How is Breast Cancer Diagnosed?

While some women find a lump in their breast, the most common way to detect breast cancer is through a mammogram. If an abnormal area is found, a diagnostic mammogram will focus on the area of concern along with some other tests that will determine if cancer is present.

A female physician discusses test results with an older, female patient

Ultrasound

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.

Breast Biopsy

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.

Breast Cancer Biopsy

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Types of Breast Cancer Biopsies

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.

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Testing for Hormones, HER2, and Genetic Mutations

Specific tests are performed on the tissue removed during the biopsy. It may take several weeks to get the test results, 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 are likely to work best for you.

Learn more about the types of breast cancer and hormone status.

Hormone Receptors

Some breast tumors have receptors for estrogen or progesterone that fuel the cancer's development. The path forward for estrogen-positive or progesterone-positive breast cancer is specific to blocking these hormones to slow the growth of the cancer.

HER2 Neu Receptors

This test shows whether the breast tissue has too much HER2/neu protein present. If it does, then a targeted therapy may be a treatment option to block that protein from producing too much, slowing the growth of the cancer.

Genetic Testing

Testing may be performed to determine if there are specific genes that have mutated to cause the breast cancer, which can be treated with specific targeted therapies. You may also qualify for testing to determine if you have an inherited genetic mutation.

You Have Breast Cancer. Now What?

After receiving a breast cancer diagnosis you'll have a lot of appointments and decisions to make with your breast cancer specialist. We've put together some information that is helpful for those first days and weeks in your journey.

There will be a lot of information to process in a short period of time while also managing your mental and emotional health. It’s important that you know you’re not alone in your diagnosis — or your emotions.

At Rocky Mountain Breast Specialists, you will find valuable sources of support as you cope and go through treatment. We have breast cancer specialists across the state of Colorado, including Colorado Springs, Denver, and the Boulder areas. 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.

Free Guide for Breast Cancer Patients

Get helpful tips from the RMBS team on what to expect and how to prepare your mind and body for breast cancer treatment. Tips for your family too!

How Do You Know if Cancer Has Spread to Your Lymph Nodes?

Your breast cancer surgeon and medical oncologist may talk about lymph node involvement. This refers to whether cancer has spread to the nearby lymph nodes. To determine if cancer cells are present in the lymph nodes, a Rocky Mountain Breast Specialists (RMBS) breast surgeon will remove one or several underarm lymph nodes so they can be examined under a microscope. This is often done at the same time as the breast cancer removal surgery, or it can be done as a separate procedure.

The results of the biopsy will be a part of the breast cancer staging process.

Lymph nodes can be checked in two different ways. The most common and least-invasive method is called sentinel lymph node biopsy. The other is called axillary lymph node dissection.

Sentinel Lymph Node Biopsy (SLNB)

The sentinel lymph node is the lymph node that’s most likely to have cancer spread to it first. A sentinel lymph node biopsy (SLNB) is a surgical procedure that identifies the sentinel lymph node so it can be removed and examined to determine whether cancer cells are present.

During this procedure, your surgeon will inject a blue dye or a radioactive substance (or both) near the breast tumor. Then, using a scanner that detects the radioactive material or by looking for the blue dye, the surgeon can tell which is the sentinel lymph node. It’s removed and checked for cancer cells by a pathologist.

breast-sentinel-node-biopsy

Axillary Lymph Node Dissection (ALND)

The axillary lymph nodes run from the breast tissue into the armpit. This area under the arm is called the axilla.

During a traditional axillary lymph node dissection (ALND), anywhere from 10 to 40 lymph nodes are removed and examined. These nodes are typically removed during your lumpectomy or mastectomy.

Sometimes, a targeted axillary lymph node dissection (TAD) will be performed. TAD involves marking metastatic nodes with clips so that selected nodes can be removed after chemotherapy for further pathology evaluation of residual nodal involvement.

Patients who have axillary lymph node dissections are more likely to develop a condition called lymphedema that causes fluid to build up in the arm near where the lymph nodes were removed. This can be treated and even prevented with special care.