Detecting and Diagnosing Breast Cancer
Breast cancer is a very scary thought— and unfortunately, it affects far too many women. Fortunately, there are things you can do to be proactive about the health of your breasts. One of which is getting screened regularly. Early detection is key in the treatment of breast cancer. While breast cancer is sometimes found after symptoms appear, many women experience no symptoms at all. This is why regular screening is so important. The earlier breast cancer is detected, the easier it is to treat successfully.
During your yearly check with your gynecologist, you may have a breast check. Your doctor will ask about your personal and family medical history and you’ll have a physical exam.
Keep in mind that this is the perfect time to speak with your doctor about any unusual changes you may have noticed in your breasts. If you suspect something isn’t right, brushing it aside will only add to your stress level. Remember, you know your health and body best, so don’t be afraid to speak up about something that doesn’t look or feel normal. And if in fact, cancer becomes your new normal, know that we at Rocky Mountain Cancer Centers are here for you.
Clinical Breast Exam
During a clinical breast exam, your healthcare provider will perform a thorough check of your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your healthcare provider will look for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your doctor checks the lymph nodes near the breast to see if they are enlarged.
If a lump has been detected, your doctor will feel its size, shape, and texture. He or she will also check to see if the lump moves easily. Benign (non-cancerous) lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests need to be done before a diagnosis can be made.
Depending on your age and history, it is likely that your doctor will also order one or more imaging tests, such as a screening mammogram. A mammogram is an x-ray picture of tissues inside the breast. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. If these are present, your doctor may request further tests to find out if abnormal cells are present.
For years, 2D mammography has been the norm for breast cancer screening. However, that’s no longer the only option. Tomosynthesis, also known as 3D mammography, is a newer method of mammography that provides a more comprehensive and in-depth view of breast tissue. This is because it takes pictures from many angles rather than a single straightforward X-ray image of the breast like 2D mammography. All women can benefit from 3D mammography, but it is especially beneficial to women with dense breasts. 2D mammograms may not be able to detect some lumps in dense breasts that a 3D mammogram would more than likely pick up. If you have dense breasts or would simply prefer to be examined with an updated method, talk with your physician to see if this option is available.
Before symptoms are experienced, women should get regular screening mammograms to detect breast cancer early:
- Women in their early 40s have the option to start screening with a mammogram every year.
- Women ages 45-54 should have mammograms every year.
- Women 55 and older can either continue with yearly mammograms or switch to having a mammogram every other year.
- Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.
If the screening mammogram shows any abnormalities in your breast, your doctor may order clearer, more detailed images of that area. A diagnostic mammogram is done to take more pictures of the breast in the area where there is a concern. These additional images can help determine whether more tests are necessary or if it was only dense breast tissue or a common cyst.
Other Imaging Tests That May Be Used for Breast Cancer Diagnosis
If an abnormal area is found during a clinical breast exam or a mammogram, your physician may order other imaging tests such as:
- Ultrasound: Often used as a follow-up to other diagnostic tests, breast ultrasounds provide evidence about whether a lump is a solid mass, a cyst filled with fluid, or a mixture of both. Unlike x-rays or CT scans that use radiation, ultrasounds use high-frequency sound waves to produce detailed images of the inside of the breasts. While cysts usually aren’t cancerous, solid lumps might be.
- MRI: Typically, breast MRIs are best for women with dense breasts as well as women who are considered high-risk. An MRI uses a powerful magnet linked to a computer to take detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue. Traditional, tube-like MRIs aren’t for everyone. If you are claustrophobic or feel extremely anxious, you may want to ask if an open MRI is in the area.
If the physician is still concerned with the abnormality, you will need to have a breast biopsy. A biopsy is the removal of tissue to look for cancer cells and the only way to tell for sure if cancer is present.
Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. The surgeon will remove fluid or tissue from your breast in one of several ways:
- Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump.
- Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue.
- Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin.
- Surgical biopsy: Your surgeon removes a sample of tissue.
- An incisional biopsy takes a part of the lump or abnormal area.
- An excisional biopsy takes the entire lump or abnormal area.
A pathologist will check the tissue or fluid removed from your breast for cancer cells. If cancer cells are found, the pathologist can tell what type of breast cancer it is. The most common type of breast cancer is ductal carcinoma, which begins in the cells that line the breast ducts. Lobular carcinoma is another common type; it begins in the lobules of the breast.
Lab Tests with Breast Tissue
If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed:
- Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is usually part of the recommended treatment plan.
- HER2/neu test: HER2/neu protein is found on some types of cancer cells. This test shows whether the tissue either has too much HER2/neu protein or too many copies of its gene. If the breast tumor has too much HER2/neu, then targeted therapy may be a treatment option.
- Genetic testing: Some breast cancers are caused by genetic factors. Genetic testing will reveal if their are any harmful BRCA1 and/or BRCA2 gene mutations which could affect your personalized, breast cancer treatment plan.
It may take several weeks to get the results of these tests, which we realize will be a stressful time for you. While it can be hard to wait patiently, be assured that going over these test results in depth will help your doctor decide which cancer treatments may be options for you.
You Have Breast Cancer. Now What?
We understand that a breast cancer diagnosis can be overwhelming. After all, it’s a lot of information to process in a very short period of time and the emotions that follow can feel like a tidal wave. While this emotional turmoil is completely normal, it’s important that you know you’re not alone in your diagnosis — or your emotions.
At Rocky Mountain Cancer Centers, you will find valuable sources of support as you cope with your breast cancer diagnosis. We have breast cancer specialists across the state of Colorado, including Colorado Springs, Denver, and the Boulder areas, and once the initial shock has worn off, you can count on us to help you find the strength to take control of the situation so you can successfully manage your life during, and after, your cancer journey.