What Is Breast Cancer?

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to
understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the
growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the
“control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly
process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can
“turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing
without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous).
Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow
slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors
are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other
parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast.
Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or
the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can
begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Breast profile:
A Ducts
B Lobules
C Dilated section of duct to hold milk
D Nipple
E Fat
F Pectoralis major muscle
G Chest wall/rib cage
Enlargement
A Normal duct cells
B Basement membrane
C Lumen (center of duct)

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic

material). However, only 5-10% of cancers are due to an abnormality inherited from
your mother or father. About 90% of breast cancers are due to genetic abnormalities
that happen as a result of the aging process and the “wear and tear” of life in general.

While there are steps every person can take to help the body stay as healthy as
possible (such as eating a balanced diet, not smoking, limiting alcohol, and exercising
regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that
breast cancer happened because of something you or anyone else did, is not
productive

Stages of Breast Cancer

Stage Definition

Stage Cancer cells remain inside the breast duct, without invasion into normal adjacent
0 breast tissue.

Stage I Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are
clear).

Stage No tumor can be found in the breast, but cancer cells are found in the axillary
IIA lymph nodes (the lymph nodes under the arm) 
OR 
the tumor measures 2 centimeters or smaller and has spread to the axillary lymph
nodes 
OR 
the tumor is larger than 2 but no larger than 5 centimeters and has not spread to
the axillary lymph nodes.

Stage The tumor is larger than 2 but no larger than 5 centimeters and has spread to the
IIB axillary lymph nodes 
OR 
the tumor is larger than 5 centimeters but has not spread to the axillary lymph
nodes.

Stage No tumor is found in the breast. Cancer is found in axillary lymph nodes that are
IIIA sticking together or to other structures, or cancer may be found in lymph nodes
near the breastbone 
OR 
the tumor is any size. Cancer has spread to the axillary lymph nodes, which are
sticking together or to other structures, or cancer may be found in lymph nodes
 near the breastbone.

Stage The tumor may be any size and has spread to the chest wall and/or skin of the
IIIB breast 
AND 
may have spread to axillary lymph nodes that are clumped together or sticking to
other structures, or cancer may have spread to lymph nodes near the breastbone. 

Inflammatory breast cancer is considered at least stage IIIB.

Stage There may either be no sign of cancer in the breast or a tumor may be any size and
IIIC may have spread to the chest wall and/or the skin of the breast 
AND 
the cancer has spread to lymph nodes either above or below the collarbone 
AND 
the cancer may have spread to axillary lymph nodes or to lymph nodes near the
breastbone.

Stage The cancer has spread — or metastasized — to other parts of the body.
IV

Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive,
whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

The purpose of the staging system is to help organize the different factors and some of the
personality features of the cancer into categories, in order to:

best understand your prognosis (the most likely outcome of the disease)

guide treatment decisions (together with other parts of your pathology report), since clinical
studies of breast cancer treatments that you and your doctor will consider are partly organized
by the staging system

provide a common way to describe the extent of breast cancer for doctors and nurses all over
the world, so that results of your treatment can be compared and understood
Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there
is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the
breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading
neighboring normal tissue) in which:

the tumor measures up to 2 centimeters, AND

no lymph nodes are involved

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the
lymph nodes under the arm), OR

the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR

the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to
the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph
nodes, OR

the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes
Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped
together or sticking to other structures, or cancer may have spread to lymph nodes near the
breastbone, OR

the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped
together or sticking to other structures, OR

the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped
together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

the tumor may be any size and has spread to the chest wall and/or skin of the breast AND

may have spread to axillary lymph nodes that are clumped together or sticking to other
structures, or cancer may have spread to lymph nodes near the breastbone

Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer in which:

there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may
have spread to the chest wall and/or the skin of the breast, AND

the cancer has spread to lymph nodes above or below the collarbone, AND

the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer in which:

the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and
nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this
is that the primary breast cancer was not found when it was only inside the breast. Metastatic
cancer is considered stage IV.

Additional staging information

You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast
cancer. Although these terms are not medically precise (they may be used differently by
different doctors), here is a general idea of how they apply to the official staging system:

Early stage

Stage 0

Stage I

Stage II

Some stage III

Later or advanced stage

Other stage III

Stage IV

Doctors use a staging system to determine how far a cancer has spread. The most common
system is the TNM staging system. You may hear the cancer described by three characteristics:

size (T stands for tumor)

lymph node involvement (N stands for node)

whether it has metastasized (M stands for metastasis)

The T (size) category describes the original (primary) tumor:

TX means the tumor can't be measured or found.

T0 means there isn't any evidence of the primary tumor.

Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).

