Breast Cancer Diagnosis
Breast cancer specialists at North Shore-LIJ Cancer Institute's Breast Cancer Center, including highly experienced radiologists and pathologists, offer leading-edge technology to ensure an accurate diagnosis of breast cancer. World-class breast cancer services are available, including breast cancer screening and diagnostic imaging, breast cancer treatment, follow-up and cancer risk assessment.
Breast Cancer Screening
Regular screening mammograms are routine for women who don't have any breast cancer symptoms. Mammograms can detect early changes in breast tissue and treat breast cancer in its earliest, most treatable stages.
Women should see their doctor when they experience symptoms such as:
- A lump or thickening in or near the breast or in the underarm area
- Changes in the breast size or shape
- A dimple or puckering in the breast skin
Be aware that these symptoms could be due to conditions other than breast cancer, so it’s best to see your doctor right away if you’re experiencing them. You must see your doctor immediately if you have any of these symptoms, even if your mammogram is negative.
Medical History and Physical Exam
The first step in making a diagnosis of breast cancer is usually a physical, during which your doctor exams your breasts and surrounding areas to detect enlarged lumps, nodules, swelling or thickening of breast tissue.
Breast Cancer Diagnostic Tests
Our specialists use a variety of tests, typically outpatient procedures, to deliver an accurate breast cancer diagnosis:
The Breast Cancer Center provides the most advanced diagnostic mammograms for women with current symptoms or previous breast cancer:
- 3-D Mammography (digital breast tomosynthesis) — This emerging 3-D technology can detect lesions and reduce false alarms.
- Full Field Digital Mammography (FFDM) — FFDM produces exceptionally sharp digital images with less radiation exposure.
High-frequency sound waves distinguish if a mass is benign or suspicious.
MRI Scan (Magnetic Resonance Imaging)
A powerful magnet, radio waves and computer imaging combine to create highly detailed 3-D breast tissue images.
CT or CAT Scan (Computerized Axial Tomography)
A combination of X-rays and computer technology produces detailed 3-D images to determine whether the cancer has spread.
PET Scan (Positron Emission Tomography)
Small amounts of radioactive sugar are injected to highlight cancer and see whether it has spread.
An injection of low-level radioactive material helps detect if breast cancer has spread to the bones.
Choosing from different types of biopsies, your doctor takes a tissue sample for further examination under a microscope by a pathologist to determine the type of cancer.
If breast cancer is discovered, additional tests will be given to gather additional information about the cancer:
- Hormone receptor tests measure the amount of estrogen and progesterone receptors are in the cancer tissue. More estrogen and progesterone receptors than normal mean the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
- Genetic tests measure the activity of genes and whether certain proteins are evident in tissue. These tests determine whether the cancer will spread more quickly and narrow down options for treatment.
Breast Cancer Staging
Once a breast cancer diagnosis has been confirmed, your doctor will conduct one or more of the diagnostic imaging tests listed above to determine the cancer's location and stage, meaning the size of the cancer and how far it has spread. Accurate staging is the foundation of the most effective treatment plan for you.
According to the National Cancer Institute, the stages of breast cancer are:
- Stage 0 — Known as carcinoma in situ, this stage means cancer cells or non-cancerous abnormal cells are not breaking out or invading neighboring normal tissue.
- Stage I — Stage I is subdivided into stages IA and IB:
- Stage IA: The tumor is 2 centimeters (about 3/4 inch) or less across, and cancer is not found in any lymph nodes or distant sites.
- Stage IB: The cancer is 2 centimeters (about 3/4 inch) or less across (or no tumor is found) and very small amounts have spread to the axillary lymph node (lymph nodes under the arm), but not to distant sites. These microscopic metastases, also called micromets, occur where the cancer has implanted and taken hold.
- Stage II — Stage II is subdivided into stages IIA and IIB
- Stage IIA: No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is 2 centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymph nodes.
- Stage IIB: The tumor is larger than 2 centimeters but not larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes; or the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 5 centimeters and has not spread to the lymph nodes.
- Stage III — Stage III is subdivided into stages IIIA, IIIB and IIC:
- Stage IIIA: No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone; or the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone.
- Stage IIIB: The tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Cancer may have spread to axillary lymph nodes or lymph nodes near the breastbone. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.
- Stage IIIC: No tumor is found in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer has spread to 10 or more axillary lymph nodes; or to lymph nodes above or below the collarbone; or to axillary lymph nodes and lymph nodes near the breastbone. Cancer that spread to the skin of the breast may also be inflammatory breast cancer, a type of breast cancer in which the breast looks red and swollen and feels warm.
- Stage IV — The cancer has spread to other parts of the body, most often the bones, lungs, liver or brain.