Breast Cancer Diagnosis

The road to a breast cancer diagnosis can begin in a few different ways. A concerning area can be found during a routine screening mammogram that warrants more testing. You may find a lump while doing a monthly breast self-exam, or you may notice changes in your breasts.What follows can include imaging tests, biopsy and/or surgery to confirm a breast cancer diagnosis and stage the condition. 

When to Seek Diagnosis: Recognizing the Symptoms

You should reach out to your primary care provider if you notice any changes to your breasts. This includes any thickened areas or breast lumps, as well as any changes in the appearance, color, shape or size. 

Ways to Diagnose Breast Cancer

Getting a breast cancer diagnosis often begins with talking to your doctor about your symptoms and receiving an exam. Afterward, several tests may be ordered to evaluate your breasts, including any areas of concern. These imaging tests may be followed by a biopsy to discover whether the concern is benign or breast cancer.

Breast Examination

A breast lump can be discovered at home during a breast self-exam or by a health care provider during a clinical breast exam. Other breast cancer symptoms beyond lumps — whether they are nipple discharge, breast dimpling or size changes — can be detected during these exams as well. 

Breast self-exams should be completed every month so you can notice subtle changes in your breasts. Women over age 25 should receive a clinical breast exam each year during their physical or well-woman visit. Women age 40 and older should get a mammogram each year as well.

These exams, when completed regularly, may help you notice a lump or change in your breasts sooner. This can help with getting a diagnosis at an earlier stage when it can be easier to treat.

Mammography

A mammogram is a test that captures X-ray images of the breast that can help doctors identify both breast cysts and breast cancer. It is the most powerful tool to help find breast cancer at earlier stages, and when a person doesn’t have symptoms. There are screening mammograms and diagnostic mammograms.

Screening mammograms are recommended starting at age 40 for women with no breast cancer symptoms. Breast cancer screening is recommended for women under age 40 when they have a strong family history of breast cancer — it is recommended that women start mammograms 10 years before their first-degree relative was diagnosed. Four views of the breast are taken during a screening mammogram, and the images are scored by a radiologist. Based on the score, you may be recommended for a diagnostic mammogram, ultrasound and/or biopsy.

Diagnostic mammogram  is the same as a screening mammogram, but additional views of concerning areas are taken. A doctor will recommend a diagnostic mammogram if your screening mammogram was abnormal, or if you report that you found a lump or have other symptoms. 

Ultrasound

An ultrasound is a test that creates real-time images or video of tissue inside the body using sound waves. A breast ultrasound is easy and painless — a technician will place gel on the breast and use a handheld wand to brush against the skin of your breast. The technician will use a computer to take images for the radiologist to review. 

A breast ultrasound is used along with a diagnostic mammogram to help radiologists get more views of concerning areas of the breasts. This test can help providers distinguish between cysts and solid tumors. Ultrasound is particularly helpful for people with dense breasts. Ultrasound may be used to help guide a provider to the correct spot during a biopsy.

An ultrasound alone should not be used as a breast cancer screening tool as it is less standardized than mammogram. However, for people younger than age 30 who are experiencing breast cancer symptoms, an ultrasound may be used first to assess symptoms.

Magnetic Resonance Imaging (MRI)

A breast MRI uses a combination of magnets and radio waves to create detailed images of the breast. It may be used along with mammogram as a screening tool for people with a family history of breast cancer and/or who have inherited gene mutations. It may also be used in addition to mammogram and ultrasound if a person’s results of both tests were inconclusive. 

A breast MRI also can be performed after a biopsy shows cancer is present to discover the exact size and location of the growth, as well as to look for other potential spread. The test also can help distinguish if someone with breast implants may have experienced a silicone leak. 

Biopsy

During a breast biopsy, a sample of tissue is removed for testing to see if cancer or abnormal cells are present. A biopsy is usually recommended to confirm or rule out a breast cancer diagnosis after suspicious areas of concern are found during other tests. A biopsy may be completed along with a mammogram, ultrasound or breast MRI to guide the provider to the correct spot in the breast.