The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast
tissue. The higher the T number, the larger the tumor and/or the more it may have grown into
the breast tissue.

The N (node involvement) category describes whether or not the cancer has reached nearby
lymph nodes:

NX means the nearby lymph nodes can't be measured or found.

N0 means nearby lymph nodes do not contain cancer.

The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved.
The higher the N number, the more the lymph nodes are involved.

The M (metastasis) category tells whether there are distant metastases (whether the cancer
has spread to other parts of body):

MX means metastasis can't be measured or found.

M0 means there are no distant metastases.

M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined in a process
called stage grouping, and an overall stage is assigned.

For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:
is less than 2 centimeters across (T1)

does not have lymph node involvement (N0)

has not spread to distant parts of the body (M0)

This cancer would be grouped as a stage I cancer.

Risk of Developing Breast Cancer

The term “risk” is used to refer to a number or percentage that describes how likely a certain
event is to occur. When we talk about factors that can increase or decrease the risk of
developing breast cancer, either for the first time or as a recurrence, we often talk about two
different types of risk: absolute risk and relative risk.

Absolute risk

Absolute risk is used to describe an individual’s likelihood of developing breast cancer. It is

based on the number of people who will develop breast cancer within a certain time period.
Absolute risk also can be stated as a percentage.

When we say that 1 in 8 women in the United States, or 12.7%, will develop breast cancer over
the course of a lifetime, we are talking about absolute risk. On average, an individual woman
has a 1-in-8 chance of developing breast cancer over an 80-year lifespan.

The absolute risk of developing breast cancer during a particular decade of life is lower than 1
in 8. The younger you are, the lower the risk.

As you can see, the older you are, the higher your absolute risk of breast cancer. Keep in mind
that these numbers and percentages are averages for the whole population. Your individual
breast cancer risk may be higher or lower, depending on a number of factors, including family
history, reproductive history (such as menstrual and childbearing history), race/ethnicity, and
other factors.
Take family history, for example. The absolute risk of breast cancer is much higher for women
who have inherited mutations in the genes

Relative risk

Relative risk is a number or percentage that compares one group’s risk of developing breast
cancer to another’s. This is the type of risk frequently reported by research studies, which often
compare groups of women with different characteristics or behaviors to determine whether
one group has a higher or lower risk of breast cancer than the other (either as a first-time
diagnosis or recurrence).

Example of breast cancer risk going up

Many studies have shown that women who have two or more alcoholic drinks each day have a
higher risk of developing breast cancer.

Breast Cancer Risk Factors

A “risk factor” is anything that increases your risk of developing breast cancer. Many of the
most important risk factors for breast cancer are beyond your control, such as age, family
history, and medical history.

Risk factors you can control

Weight. Being overweight is associated with increased risk of breast cancer, especially for
women after menopause. Fat tissue is the body’s main source of estrogen after menopause,
when the ovaries stop producing the hormone. Having more fat tissue means having higher
estrogen levels, which can increase breast cancer risk.

Diet. Diet is a suspected risk factor for many types of cancer, including breast cancer, but
studies have yet to show for sure which types of foods increase risk. It’s a good idea to restrict
sources of red meat and other animal fats (including dairy fat in cheese, milk, and ice cream),
because they may contain hormones, other growth factors, antibiotics, and pesticides. Some
researchers believe that eating too much cholesterol and other fats are risk factors for cancer,
and studies show that eating a lot of red and/or processed meats is associated with a higher
risk of breast cancer. A low-fat diet rich in fruits and vegetables is generally recommended. For
more information, visit our page on healthy eating to reduce cancer risk in the Nutrition
section.
Exercise. Evidence is growing that exercise can reduce breast cancer risk. The American Cancer
Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week.

Alcohol consumption. Studies have shown that breast cancer risk increases with the amount of
alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the
hormone estrogen, which in turn can increase risk.

Smoking. Smoking is associated with a small increase in breast cancer risk.

Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth,
exposure to estrogen over long periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are under your control, such as:

taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several
years or more, or taking estrogen alone for more than 10 years

being overweight

regularly drinking alcohol

Recent oral contraceptive use. Using oral contraceptives (birth control pills) appears to slightly
increase a woman’s risk for breast cancer, but only for a limited period of time. Women who
stopped using oral contraceptives more than 10 years ago do not appear to have any increased
breast cancer risk.

Stress and anxiety. There is no clear proof that stress and anxiety can increase breast cancer
risk. However, anything you can do to reduce your stress and to enhance your comfort, joy, and
satisfaction can have a major effect on your quality of life. So-called “mindful measures” (such
as meditation, yoga, visualization exercises, and prayer) may be valuable additions to your daily
or weekly routine. Some research suggests that these practices can strengthen the immune
system.
Risk factors you can’t control

Gender. Being a woman is the most significant risk factor for developing breast cancer.
Although men can get breast cancer, too, women’s breast cells are constantly changing and
growing, mainly due to the activity of the female hormones estrogen and progesterone. This
activity puts them at much greater risk for breast cancer.

