How is Breast Cancer Diagnosed?
- Clinical examination – especially if there is a lump or nipple discharge, or an unusual breast change is detected.
- Mammogram – a special x-ray imaging tool that can detect abnormal masses in the breast like calcium deposits, cysts and tumours.
- Ultrasound scan – to examine abnormalities found in the mammogram. It can tell the difference between a solid mass, which may be a cancer, or a fluid-filled cyst which is usually not cancer.
- Magnetic resonance imaging (MRI) – an MRI scan can better examine areas of concern in the breast. This is useful for younger women because they tend to have higher breast tissue density, which could reduce the effectiveness of standard imaging tests (eg. mammogram and ultrasound) in detecting breast cancer.
What is a Biopsy?
A biopsy has to be done to confirm the presence of breast cancer. This involves the removal of the abnormal tissue to be examined closely under a microscope.
Common biopsy techniques:
- Fine needle aspiration (FNA)
- Core needle or tru-cut biopsy
- Excision biopsy
How is Breast Cancer Assessed?
Stages / Extent of Spread
| Stage |
Extent of Spread |
Average 5-year Survival Rate (%)* |
| 0 |
Non-invasive cancer |
99 |
| I |
Small invasive cancer
(less than 2cm without spreading to the axillary lymph nodes)
|
90 |
| II |
Invasive cancer
(between 2 – 5cm or/with lymph nodes invasion)
|
70 |
| III |
Large invasive cancer
(more than 5cm with skin invasion or spread to multiple lymph nodes)
|
40 |
| IV |
Widespread or metastatic cancer |
20 |
*Individual patients may have a different experience depending on the specific characteristics of their breast cancer, and will influence which therapies can be used to target their cancer.
These characteristics of breast cancer can affect the chances of relapse and the patient’s survival rate.
Tumour Grade / Histologic Grade
This refers to how much the tumour cells look like normal cells when examined under the microscope, rated from grade 1 – 3. Grade 3 tumours contain very abnormal and quick growing cancer cells. The higher the histologic grade, the greater the chance of the breast cancer returning.
Lymph Nodes
The number of invaded (positive) lymph nodes, that are in the armpit on the side of the affected breast, is an important indicator of the chances of a successful recovery rate. A higher number of positive nodes will often result in a less positive outcome and requiring more aggressive treatments.
Tumour Size
In general, the larger the size of the tumour, the greater the chance of the breast cancer returning.
Oestrogen/Progesterone Receptors
Close to 2 out of 3 breast cancers cases involve significant levels of oestrogen and/or progesterone receptors. They are also known as oestrogen receptor positive (ER+) tumours. These tumours tend to grow less aggressively and may respond well to treatment with hormones.
HER2
HER2 is a protein that helps the growth of cancer cells and can be found on the surface of certain cancer cells. A HER2-positive tumour is a type of tumour with an excess of the HER2 protein on its cells. These tumours tend to grow more quickly than other types of breast cancer tumours, and 20-25% of all breast cancer cases have these HER2-positive tumours.
Knowing if a cancer is HER2-positive can affect the choice of treatment because women with such tumours can benefit from HER2-targeted therapies. These include therapies that use drugs like trastuzumab (Herceptin®), pertuzumab (Perjeta®) or TDM-1 (Kadcyla®).