Your doctor will ask about your medical history, including any family history of breast cancer. Your breasts will be examined for characteristic symptoms, including lumps or thickening, nipple discharge or inversion, redness or changes in the skin or contour of the breast. The underarm area will also be examined. Your doctor may recommend different tests in order to identify tumors and confirm diagnosis.
If your doctor finds abnormal results from physical exam the following tests may be done to better identify the changes. Not all breast changes are cancer. Tests to help distinguish noncancerous and potential cancerous changes include:
Blood tests may identify markers or genetic mutations in the blood. For example, tumor markers or specific blood proteins may be elevated in the presence of cancer. Tumor markers are also used to stage the cancer and evaluate if the treatments are working .
Imaging tests may be used to look for the presence of tumors. They can also help assess their size and location. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
A mammogram is an x-ray of the breast. It can often find tumors that are too small for you or your doctor to feel. The accuracy of a mammogram to detect cancer will depend on several factors. It may be affected by the size of the tumor, your age, breast density, and the skill of the radiologist. Although mammograms are the most sensitive test currently used to evaluate the breast, they will miss 10%-15% of breast cancers.
During an ultrasound, sound waves are bounced off tissues. The echoes are converted into a picture. Ultrasound is used to evaluate lumps that have been identified through breast self-exam, clinical breast exam, or mammography. They help to see if a mass is solid or liquid-filled. Solid masses are generally more concerning than cystic or liquid-filled masses
Ultrasound may also be used to:
An MRI scan of the breast may have better accuracy in detecting some types of tumors. It may be more accurate in cases where the breast tissue is more dense than usual or when breast cancer of both breasts is suspected. MRI scans can also be used if there are conflicting results from other tests, such as a mammogram and/or ultrasound.
The clinical breast exam and imaging (like a mammogram) can suggest cancer, but a biopsy will confirm the presence of cancer cells. During a biopsy, a sample of suspicious tissue is removed so it can be examined under a microscope.
Biopsy types include:
Biopsies needles may be guided by imaging, such as an MRI scan or ultrasound, to improve accuracy.
If breast cancer is confirmed, results from completed tests and new tests will help determine the stage of cancer. Staging is used to identify characteristics of the tumor that will help determine the prognosis and treatment plan. Factors that play a role in staging include how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue, and microscopic cellular details.
Tests that may help determine breast cancer stage:
Breast cancer is staged from 0-IV:
Treatment and outcomes depend on several factors, such as location, tumor size, stage, overall health, and age. In a large study, for example, younger women (less than age 40 years), who were initially diagnosed with Stage I or II breast cancer, had lower survival rates compared to older women. Researchers are investigating what may account for this unexpected result.
Breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed October 26, 2015.
Breast cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/breast-cancer. Updated September 2013. Accessed October 26, 2015.
Breast cancer in women. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113654/Breast-cancer-in-women. Updated September 14, 2016. Accessed October 3, 2016.
Palpable breast mass evaluation in women. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T543852/Palpable-breast-mass-evaluation-in-women. Updated September 15, 2015. Accessed October 3, 2016.
Sentinel lymph node biopsy for breast cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900237/Sentinel-lymph-node-biopsy-for-breast-cancer. Updated December 22, 2015. Accessed October 3, 2016.
Stages of breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_148. Updated October 22, 2015. Accessed October 26, 2015.
Tumor markers. National Cancer Institute website. Available at: http://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet. Updated December 7, 2011. Accessed October 26, 2015.
5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113654/Breast-cancer-in-women: Gnerlich JL, Deshpande AD, Jeffe DB, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg. 2009;208(3):341-347.
Last reviewed December 2014 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.