Age. Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39,
the risk is 1 in 233, or .43%. That jumps to 1 in 27, or almost 4%, by the time you are in your
60s.

Family history of breast cancer. If you have a first-degree relative (mother, daughter, sister)
who has had breast cancer, or you have multiple relatives affected by breast or ovarian cancer
(especially before they turned age 50), you could be at higher risk of getting breast cancer.

Personal history of breast cancer. If you have already been diagnosed with breast cancer, your
risk of developing it again, either in the same breast or the other breast, is higher than if you
never had the disease.

Race. White women are slightly more likely to develop breast cancer than are African American
women. Asian, Hispanic, and Native American women have a lower risk of developing and dying
from breast cancer.

Radiation therapy to the chest. Having radiation therapy to the chest area as a child or young
adult as treatment for another cancer significantly increases breast cancer risk. The increase in
risk seems to be highest if the radiation was given while the breasts were still developing
(during the teen years).

Breast cellular changes. Unusual changes in breast cells found during a breast biopsy (removal
of suspicious tissue for examination under a microscope) can be a risk factor for developing
breast cancer. These changes include overgrowth of cells (called hyperplasia) or abnormal
(atypical) appearance.

Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth,
exposure to estrogen over long periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are not under your control, such as:

starting menstruation (monthly periods) at a young age (before age 12)

going through menopause (end of monthly cycles) at a late age (after 55)

exposure to estrogens in the environment (such as hormones in meat or pesticides such as

DDT, which produce estrogen-like substances when broken down by the body)

Pregnancy and breastfeeding. Pregnancy and breastfeeding reduce the overall number of
menstrual cycles in a woman’s lifetime, and this appears to reduce future breast cancer risk.
Women who have never had a full-term pregnancy, or had their first full-term pregnancy after
age 30, have an increased risk of breast cancer. For women who do have children,
breastfeeding may slightly lower their breast cancer risk, especially if they continue
breastfeeding for 1 1/2 to 2 years. For many women, however, breastfeeding for this long is
neither possible nor practical.

DES exposure. Women who took a medication called diethylstilbestrol (DES), used to prevent
miscarriage from the 1940s through the 1960s, have a slightly increased risk of breast cancer.
Women whose mothers took DES during pregnancy may have a higher risk of breast cancer as
well.

Myths About Breast Cancer Risk

Here are ten common myths about breast cancer, followed by myths about specific types of
breast cancer treatment.

Breast cancer only affects older women.

No. While it's true that the risk of breast cancer increases as we grow older, breast cancer can
occur at any age. From birth to age 39, one woman in 231 will get breast cancer (<0.5% risk);
from age 40–59, the risk is one in 25 (4% risk); from age 60–79, the risk is one in 15 (nearly 7%).
Assuming you live to age 90, the risk of getting breast cancer over the course of an entire
lifetime is one in 7, with an overall lifetime risk of 14.3%.

If you have a risk factor for breast cancer, you're likely to get the disease.

No. Getting breast cancer is not a certainty, even if you have one of the stronger risk factors,
like a breast cancer gene abnormality. Of women with a BRCA1 or BRCA2 inherited genetic
abnormality, 40–80% will develop breast cancer over their lifetime; 20–60% won't. All other risk
factors are associated with a much lower probability of being diagnosed with breast cancer.

If breast cancer doesn't run in your family, you won't get it.

No. Every woman has some risk of breast cancer. About 80% of women who get breast cancer
have no known family history of the disease. Increasing age – just the wear and tear of living –
is the biggest single risk factor for breast cancer. For those women who do have a family history
of breast cancer, your risk may be elevated a little, a lot, or not at all. If you are concerned,
discuss your family history with your physician or a genetic counselor. You may be worrying
needlessly.

Only your mother's family history of breast cancer can affect your risk.

No. A history of breast cancer in your mother's OR your father's family will influence your risk
equally. That's because half of your genes come from your mother, half from your father. But a
man with a breast cancer gene abnormality is less likely to develop breast cancer than a woman
with a similar gene. So, if you want to learn more about your father's family history, you have to
look mainly at the women on your father's side, not just the men.

Using antiperspirants causes breast cancer.

No. There is no evidence that the active ingredient in antiperspirants, or reducing perspiration
from the underarm area, influences breast cancer risk. The supposed link between breast
cancer and antiperspirants is based on misinformation about anatomy and a misunderstanding
of breast cancer.

