Breast Cancer: Diagnosis
This overview explains our diagnosis process to help you understand what to expect as you go through the early steps of your care.
Because breast cancer is a diverse group of diseases, an accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options for you, in the right sequence.
WHAT TO KNOW ABOUT BREAST CANCER DIAGNOSIS
1Getting Started In Your Care
2Getting Your Diagnosis
Consultation & Testing: What to Expect »
3Planning Your Treatment
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
For everyone who comes to us, we start your care by establishing or confirming a diagnosis.
FIRST Visit
TEST RESULTS
complex Cases
Before your first appointment, we collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
- Our goal is to review them before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
- When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather all of your records. If we cannot obtain them in time, we may need to reschedule your appointment.
- Some types of medical records that you should keep include:
- Your full medical history
- Your family history
- Imaging test results, either on paper or stored on a DVD
- Pathology reports from any biopsies or surgeries
- Operative reports from any surgeries
- Treatment summary for radiation therapy, if you had it
- List of medications, doses, and how long you took them for systemic therapy such as chemotherapy or targeted therapy
- Allergies to medications
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
If needed, you may undergo further imaging tests, blood work, or a biopsy.
After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you.
Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist. Years of experience studying breast cancer every day means your pathologist can accurately identify critical details, such as whether the cancer:
i. Is invasive or noninvasive
ii. Is aggressive or slow growing
iii. The subtype of your breast cancer
Your care team will also determine the stage of breast cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
Stanford breast cancer experts from several specialties meet as a team in weekly tumor boards to review certain complex patients. Based on the diagnosis, we determine our recommendations for the type and sequence of treatment.
Treatment recommendations
The oncologist (either medical, surgical, or radiation) who will begin your first treatment meets with you to discuss the recommended treatment plan. Together, you and your doctor decide on the treatment options that are right for you.
Before your first appointment, we collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
- Our goal is to review them before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
- When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather all of your records. If we cannot obtain them in time, we may need to reschedule your appointment.
- Some types of medical records that you should keep include:
- Your full medical history
- Your family history
- Imaging test results, either on paper or stored on a DVD
- Pathology reports from any biopsies or surgeries
- Operative reports from any surgeries
- Treatment summary for radiation therapy, if you had it
- List of medications, doses, and how long you took them for systemic therapy such as chemotherapy or targeted therapy
- Allergies to medications
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
If needed, you may undergo further imaging tests, blood work, or a biopsy.
close FIRST Visit
After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you.
Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist. Years of experience studying breast cancer every day means your pathologist can accurately identify critical details, such as whether the cancer:
i. Is invasive or noninvasive
ii. Is aggressive or slow growing
iii. The subtype of your breast cancer
Your care team will also determine the stage of breast cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
close TEST RESULTS
Stanford breast cancer experts from several specialties meet as a team in weekly tumor boards to review certain complex patients. Based on the diagnosis, we determine our recommendations for the type and sequence of treatment.
Treatment recommendations
The oncologist (either medical, surgical, or radiation) who will begin your first treatment meets with you to discuss the recommended treatment plan. Together, you and your doctor decide on the treatment options that are right for you.
close complex Cases
At Stanford, we tailor the diagnostic phase of Breast cancer care to each patient. If you need further testing to complete your diagnosis, your doctor and care team will work with you to determine which tests you need. Tests may include:
- Breast Cancer Imaging Tests (Radiology)
To obtain the most precise understanding of your cancer, your doctor may schedule you for different types of imaging that help to diagnose. If you have been screened elsewhere and received abnormal results, we may perform additional imaging, if needed. - Breast Cancer Biopsy (Pathology)
If your imaging or other screening tests show that you may have breast cancer, you will need a biopsy. A biopsy takes a sample of cells from abnormal tissues to establish a diagnosis. - Genetic Testing for Breast and Ovarian Cancer
Genetic testing is a medical test that identifies changes in genes, chromosomes, or proteins. For breast cancer, genetic testing can show whether you have inherited mutations in genes related to the disease and whether you are at risk for other types of cancer. - Breast Cancer Lab Tests (Blood Draws)
Before and during treatment, your doctor will ask you to have your blood drawn and tested at a lab. Blood tests can provide a variety of information, helping to establish your diagnosis, plan your course of breast cancer treatment, and monitor your progress during and after treatment.
Cancer Care Services
Connect you and your loved ones to personalized, supportive services before, during and after your treatment
Learn More About Breast Cancer
What We Offer
Our providers use leading edge techniques to diagnose and treat breast cancer.
About this Condition
Learn about the symptoms, risk factors, types, diagnosis, stages and prevention of breast cancer.