Core needle biopsy

During this type of breast biopsy, a hollow needle is used to take out a sample of breast tissue. 

Vacuum-assisted core biopsy or minimally invasive breast biopsy

Providers will use a biopsy needle and a suction-style instrument to remove several small samples of breast tissue. More tissue is removed using the vacuum tool than during a biopsy using a core needle alone.  

Genetic Testing for Breast Cancer 

People can inherit gene mutations on the BRCA1, BRCA2, PALB2, ATM, PTEN, TP53 or CHEK2 genes, which are associated with a higher risk of cancer. Genetic testing and counseling aren’t for everyone, since most of the mutations are rare. Getting tested can be as simple as a provider taking a blood or saliva sample or a swab of the inside of the mouth. The sample then is sent to a lab, where it is tested for certain mutations. The testing may focus on a certain number of mutations or be more extensive, based on a person’s unique situation.

Who should get genetic testing for breast cancer?

Providers may recommend genetic testing to help people understand their unique risk for cancer and to help individuals take actions to monitor and lower their risk. Genetic testing may also be suggested after a breast cancer diagnosis to guide providers in selecting individualized treatments.

Your provider may recommend genetic testing if:

 

• You have a strong family history of breast cancer, especially if a first-degree relative was diagnosed younger than age 50 or multiple family members have experienced the condition.
• There is a known history of BRCA or other gene mutations in your family.
• You are of Ashkenazi Jewish descent. 
• You have been diagnosed with breast cancer younger than age 50.
• You have cancer present in both breasts.
• You are a man with breast cancer
• You have been diagnosed with triple-negative breast cancer. 

 

Genetic testing results

The results of genetic testing for breast cancer can come back as: 

 

• Positive: This means that the gene mutation(s) tested for are present in your DNA.
• Negative: This means that the gene mutation(s) tested for are not present in your DNA.
• Inconclusive: This means that the test didn’t show either way if the genetic mutation(s) were present.
• Positive for a variant of unknown significance (VUS): A gene variation was present, but it’s unknown if it could change or increase your risk.

 

I’m curious about my genetic breast cancer risk

There are over-the-counter genetic tests that screen for BRCA1 or BRCA2 mutations available online and at pharmacies. It’s important to know that there are more than 1,000 known BRCA gene mutations, as well as several other genes that increase your risk of breast cancer beside BRCA. Commercially available tests only screen for very few specific mutations. That means some people may get negative results when they may be positive for a different mutation, or someone may test positive for one but not be at an elevated risk based on other factors. If you’re seriously concerned about your risk for breast or any other type of cancer, talk to your primary care provider.   

First Steps in Breast Cancer Diagnosis: Initial Examination & Consultation

Your first meeting with a breast specialist includes a conversation about your breast cancer diagnosis and treatment plan options. Your doctor will outline treatment options that are unique to your condition.

An oncology nurse navigator will be present to help support you and help guide you with next steps, including setting up subsequent appointments. Since this initial exam can be overwhelming emotionally, the nurse navigator will give you a packet that includes information about your diagnosis, treatment plan and additional resources that you can review later.

Understanding Pathology Reports

After having a breast biopsy, a pathologist will prepare a report based on the findings. The report will describe the characteristics of the lump or tissue sample taken during a biopsy. 

The two main types of pathology reports are a biopsy pathology report and surgical pathology report. These two types of reports are very similar, but an excision pathology report will share the stage of the cancer, as the whole lump or affected tissue was removed during a surgery, also called excision (lumpectomy). Staging breast cancer comes down to knowing the full size of the cancer, so if a biopsy report shows that breast cancer is present, surgery may be needed to fully understand the cancer’s size to begin the staging process.

