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Diagnosing and Detecting Breast Cancer, Tumors and Symptoms

How Is Breast Cancer Diagnosed?

Breast cancer is often first suspected when a lump is felt (either by a woman or her physician) or when an abnormal area is found on a mammogram. Most of the time, these suspicious areas do not turn out to be cancer, but the only way to know for sure is through follow-up tests and/or breast biopsy. Follow-up tests, such as diagnostic mammogram and ultrasound breast imaging, can provide additional information about suspicious areas and help determine which are likely to be cancer and which are not. For those that are likely to be cancer, cells or tissue must be removed from the abnormal area of the breast and examined under a microscope. This procedure of removing cells or tissue is called a biopsy and is the only way to make a definitive diagnosis of cancer.

If a diagnosis proves not to be breast cancer, breast health related services such as mammograms and  cancer risk assessment  are offered via the Emory Breast Center.

Breast Cancer Screening Recommendations:  Winship Cancer Institute and Emory Healthcare recommend following established American Cancer Society guidelines for screening mammography.

Carl D'Orsi, MD, Director of Breast Imaging Research, Department of Radiology, Emory University School of Medicine, has dedicated much of his career to research in the area of breast imaging and early detection of breast cancer. Dr. D'Orsi comments on the latest breast cancer screening recommendations.




Breast Cancer Stages

After a diagnos is of cancer has been confirmed, the cancer is classified into a particular stage. The stage of cancer helps determine what treatment  combinations are most  effective in treating the disease and prolonging life (prognosis). Detecting breast cancer early is very important. The earlier the stage at diagnosis, the better the prognosis.

A number of methods for classifying stage exist. Most widely used, though, is the TNM classification (standing for Tumor, Nodes, Metastases). TNM takes into account

  • (T) Size of the tumor
  • (N) Number of cancerous lymph nodes (N)
  • (M) Whether or not the cancer has spread or metastasized to other areas of the body

The stage of a cancer is usually determined at two separate times. The first time is based on results from a doctor's physical exam and tests like mammography (known as clinical staging), and the second time is based on a direct examination of the lymph nodes and tumor removed during surgery (known as pathologic staging).

The elements that may contribute to your breast cancer stage include:

  • Tumor size: The size of a tumor can be a prognostic factor. Tumor size can be determined by touch, imaging, or measurement after removal.
  • Tumor grade: Tumors are graded based on how closely they resemble healthy breast tissue. In general, a lower number indicates a slower-growing tumor that is less likely to spread. A higher number indicates a faster-growing tumor that is more likely to spread. Tumor grade helps the cancer team decide whether further treatment will be necessary after surgery.
  • Estrogen receptor (ER) and progesterone receptor (PR) status: Certain tumors are fueled by the hormones estrogen and progesterone. Tumors that respond to estrogen are called estrogen receptor positive (ER+), and tumors that respond to progesterone are called progesterone receptor positive (PR+). Determining ER and PR status helps the cancer team decide if hormone therapy will be effective in treating the cancer.
  • HER2/neu expression: HER2/neu is a protein that can cause breast tumors to grow aggressively. HER2/neu status helps the cancer team decide whether or not to include a drug called Herceptin in the treatment regimen.
  • Lymph node status: The lymph nodes act as a cellular waste removal system for the body. Sentinel lymph nodes are the first nodes to receive lymphatic drainage from a cancerous tumor. When no sentinel nodes have cancer cells, it is referred to as "node negative." The number of nodes that contain cancer cells is a very important factor in determining treatment options.