Patient Care Resources
Learn what to expect as you go through the early steps of your care.
At Stanford Health Care, we offer you the most advanced diagnosis and treatment techniques for breast cancer, no matter how common or complex the type. Our center is a major referral center for women and men across the country with breast cancer.
Overview
What is breast cancer?
The breast is made up of a system of lobes (separate parts) and branching tubes that exit at the nipple. Breast cancer develops in the tissues that make up this system. It has many different forms, each with different behavior and treatments.
In general, cancer develops after the genetic material in cells changes and the cells grow out of control. When there are enough of these abnormal cells, they form a tumor that is visible on a mammogram or felt as a lump during a breast exam.
Not all tumors in the breast are cancerous. A biopsy can help your doctor evaluate a tumor that looks suspicious.
How does breast cancer develop?
Many patients wonder why they developed breast cancer or if they are at a high risk for the disease.
Most breast cancers result from the accumulation of random mutations, or mistakes, in genes. Because these mutations increase over time, your risk of developing cancer also increases as you get older.
Only about 5% to 10% of breast cancers are linked to inherited genetic mutations such as BRCA1 and BRCA2. These mutations make it difficult for cells to fix the random mutations that occur over time. Patients who have an inherited mutation are at a much higher risk of developing breast cancer, often at a younger age than the average woman.
Connect to Care
Let us help find personalized care options for you and your family.
Understanding Breast Cancer
Symptoms of Breast Cancer
While screening mammograms detect most breast cancers, self-detection plays an important role in recognizing breast cancer early. Signs and symptoms of breast cancer you can watch out for include:
- A lump or irregular area of firmness
- A lump under the arm, along or above the collarbone, or at your neck
- Changes such as retraction or dimpling in the breast skin, nipple, or areola
- Nipple discharge or bleeding
- Nipple inversion, where the nipple flattens or points inward instead of outward
- Skin inflammation or redness that does not go away
Breast Cancer Risk Factors
Some risk factors for breast cancer fall within your control, while others do not. Having one or more of these factors does not necessarily mean that you will develop breast cancer. Most people who develop the disease have minimal risk factors.
Breast cancer risk factors include:
- Age: Breast cancer risk increases with age, especially in women over 50.
- Gender: Women are much more likely to develop breast cancer than men.
- Breast density: Dense breast tissue makes it harder to detect cancer on mammograms.
- Ethnicity: Women of Ashkenazi Jewish heritage are more likely to have an inherited BRCA gene mutation.
- Exposure to radiation: Radiation exposure to the chest from childhood through early adulthood increases breast cancer risk.
- Family history: Breast cancer risk increases if you have a close relative who had breast cancer.
- History of breast or ovarian cancer: Having cancer in one breast slightly increases the risk of developing a second separate breast cancer. Women with ovarian cancer associated with BRCA1 or BRCA2 genetic mutation have an increased risk of breast cancer.
- Hormone replacement therapy: Taking hormone replacement therapy after menopause increases the risk of developing breast cancer.
- Inherited genetic predisposition: Having specific hereditary genetic mutations, such as a BRCA1 or BRCA2 mutation, increases your risk.
- Lifestyle factors: Factors such as lack of physical activity and overconsumption of alcohol can increase the risk of breast cancer.
- Menstrual history: Women whose periods began before age 12 or who experienced menopause after age 55 are at a higher risk for breast cancer.
- Reproductive history: Women who gave birth to their first child after 30 or have never been pregnant have an increased risk of breast cancer.
Types of Breast Cancer
Breast cancer types are often named for where they start in the breast. Several types of breast cancer exist, including:
- Invasive ductal carcinoma makes up about 80% of all breast cancers. It invades the breast ducts and may spread nearby or to distant parts of the body.
- Invasive lobular carcinoma invades throughout the lobule system of the breast and has the potential to spread nearby or to other parts of the body.
- Invasive inflammatory breast cancer spreads in the breast and skin lymph vessels, causing blockage that leads to fluid buildup. As a result, the skin appears red, dimpled, and swollen
- Invasive metastatic breast cancer means the cancer has spread to other parts of the body. This advanced form of breast cancer is treatable but most often not curable.
- Noninvasive ductal carcinoma (also known as ductal carcinoma in situ) develops only within the milk ducts. If left untreated, it likely evolves into invasive ductal cancer.
- Noninvasive lobular carcinoma (also known as lobular carcinoma in situ) begins in the lobes and increases the risk of developing other breast cancers.
