Whether you've been recently diagnosed, have just finished treatment or have been a survivor for many years, staying informed and having your questions answered is a primary objective in understanding your diagnosis. This section of our website aims to provide some of the most frequently requested information pertaining to:
While the information below is useful, it is not a complete and comprehensive guide to all topics related to a diagnosis. If you're looking for an in-depth resource with more information, please follow the link below to the diagnosis page on Komen National's website. If at any time you'd like to speak with someone here at Komen Greater NYC about your diagnosis or upcoming visits with your physician, please don't hesitate to contact us.
In many cases, breast cancer can be ruled out with a diagnostic mammogram, ultrasound or breast MRI. However, if cancer can't be ruled out, you will need to have a biopsy. A biopsy involves removing cells or tissue from the suspicious area of the breast. The cells or tissue are studied under a microscope to see if they show cancer. If you need to have a biopsy, don't panic. Having a biopsy can be scary, but keep in mind that most breast biopsies in the U.S. do not show cancer . Still, a biopsy is needed to know if something is cancer or not. If breast cancer is found, it can be treated. When breast cancer is found early, the chances for survival are highest.
There are two main types of biopsies used to diagnose breast cancer:
A needle biopsy uses a hollow needle to remove samples of tissue or cells from the breast. A pathologist studies these samples under a microscope to see if they contain cancer. If they do, more tests will be done to help you and your health care provider plan your treatment. Needle biopsies can be used to study either a lump that can be felt (palpable mass) or a suspicious area that can only be seen on a mammogram or other imaging test (non-palpable mass)
A surgical biopsy is the most accurate way to diagnose breast cancer and get complete information about the tumor. However, it is more invasive than a needle biopsy. Because core needle biopsy is accurate in diagnosing cancer and does not involve surgery, it is often the preferred biopsy method [3,5]. In most surgical biopsies, the entire suspicious area plus some of the surrounding normal tissue is removed from the breast (excisional biopsy). In certain cases, when the entire area is too large to remove, only part of it is taken out (incisional biopsy). The tissue removed is tested for signs of cancer. If cancer is found, other tests can be done to help you and your health care provider plan treatment.
The breast tissue removed during a biopsy is sent to a pathologist. A pathologist is a physician who looks at the tissue under a microscope and determines whether or not the tissue contains cancer.
The pathologist prepares a report of the findings, including the diagnosis, and sends it to the ordering physician (either your surgeon or your oncologist).
When needed, the pathologist does more tests on the tissue sample. These results may be written up in separate reports, so you may get more than one report for the same biopsy. Along with other test results or X-rays, the pathology report(s) informs your diagnosis, prognosis and treatment. Ideally, an interdisciplinary team that includes your oncologist, radiologist, surgeon and pathologist will plan your treatment.
Your pathology report contains the information that describes your diagnosis. Try not to focus on any one item in the report since it is the sum of all the information that is most important to your prognosis and treatment. Your physician (either your surgeon or your oncologist) will go over the main findings of the report with you and answer any questions you may have.
It is a good idea to ask for a copy of your pathology report for your personal medical records. It can be hard to take in all the findings at once and having a copy of the report you can refer to later is helpful.
Inside the pathology report, you may see a diagnosis classified as one of the following types of cancer:
Doctors use a scale to describe the stage of advancement of breast cancer. The scale includes five stages: 0, I, II, III and IV. The higher the stage, the more serious the cancer. The stage depends on:
Your report may include the size, pattern and other features of the cancer. You will find out the stage of your cancer after surgery when your doctor is able to check whether cancer was found in your lymph nodes.
Sometimes breast cancer cells have receptors for hormones and sometimes they do not. Receptors are the parts of a cancer cell that allow a hormone to attach and activate the cell. Breast cancer cells can have receptors for the hormones estrogen and progesterone together, or for either hormone alone. When this is the case, the cancer is called estrogen receptor (ER) and/or progesterone receptor (PR) positive. Women with a receptor-positive cancer have a somewhat better prognosis than those without. A doctor can treat hormone receptor-positive cancers with hormone therapy drugs.
