Detection, Diagnosis and Staging

The term screening refers to tests and exams used to find a disease like cancer in people who do not have any symptoms. The earlier breast cancer is found, the better the chances that treatment will work. The goal is to find cancers before they start to cause symptoms. The size of a breast cancer and how far it has spread are the most important factors in predicting the outlook for the patient. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year. Following the guidelines given here improves the chances that breast cancer can be found at an early stage and treated with success.

The following guidelines are recommended for finding breast cancer early in women without symptoms:

Mammogram:
Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

Clinical breast exam:
Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, at least every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.

Breast self-exam (BSE):
BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away.

Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it's OK not to do BSE or not to do it on a fixed schedule.

The goal, with or without BSE, is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.

Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. This might mean starting mammograms when they are younger, having extra screening tests, or having more frequent exams.

• Mammogram

[+] Show All

• Clinical Exam

[+] Show All

• Breast awareness and breast self-exam

[+] Show All

• MRI (magnetic resonance imaging)

[+] Show All

Symptoms of breast cancer

The widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms, but some are still missed.

The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded. So it's important to have anything unusual checked by a doctor.

Other signs of breast cancer include the following:

• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain or the nipple turning inward
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

If You Suspect Breast Cancer

If you have any symptoms that might be a sign of breast cancer, be sure see your doctor as soon as you can. After asking you some questions and doing a complete physical exam (including a clinical breast exam), your doctor may want to do more tests, such as those listed below.

Imaging tests

• Mammograms
• MRI scans
• Breast ultrasound
• Ductogram (also called a galactogram)

Biopsy

• Fine needle aspiration biopsy (FNAB)
• Stereotactic core needle biopsy
• Surgical biopsy
• Biopsy lab tests

[+] Show All

When Breast Cancer is Confirmed: Staging

Staging is the process of finding out how widespread the cancer is at the time it is found. The stage of a cancer is the most important factor in choosing among treatment options. The stage is based on the results of the physical exam, biopsy, and other tests the doctor may have done.

Tests to find breast cancer spread:

• Chest x-ray
• Mammogram
• Bone scan
• CT scan (computed tomography)
• MRI (magnetic resonance imaging)
• Ultrasound
• PET scan (positron emission tomography)

The TNM staging system

The most common system used to describe the stages of breast cancer is the AJCC/TNM system. This system takes into account the tumor size and spread (T), whether the cancer has spread to lymph nodes (N), and whether it has spread to distant organs (M, for metastasis). Numbers after the T, N, and M give details about the cancer....

Breast cancer survival by stage

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. This means that they may or may not be cancer-free during this 5 year period. Of course, many people live much longer than 5 years. Five-year relative survival rates leave out patients dying of other diseases. This means that anyone who died of another cause, such as heart disease, is not counted...

[+] Show All