Biological Factors
Invasive breast cancer is characterized based on additional pathology findings. Some of these pathology findings include:
- Cell type (histologic type): This feature is based on the growth pattern of the cancer under the microscope. The vast majority (approximately 80%) of breast cancers are a ductal histologic subtype. About 5-10% of breast cancers are lobular. Lobular cancers are less likely to form a distinct mass and their extent may be harder to identify on mammography. There are other less common special histologic types, like mucinous and tubular carcinomas, that have a particularly slow growth and good prognosis.
- Grade: This feature describes how like or unlike normal tissue the cancer is. A higher grade means it is more aggressive and fast growing, with features that are less like normal breast tissue. A lower grade is usually associated with slower growth. One method of determining grade is the Nottingham system, with a range of grades from 1 (low), to 2 (intermediate) to 3 (high).
- Hormone receptor status: Breast cancers that produce estrogen receptors (ER) and/or progesterone receptors (PR) are considered hormone receptor positive. Approximately 80% of breast cancers are hormone receptor positive. These cancers may require estrogen and/or progesterone to grow so anti-hormone treatments can be very effective treatments for these cancers.
- HER2 status (human epidermal growth factor 2): Between 10-20% of breast cancers have too many copies of the HER2 gene, which results in increased production of the HER2 protein on the cancer cell. This high level of HER2, which is a growth factor receptor, allows the cancer cells to grow very quickly. There are special antibody treatments targeted to the HER2 protein that can be given with chemotherapy to treat this particularly aggressive form of breast cancer.
- Oncotype DX: Special genetic testing performed on early-stage tumors, which predicts a breast cancer recurrence score. This helps your provider to evaluate whether chemotherapy may benefit you.
Breast Cancer Stages
When your care team determines your diagnosis, they also assess what stage of breast cancer you have. Staging helps you and your doctor make decisions about your treatment plan. This information also helps in determining your prognosis, or probable outcome, after treatment based on the experience of others.
The specific stages of breast cancer tumors are:
- TX: A primary tumor cannot be assessed.
- T0: No evidence of a primary tumor.
- Tis: Ductal carcinoma in situ.
- T1a, b, c: The tumor is smaller than 2 centimeters across.
- T2: The tumor is between 2 centimeters and 5 centimeters across.
- T3: The tumor is more than 5 centimeters across.
- T4(metastatic): The tumor of any size has grown beyond the breast to the chest wall or skin. Inflammatory breast cancers are stage T4.
- Recurrent: Breast cancer that has come back after treatment.
Breast Cancer Prevention
While some breast cancer risk factors are out of your control, you can take many other precautions to protect yourself from breast cancer. Take care to:
- Avoid smoking.
- Breastfeed your child if you are able.
- Drink less than one alcoholic drink per day.
- Eat a diet that can help reduce your risk of breast cancer, such as a plant-based diet (learn more about nutrition and breast cancer).
- Limit your radiation exposure, including X-ray imaging and sun exposure.
- Maintain a healthy weight, especially after menopause.
- Stay physically active and exercise regularly.
Diagnosis
Wherever you are in the process, your Stanford Health Care doctor and care team will work closely with you to determine which tests you need to complete your diagnosis. Tests may include:
If your mammogram or other screening tests show an abnormality, you may need a breast biopsy. This procedure takes a tiny sample of cells the abnormal breast tissue.
To obtain the most precise understanding of your cancer, your doctor may schedule different types of breast imaging to diagnose breast cancer. If you have been screened elsewhere and received abnormal results, we may perform additional imaging if needed. If there is a risk the cancer has spread, you may require body-wide imaging to look for distant disease.
Before and during treatment, your doctor may ask you to have your blood drawn and tested at a lab. Blood tests can provide a variety of information to help establish your diagnosis and plan your course of breast cancer treatment.
Genetic testing identifies mutations, or changes, in genes or chromosomes that increase your risk of developing cancer. For breast cancer, genetic testing can show whether you have inherited mutations in genes related to the disease, like BRCA1 or BRCA2.
Complex Cases
Stanford Health Care breast cancer experts from several specialties meet as a team in weekly reviews to discuss cases that require more complex recommendations. Based on your diagnosis, we determine our recommendations for the type and sequence of treatment.
If a doctor or facility outside Stanford Health Care has already given you a diagnosis, our medical team will review your test results. We will then discuss your diagnosis and treatment options with you.
Genetic Counseling for Breast Cancer
Our comprehensive risk assessment can help when breast cancer appears to run in your family. Given that 5-10% of breast cancers likely have hereditary causes, we offer additional steps to protect your health or adjust your treatment. Learn more about our Cancer Genetics Program and cancer risk assessment.