Your pathology report will help provide a diagnosis and include information regarding the samples studied, which can include breast and lymph tissue, if removed. A pathology report can contain the following: 

 

• HER2 status: This section will show if the breast cancer cells contain human epidermal growth factor receptor 2 (HER2), a protein that can exist on some types of cancer cells. This can help guide breast cancer treatment.
• Hormone receptor status: This shares whether the cancer cells contain hormone receptor proteins that hormones can attach to and cause cancer cells to grow. Receptor status can be positive or negative, with positive showing that the cancer does have hormone receptors.
• Lymph node spread (N): Should the lymph nodes near the breast be removed and tested, the report will show whether cancer is present in lymph node tissue. 
• Lympho-vascular invasion: This will show whether cancer cells are present in small blood vessels or lymph channels.  
• Microscopic description: This includes detailed measurements and information about what the pathologist saw in the microscope.
• Non-invasive or invasive: This details whether the cancer was non-invasive, or contained to its original site, also called “in situ,” or invasive, or spread to other breast tissue or lymph nodes.  
• Nuclear grade: This will share whether the nucleus of the cancer cell resembles that of a healthy breast tissue cell. A higher grade indicates that the cancer cell is more aggressive.
• Tumor margins: This shares whether the rim of tissue around the tumor contains cancer cells or not. 
• Tumor size (T): This will show how small or large the breast cancer is, usually measured in centimeters or millimeters. 
• Cancer grade (G): This describes the structure of the cancer cells, and is graded from 1 to 3, with Grade 1 being the most like normal breast cells and Grade 3 being very abnormal, fast-growing cancer cells.   

Breast Cancer Staging

Breast cancer staging is the process to determine how much cancer is present in the body, if it has spread and how far. This process indicates how serious the condition is and is used along with other factors to determine treatment options. Staging happens after breast cancer is diagnosed. 

How Breast Cancer Stages Are Determined

Staging can be completed by using the information in the pathology report after biopsy and after surgery. If surgery was not performed or not possible, cancer can be staged based on the results of other tests, including the exam, biopsy, mammogram and other imaging. 

The following pieces of information are used to stage breast cancer:

 

• Cancer grade (G): The grade shows how similar cancer cells are to normal cells. A lower number means the cancer looks more like normal cells, and a higher number means the cancer cells look very different than healthy cells. Cancer can be graded from 1 to 3, or using terms such as: well-differentiated, moderately differentiated and poorly differentiated.
• Estrogen receptor (ER) status: This shows if estrogen receptors are present. The hormone estrogen can attach to these receptors and encourage cancer growth. Knowing receptor status can help in selecting treatments.
• HER2 status: This shows if HER2, a protein that helps cancer grow faster, is present. If HER2 is produced in higher-than-normal levels in the cancer cells, it is HER2-positive.
• Lymph node spread (N): This shows whether the cancer has spread to the lymph nodes and how many are impacted.
• Metastasis (M) (spread) to distant sites: This shows whether the cancer has spread to other organs.
• Progesterone receptor (PR) status: This shows if progesterone receptors are present. The hormone progesterone can attach to these receptors and activate cancer growth. Knowing receptor status can help in selecting treatments.
• Tumor size (T): The size of the tumor, and whether it has spread to other nearby areas of the body.

Breast Cancer Stages

Once these factors are determined and reviewed, the cancer is given a stage from 0 to 4. Breast cancer stages can range from stage 0, considered carcinoma in situ, all the way to stage 4. A higher number stage means that there has been more spread, whereas there may be little spread in lower number stages. There are also letters associated with staging. Letters can indicate severity within a stage; with C being more serious than A, for example.

Why Choose Houston Methodist as Your Cancer Care Provider

Houston Methodist Neal Cancer Center is where innovation meets personalized treatment — offering compassionate, expert breast cancer care. Our dedicated team of specialists employs some of the most advanced, cutting-edge techniques in the country.

At Houston Methodist, you're not just a patient — you're part of a family united in the fight against breast cancer. You can trust our team to provide top-tier medical care and unwavering support every step of the way.