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