal cylinder that is 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 are uncomfortable. It may be helpful to take 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.

A PET and MRI are not routine tests but they may be used if other types of scans don't give doctors the information they need.

Bone scan

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 is cancer. After a few hours, the bones are viewed with a scanning machine, which sends pictures to a computer. This scan is painless and will not make you radioactive.

Amanda's story

"I was diagnosed with breast cancer in April, when I was 35 years old. I felt a lump in my breast and had a mammogram and an ultrasound. The scans
showed I had cancer.
"My doctor followed up with a biopsy and some other scans to see if the cancer had spread throughout my body. The waiting and not knowing the results were the worst. I found it helpful to take a friend to my appointments for some support. It was good to have someone else there with me.
"Once I knew the details about my diagnosis and the plan of attack, I felt better. It really does make you feel more secure to know what is ahead of you.
"During my treatment, I had good days and bad ones but I got through it. I found it very comforting to speak with other women with breast cancer and share stories.
"The breast care nurses have also been wonderful - they are there for support and I have leaned on them when I've needed to."

Staging breast cancer

The tests described above show if the cancer has spread to other parts of your body. Working out how far the cancer has spread is called staging. Stages of breast cancer are numbered from 1 to 4. Early cancers are classified in the stages below:

Stage 1 The tumour is less than 2 cm in diameter, and has not spread to the lymph nodes.
Stage 2A The tumour is less than 2 cm in diameter, and has spread to the lymph nodes or it is larger (2-5 cm) and has not spread.
Stage 2B (early) The tumour is 2-5 cm in diameter, and has spread to the lymph nodes.

 

Grading breast cancer

The cancer will also be given a grade. The grade shows how fast the cancer is growing. The higher the grade, the more likely that you'll have chemotherapy after surgery.

Stages 2B (advanced), 3 and 4 refer to advanced breast cancer. For information about these stages, call Cancer Council Helpline 13 11 20 or visit Cancer Australia.


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 a little more abnormal and grow faster than grade 1 but not as fast as grade 3.
Grade 3 High grade. Cells are very abnormal and faster growing.


Prognosis

Prognosis means the expected outcome of a disease. Most people with early breast cancer can be treated successfully. Survival rates have increased significantly over time due to better diagnostic tests and scans, earlier detection, and improvements in treatment methods. According to recent statistics, the five-year survival rate for breast cancer is approximately 88%.

A cure may still be possible for people with more advanced breast cancer. For other people, treatment can reduce symptoms and improve quality of life.

Assessing prognosis

You will need to discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Test results, the growth rate and size of the tumour, how well you respond to treatment, and other factors such as age, fitness and your medical history are all important considerations in assessing your prognosis.

Which health professionals will I see?

You will be cared for by health professionals who specialise in different aspects of your treatment. Specialist health professionals are highly skilled in a specific field.

Specialist health professionals


Health professional Role
breast surgeon specialises in surgery and performs biopsies
pathologist examines cells and tissue that is removed from the breast to determine the type and extent of the cancer
radiologist specialises in reading x-rays, such as mammograms
medical oncologist prescribes and coordinates chemotherapy, hormone therapy and targeted drug therapies

 

You may also see other allied health professionals who work alongside the doctors and nurses. Allied health professionals provide important care and support services. The following health professionals may be in the multidisciplinary team: 

Allied health professionals


Health professional Role
physiotherapist and occupational therapist assist in restoring range of movement after surgery and educate patients about lymphoedema management
social worker links you to support services and help you with any emotional, physical or practical problems
nurses, including breast care nurses support and help you through all stages of your treatment
radiation oncologist prescribes and coordinates radiotherapy
reconstructive (plastic) surgeon performs breast reconstruction for women who have had a mastectomy
GP (general practioner) explains information provided by specialists, helps you with treatment decisions and assists you in obtaining practical and emotional support
counsellor, psychologist and psychiatrist provide emotional support and help manage anxiety and depression
genetic counsellor provides advice for people with a strong family history of breast cancer

Information reviewed by: Professor John Boyages, Executive Director, Westmead Breast Cancer Institute, Westmead Hospital and author, Breast Cancer: Taking Control; Lynn Buglar, Breast Physician, BreastScreen NSW; Bronwyn Chalmers, Cancer Information Consultant, Helpline, Cancer Council NSW; Susan Munro, McGrath Breast Care Nurse, Community Health/Wagga Wagga Base Hospital, Wagga Wagga; and Kathryn Rutkowski, Consumer. 

Updated: 31 Oct, 2011