Types of Tests
Tests for breast cancer may include the following tests.
General Health Tests
Medical history is a record of all health issues and treatments you have had in your life. Be prepared to list any illness or injury and when it happened. Bring a list of old and new medicines and any over-the-counter medicines, herbs, or supplements you take.
Tell your doctor about any symptoms you have. A medical history will help determine which treatment is best for you.
Some cancers and other diseases can run in families. Your doctor will ask about the health history of family members who are blood relatives. This information is called a family history. You can ask family members about their health issues like heart disease, cancer, and diabetes, and at what age they were diagnosed.
A physical exam is a study of your body and check for signs of the disease.
Hormone Receptor Tests
A hormone is a substance made by a gland in your body. Your blood carries hormones throughout your body. A receptor is a protein found inside or on the surface of a cell. Substances such as hormones attach (bind) to these receptors. This causes changes within the cell.
Hormones recognize and bind to specific hormone receptors.
There are 2 types of hormone receptors:
- Estrogen – plays a role in breast development
- Progesterone – plays a role in the menstrual cycle and pregnancy
Once these hormones attach to receptors inside breast cancer cells, they can cause cancer to grow. If found, these receptors may be targeted for treatment using endocrine therapy.
Immunohistochemistry (said immuno- histochemistry or IHC) is a special staining process that involves adding a chemical marker to cells. These cells are then studied using a microscope. IHC can find estrogen receptors in breast cancer cells. A pathologist will measure how many cells have estrogen receptors and the number of estrogen receptors inside each cell. Test results will either be estrogen receptor-positive (ER+) or estrogen receptor-negative (ER-).
In estrogen receptor-positive (ER+) breast cancer, IHC finds estrogen hormone receptors in at least 1 out of every 100 cancer cells. ER+ cancer cells may need estrogen to grow. These cells may stop growing or die with treatment to block estrogen. Treatment to block estrogen is called endocrine therapy.
Estrogen receptor-negative (ER-) breast cancer cells do not have estrogen hormone receptors. These cancer cells do not need estrogen to grow and continue to grow despite treatment to block estrogen.
To confirm cancer is present, a tissue sample needs to be removed and tested. If cancer is confirmed, more lab tests will be done to learn about the cancer. Not all breast cancers are alike. Your doctor will use the lab results to decide which treatment options are right for you.
A biopsy is a procedure that removes a sample of tissue or fluid. The sample is sent to a lab for testing. A pathologist will test the biopsy for cancer and write a report called a pathology report. Ask questions about your biopsy results and what it means for your treatment.
There are different types of biopsies. Some biopsies are guided using imaging, such as an ultrasound or MRI. The primary or main tumor is biopsied first. Other tumors or tumors in different areas may also be biopsied. You may have tissue removed from the breast, lymph nodes, or both.
Types of possible biopsies include:
- Fine-needle aspiration (FNA) uses a thin needle to remove a sample of tissue or fluid.
- Core needle biopsy removes tissue samples with a wide, hollow
- Incisional biopsy removes a small amount of tissue through a cut in the skin or
Sentinel lymph node biopsy
A sentinel lymph node is the first lymph node that cancer cells are most likely to spread to from a primary tumor. Sometimes, there can be more than one sentinel lymph node. A sentinel lymph node biopsy (SLNB) is done during surgery such as a mastectomy (surgery to remove the breast) or lumpectomy (surgery to remove the tumor) to determine if any cancer cells have traveled to the lymph nodes. The lymph nodes removed are called the sentinel nodes. They may or may not contain any cancer cells. It is also called a sentinel node biopsy (SNB).
To find the sentinel lymph nodes, a radioactive material and other dyes are injected into the body near the breast where they travel through the lymphatics in the breast to the lymph nodes. This helps the surgeon find the sentinel lymph nodes. Once the nodes are found, one is removed and tested by a pathologist. If cancer is found, more than one lymph node may be removed.
Imaging tests take pictures of the inside of your body. These tests are used to find and treat DCIS. Imaging tests show the primary tumor, or where the cancer started, and look for cancer in other parts of the body.
A radiologist, an expert who looks at test images, will review test images and write a report. The radiologist will send this report to your doctor who will discuss the results with you.
A mammogram is a picture of the insides of your breast. The pictures are made using x-rays. A computer combines the x-rays to make detailed pictures. Diagnostic mammograms look at specific areas of your breast which may not be clearly seen on screening mammograms. A bilateral mammogram includes pictures of both breasts. It is used to see if there is more than one tumor and the size of the tumor(s). Mammogram results are used to plan treatment. Other tests on your breast may be ultrasound or breast MRI.
A magnetic resonance imaging (MRI) scan uses radio waves and powerful magnets to take pictures of the inside of the body. It does not use x-rays. If needed, an MRI would be used in addition to a mammogram. In most cases, contrast material is used to improve the pictures of the inside of the body. Contrast materials are not dyes, but substances that help certain areas in the body stand out. Contrast is used to make the pictures clearer.
Breast MRI should be performed and interpreted by an expert breast imaging team working together with a multidisciplinary treatment team.
An ultrasound uses high-energy sound waves to form pictures of the inside of the body. Ultrasound is good at showing small areas of cancer that are near the skin. Sometimes, an ultrasound or MRI is used to guide a biopsy.