Tumors with high levels of HER2/neu have been linked to more aggressive types of breast cancer and possibly to resistance to certain types of chemotherapy and hormonal therapy. Tumors that over-express HER/neu are also effective targets for the drug, trastuzumab (Herceptin®).
Histologic grade is a measure of how abnormal the cells from a tumor look under a microscope. The more the cells have changed to appear cancerous, and not like normal breast cells (histology), and the greater the percentage of the cells that are dividing, the higher the grade. Tumors are given a histologic grade of 1 to 3. Grade 1 has the best prognosis.
The proliferation rate describes how quickly the tumor cells are growing. It can also help show how aggressive a tumor is and how likely it is to spread to other parts of the body. When the proliferation rate is low, the cancer is growing more slowly and the prognosis is better. The Ki-67 test is a common way to measure proliferation rate.
In addition to the information about biopsies and pathology reports above, we've also prepared a list of questions for you to ask your doctor. The questions listed are intended to assist you in preparing for an upcoming visit with your physician, but they are by no means required nor exhaustive. Please feel free to augment or reduce this list as you see fit: what's most important is that you get all the information you need.
*For a more comprehensive guide to understanding your diagnosis, please visit the diagnosis page on Komen National's website
Although the terms “genetics” and “genomics” may sound similar, they refer to different areas of study — both of which may be helpful in preventing and treating cancer.
Genetics is the study of inherited traits, passed on from one generation to the next through genes. These traits include hair and eye color, as well as a greater risk for certain diseases, such as breast cancer. It is estimated that 5% to 10% of breast cancers are hereditary, caused by abnormal genes passed from parent to child.
Genomics is the study of groups of genes and how they interact with each other, including their role in certain diseases. For example, if you have breast cancer, the activity and interaction of specific genes in your tumor affect its behavior, including how likely it is to grow and spread.
Most women who develop breast cancer have no family history of the disease. However, if you have multiple family members who have had breast cancer, you may have inherited an abnormal change (also called a mutation) in a gene linked to a higher risk of breast cancer. In that case, you may choose to undergo genetic testing, which is conducted on a sample of your blood, saliva or other tissue.
The most common genes that can mutate and raise breast cancer and ovarian cancer risk are BRCA1, BRCA2, and PALB2. Taking your family history and personal situation into account, you should talk with your doctor to decide if genetic testing is a good idea for you. If you discover you have a higher genetic risk for cancer, you can take steps to lower that risk, such as making lifestyle changes, having preventive surgery, and getting screened more frequently.
While genetic tests can help to tell you your risk of getting cancer, genomic tests can help once you have been diagnosed with cancer to optimize and personalize your treatment plan. These tests look at the activity of certain cancer-related genes in your individual tumor, providing valuable information about your unique cancer that is not available from traditional tests and measures, such as the size and grade of your tumor.
There are several tests used to analyze the genes in a breast tumor to help predict whether the breast cancer will come back (recurrence). These include the EndoPredict test, the Mammaprint test, the Mammostrat test, the Oncotype DX Breast Recurrence Score test, the Oncotype DX Breast DCIS Score test, and the Prosigna Breast Cancer Prognostic Gene Signature Assay. All of these tests can be done on a sample of preserved tissue that was removed from the breast during the original biopsy or surgery.
The Oncotype DX Breast Recurrence Score test is the only genomic test that can be used to predict low likely you are to benefit from chemotherapy, as well as to estimate your risk of recurrence if you have early-stage, hormone receptor- positive breast cancer. In addition, the Oncotype DX test has the most thorough data supporting its use in making treatment decisions. For these reasons, it is included in all major breast cancer treatment guidelines, and is the most common genomic test used in the U.S. to make treatment decisions.
If you are diagnosed with DCIS, or ductal carcinoma in situ, the Oncotype DX Breast DCIS Score test is the only genomic test available to help you find out how likely your disease is to return. This information can then be used to help you choose among several treatment options.
Whichever test you have, you and your doctor will consider your scores in combination with the other information in your pathology report to come up with the best treatment plan for you.