Finding out you have breast cancer can trigger a lot of anxiety and fear. The three main goals of the diagnosis phase — testing to confirm breast cancer, identifying the stage of breast cancer through other tests and exams, and generating a pathology report which will help guide the treatment plan — may help alleviate some of these feelings. You’ll finally start receiving answers to some of your lingering questions.
The tests are designed to provide you and your care team with an accurate overview of your particular situation. These may include:
- a complete health evaluation, including family history and a physical exam
- blood tests, including a complete blood count (CBC) and a complete metabolic panel
- breast imaging tests, such as ultrasound or magnetic resonance imaging (MRI)
After a breast exam and screening mammogram, the next test is typically a diagnostic mammogram. This involves more pictures of the breast from different angles. It may include close-ups of the lump.
If the mammogram doesn’t provide enough information, an ultrasound may be used to view the breast and the area where the breast meets the armpit. This can be helpful to determine whether the lump is a hard mass (tumor) or a fluid-filled cyst. In some instances, an ultrasound may be more helpful than a mammogram. This is generally the case for young women with dense breast tissue.
If the diagnostic mammography shows an abnormality, additional imaging tests may be necessary. For instance, you may need bone scans, computed tomography (CT) scans, or positron emission tomography (PET) scans. These tests can detect the exact location of the cancer and identify whether it is spreading.
For treatment planning, some women may undergo genetic testing. This test will determine if you have an abnormal gene that is linked to a higher risk of breast cancer.
If it’s determined that you do have a mass, a biopsy may be performed. There are different types of biopsies. For a biopsy, a physician will remove a small amount of breast tissue so that it can be examined for disease. The most common types of biopsies are fine needle aspiration, core needle biopsy (including stereotactic biopsy and vacuum-assisted biopsy), MRI-guided biopsy, and surgical biopsy.
Receptors act like switches in normal breast cells. They react to certain substances in the bloodstream to tell the cells what to do. Breast cancer cells also often contain receptors. This test can be done in the lab, using a special staining process, and is performed on the actual cancer cell once a diagnosis of breast cancer is made. Cancer cells may be found to be positive for hormone receptors (estrogen or progesterone) or human epidermal growth factor receptor 2 (HER2). Knowing if the cells are positive, and understanding what types of receptors are present, can help clinicians determine if you’re a good candidate for anti-hormone therapy.
Your Pathology Report
Once all diagnostic tests are performed, a pathology report is created. A pathology report provides important information about your cancer. This report is used by your healthcare team to form a treatment plan. It reveals whether the cancer is invasive, estimates the size of the tumor, and what stage it’s in. You’ll receive a new pathology report every time tissue is removed and tested for cancer.