Breast Cancer Screening & Diagnosis

Breast cancer screening & diagnosis at a glance

• Breast cancer screening evaluates a woman for breast cancer before any signs or symptoms appear, in hope of catching any cancer early when it is more likely to respond to treatment.
• According to the National Cancer Institute, a mammogram is the best way to detect breast cancer in its earlier stages, with clinical breast exam and an MRI providing other screening options.
• Oncologists give a breast cancer diagnosis when they have detected cancer and further categorize the cancer by its stage of development.
• The stage helps determine the course of treatment.

Breast cancer screening & diagnosis

Screening attempts to find a disease when no symptoms are present, and such early detection may result in better treatment outcomes. The size of the breast cancer and the extent of its spread are the most important factors in the prognosis of a woman with the disease, and screenings are more likely to detect breast cancers when they are smaller and haven’t spread.

When physicians suspect breast cancer, either due to symptoms or when a screening indicates the presence of cancer, they take a sample of the suspect tissue and have a lab confirm or deny the presence of cancer cells. If cancer is present, the oncologist gives the patient a diagnosis of breast cancer and conducts further evaluations to determine the cancer’s stage.

Mammogram screening

Oncologists primarily use a mammogram to screen women for breast cancer. The Centers for Disease Control and Prevention (CDC) says that having regular mammograms may reduce a woman’s risk of dying from breast cancer. Research does not show any clear benefit from a clinical breast exam (CBE) by a physician or self-exams as effective screening tools, and the American Cancer Society (ACS) does not suggest a routine annual CBE.

A mammogram involves an X-ray image taken of the breast while it is briefly compressed. A mammogram can detect a cancer years before it would be detected otherwise.

ACS says that women age 40-74 who get regular mammogram screenings have a lower chance of dying from the disease than women who do not get mammograms. However, cancer experts and organizations can have differing opinions on when and for whom mammograms should be recommended. Patients should discuss this carefully with their healthcare provider.

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Mammogram breast cancer screening risks

Mammograms are not perfect and can return incomplete or faulty screening results, such as false-positives (cancer is reported present when it actually isn’t) and false negatives (the report says there is no cancer when there actually is cancer present). These can result in undue emotional stress and unneeded medical treatments, or critical delays in medical treatments and even death.

Women should discuss these mammogram risks with their physician before having a mammogram. For instance, the size of the tumor and the density of the breast tissue can affect the accuracy of a mammogram. Oncologists seek to improve screening tests through clinical trials. Physical risks involve soreness and damage to the breast during the mammogram.

Women who do get breast cancer but are receiving regular mammograms, according to the ACS, are more likely to find the cancer early, more likely to be cured of the breast cancer and less likely to receive aggressive treatments. Here are the ACS’s mammogram guidelines for women at average risk of breast cancer.

• Age 40-44, optional
• 45-54, yearly mammogram
• 55 and older, either yearly or every two years

Other screening methods

Other forms of screening may also be used to detect breast cancer. A clinical breast exam (CBE) involves a physician or other healthcare provider examining a woman’s breasts and under her arms for lumps and other unusual issues. Oncologists may also conduct a tissue biopsy if they suspect a problem.

A magnetic resonance imaging (MRI) screening makes detailed images of the breast using magnetics, a computer and radio waves. MRIs find cancers more often than mammograms, but MRIs are also prone to falsely reporting abnormalities when none exist. Women should consider an MRI screening if they have one of the following conditions:

• Family history of breast cancer in a relative of the first degree (mother, sister, daughter)
• Changes in the BRCA1 or BRCA2 genes, and in other genes
• Cowden syndrome or other particular genetic syndromes.

Breast cancer diagnosis & staging

If screening results or symptoms indicate the presence of breast cancer, oncologists generally take a biopsy, which is a sample of the affected tissue, and have it analyzed by a laboratory. Presence of cancerous cells will result in the oncologist delivering a diagnosis of breast cancer to the patient and her or his family members.

Once breast cancer is diagnosed, oncologists will seek to determine the stage of the cancer, meaning the size and location of the cancer and how far it has progressed, either in the breast or to other parts of the body. Various scans and biopsies are used to pinpoint the stage of the breast cancer.

The stage helps oncologists determine the type of treatment, the patient’s prognosis (likely outcome) including chances of survival, and whether clinical trials are appropriate. Oncologists have several methods of staging they can use, including the TNM system, which evaluates size and extent of the tumor (T), number (N) of lymph nodes close by that have cancer and whether the cancer has metastasized (M).

The TNM scale allows oncologists to make more detailed categorizations about the stage. When cancer caregivers discuss staging with patients, they usually combine the detailed TNM stages into three simpler categories.

1. Stage 0 (carcinoma in situ): Abnormal cells present but they haven’t moved to other tissue.
2. Stages I, II, III: Cancer definitely detected, and the larger the tumor and the greater the spread to nearby tissue, the higher the stage number.
3. Stage IV: Cancer is present in other, distant parts of the body.

Treatments for the first six stages (0-III) have the goal of curing the cancer and keeping it from coming back. With the last stage, Stage IV, oncologists work to improve symptoms and keep the patient alive, as Stage IV cannot be cured.