How is Breast Cancer Diagnosed?
- Clinical Examination – Especially if there is a lump or nipple discharge, or an unusual breast change is detected.
- Mammogram – This is special x-ray imaging that can detect abnormal masses in the breast such as calcium deposits, cysts and tumours.
- Ultrasound Scan – Used to examine abnormalities found the mammogram. An ultrasound scan can distinguish between a solid mass, which may be a cancer, or a fluid-filled cyst which is usually not cancer.
- Magnetic Resonance Imaging (MRI) – A MRI scan can better assess areas of concern in the breast. This is particularly useful for younger women because this group tends to have higher breast tissue density, reducing the effectiveness of conventional imaging tests such as the mammogram and ultrasound in detecting breast cancer.
What is a biopsy?
To confirm breast cancer, a biopsy will have to be performed in which cells are removed and examined 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)
|II || |
(between 2 – 5cm or/with lymph nodes invasion)
|III || |
Large invasive cancer
(more than 5cm with skin invasion or spread to multiple lymph nodes)
|IV ||Widespread or metastatic cancer ||20 |
*Individual patients may have a different experience depending on the specific characteristics of their breast cancer, and which therapies can be used to target their cancer.
These characteristics of breast cancer can impact the chances of relapse and affect the patient’s survival rate.
Tumour Grade Histologic Grade
This refers to how much the tumour cells resemble normal cells when viewed under the microscope, rated from 1 to 3. Grade 3 tumours contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater the chance of breast cancer relapsing.
The number of lymph nodes that is in the armpit, on the same side of the affected breast, is an important indicator. A higher number of positive nodes will often result in a worse outcome and warrants more aggressive treatments.
In general, the larger the size of the tumour, the greater the chance of breast cancer recurrence.
Close to 2/3 of all breast cancers contain significant levels of oestrogen and/or progesterone receptors. They are referred to as oestrogen receptor positive (ER+) tumours. ER+ tumours tend to grow less aggressively and may respond favourably to treatment with hormones.
HER2 is a protein found on the surface of certain cancer cells. A tumour is described as HER2-positive if tests show an excess of the HER2 protein on its cells. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. 20-25% of all breast cancers have 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 drugs such as trastuzumab (Herceptin®), pertuzumab (Perjeta®) or TDM-1 (Kadcyla®).