Mammography is a diagnostic screening method that uses x-rays to detect suspicious lumps. Digital mammography involves digitally coding x-ray images into a computer while 3-D mammography produces a clear 3-D image of the breast tissue. Mammograms are typically recommended every 1-2 years as early as age 40. Mammography screenings may be done earlier if the woman has a family history, genetic link, or previous diagnosis of breast cancer. The comparison of previous and current mammograms may reveal early changes in breast tissue.
Ultrasound is a diagnostic tool that determines whether the mass detected via mammography is cystic or solid. Ultrasound is also used to locate a suspicious lesion for biopsy.
Women with increased risk of breast cancer may have an MRI done to determine breast tissue abnormalities not visible via mammography.
Tissue biopsy is a definitive tool for diagnosing breast cancer. Although surgical biopsy may be done to remove a breast mass or lump for analysis, less invasive techniques are more commonly performed. After locally anesthetizing the breast area, a needle is inserted into the breast tissue to extract cells for further examination. A larger tumor size indicates a poorer prognosis of breast cancer. Cells collected from biopsy that are poorly differentiated suggest a more aggressive cancer.
Since breast cancer may spread to lymph nodes, examining the axilla is important to determine if the cancer has spread. Increased lymph node involvement raises the risk of reoccurrence. Diagnostic tests to determine lymph node involvement include lymphatic mapping and sentinel lymph node dissection (SLND). During an SLND, a dye is injected in the affected breast to determine which lymph nodes are involved and may be removed.
Determining receptor positivity, or what receptors are expressed on the surface of cancer cells, is helpful in determining breast cancer treatment and prognosis. Using diagnostic testing to find out the presence of estrogen, progesterone, and HER-2 receptors helps determine appropriate drug therapy and sequence.
Estrogen and progesterone are hormones that affect the growth of breast cancer cells. Receptor-positive tumors express receptors for these hormones, and are well differentiated, have more normal DNA material, have a lower risk of recurrence, and are more responsive to hormone therapy. Receptor-negative tumors are poorly differentiated, have more abnormal DNA content, have higher recurrence risks, and unresponsive to hormone therapy.
In patients with breast cancer, overexpression of the HER-2 receptor is related to aggressive tumor growth, increased risk of recurrence, and a poorer prognosis. By using diagnostic testing to determine the increased number of HER-2 receptors, appropriate drug therapy selection can be initiated. Trastuzumab is a monoclonal antibody against this receptor which is useful in treating these types of cancers.
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