Breast Cancer Health Article

Diagnosis

More than 90% of all breast cancers are detected by mammogram (a low-dose x ray of the breast). Mammograms should be done to evaluate a suspicious lump. Screening mammograms should be ordered according to the doctor's guidelines. Despite the controversy about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with the current American Cancer Society guidelines that recommend screening mammograms every year or two for women between 40 and 49, and every year after age 50. Women with a family history of breast cancer may want to have a mammogram every year after age 40.

A typical mammography screening includes two views of each breast (one from above, and one from the side). Normally, the technologist examines the x-ray films immediately to make sure views are complete. A radiologist determines if further views or follow-up ultrasound studies are needed.

If anything irregular is detected, such as a mass, changes from earlier mammograms, abnormalities of the skin, or enlargement of the lymph nodes, further testing may be recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a breast surgeon.

Biopsy of the breast is a removal of breast tissue for examination by a pathologist. An excisional biopsy is a surgical procedure in which the entire lump area and some surrounding tissue is removed for examination. If the mass is very large, an incisional biopsy is done where only a portion of the area is removed and analyzed. Needle biopsy can be done in two methods. An aspiration needle biopsy uses a very fine needle to withdraw cells and fluid from the mass for analysis. A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue from the mass that can be analyzed. These analyses can determine whether the mass is benign (noncancerous) or cancerous and therefore, whether further treatment is required.

To find out if the cancer has spread to other parts of the body (metastasized), doctors remove some underarm lymph nodes to test for cancer cells that have spread and to assist in making decisions for treatment. A newer technique, called sentinel lymph node biopsy, allows physicians to check the sentinel node, or the one that first receives fluid drained from the cancerous area, to preserve as many lymph nodes as possible. If this node is free of cancer cells, the cancer should not have spread any further than locally. Checking to see if there are cancer cells in the lymph nodes is also a way to tell how advanced the cancer is ("staging" cancer). Breast cancer is rated from Stage 0 to Stage IV. Staging uses the diagnostic information to tell the cancer physician (oncologist) how widespread the disease is and includes:

• Stage I. The cancer is no larger than 2 cm and no cancer cells are found in the lymph nodes.
• Stage II. The cancer is no larger than 2 cm but has spread to the lymph nodes or is larger than 2 cm but has not spread to the lymph nodes.
• Stage IIIA. Tumor is larger than 5 cm and has spread to the lymph nodes or is smaller than 5 cm, but has spread to the lymph nodes, which have grown into each other.
• Stage IIIB. Cancer has spread to tissues near the breast or to lymph nodes inside the chest wall, along the breastbone.
• Stage IV. Cancer has spread to skin and lymph nodes near the collarbone or to other organs of the body.