More on antiperspirants and breast cancer

Birth control pills cause breast cancer.

No. Modern day birth control pills contain a low dose of the hormones estrogen and
progesterone. Many research studies show no association between birth control pills and an
increased risk of breast cancer. However, one study that combined the results of many different
studies did show an association between birth control pills and a very small increase in risk. The
study also showed that this slight increase in risk decreased over time. So after 10 years, birth
control pills were not associated with an increase in risk. Birth control pills also have benefits:

decreasing ovarian and endometrial cancer risk

relieving menstrual disorders, pelvic inflammatory disease, and ovarian, and cysts

improving bone mineral density

As with any medicine, you have to weigh the risks and benefits and decide what is best for YOU.

Eating high-fat foods causes breast cancer.

No. Several large studies have not been able to demonstrate a clear connection between eating
high-fat foods and a higher risk of breast cancer. Ongoing studies are attempting to clarify this
issue further. We can say that avoidance of high-fat foods is a healthy choice for other reasons:
to lower the "bad" cholesterol (low-density lipoproteins), increase the "good" cholesterol (high-
density lipoproteins); to make more room your diet for healthier foods, and to help you control
your weight. Excess body weight, IS a risk factor for breast cancer, because the extra fat
increases the production of estrogen outside the ovaries and adds to the overall level of
estrogen in the body. If you are already overweight, or have a tendency to gain weight easily,
avoiding high-fat foods is a good idea.

A monthly breast self-exam is the best way to diagnose breast cancer.

No. Digital mammography or high quality film-screen mammography is the most reliable way to
find breast cancer as early as possible, when it is most curable. By the time a breast cancer can
be felt, it is usually bigger than the average size of a cancer first found on mammography.
Breast examination by you or your healthcare provider is still very important. About 25% of
breast cancers are found only on breast examination (not on the mammogram), about 35% are
found on mammography alone, and 40% are found by both physical exam and mammography.
Keep both bases covered.

I'm at high risk for breast cancer and there's nothing I can do about it.

No. There are several effective ways to reduce—but not eliminate—the risk of breast cancer in
women at high risk. Options include lifestyle changes (minimize alcohol consumption, stop
smoking, exercise regularly), medication (tamoxifen, also called Nolvadex); and in cases of very
high risk, surgery may be offered (prophylactic mastectomies, and for some women,
prophylactic ovary removal). Be sure that you have consulted with a physician or genetic
counselor before you make assumptions about your level of risk.

A breast cancer diagnosis is an automatic death sentence.

No. Fully 80% of women diagnosed with breast cancer have no signs of metastases (no cancer
has spread beyond the breast and nearby lymph nodes). Furthermore, 80% of these women live
at least five years, most longer, and many live much longer. Even women with signs of cancer
metastases can live a long time. Plus promising treatment breakthroughs are becoming
available each day.

Screening and Testing

Most breast-cancer-related tests fall into one or more of the following categories:

 Screening tests: Screening tests (such as yearly mammograms) are given

routinely to people who appear to be healthy and are not suspected of having
breast cancer. Their purpose is to find breast cancer early, before any symptoms
can develop and the cancer usually is easier to treat.

 Diagnostic tests: Diagnostic tests (such as biopsy) are given to people who are
suspected of having breast cancer, either because of symptoms they may be
experiencing or a screening test result. These tests are used to determine whether
or not breast cancer is present and, if so, whether or not it has traveled outside the
breast. Diagnostic tests also are used to gather more information about the cancer
to guide decisions about treatment.

 Monitoring tests: Once breast cancer is diagnosed, many tests are used during
and after treatment to monitor how well therapies are working. Monitoring tests
also may be used to check for any signs of recurrence.

Biopsy
A biopsy is a small operation done to remove tissue from an area of concern in the body

he tissue sample is examined by a pathologist

(a doctor who specializes in diagnosing
disease) to see whether or not cancer cells are
present. If cancer is present, the pathologist
can then look at the cancer’s characteristics.
The biopsy will result in a report that lays out
all of the pathologist’s findings.

Biopsy techniques
Different techniques can be used to perform
biopsy, and it’s likely that your surgeon will try
to use the least invasive procedure possible —
the one that involves the smallest incision and
the least amount of scarring. However, the
choice of procedure really depends on your
individual situation. Biopsy can be done by
placing a needle through the skin into the
breast to remove the tissue sample. Or, it can
involve a minor surgical procedure, in which
the surgeon cuts through the skin to remove
some or all of the suspicious tissue.

Fine needle aspiration biopsy

Fine needle aspiration (FNA) is the least
invasive method of biopsy and it usually leaves
no scar. You will be lying down for this
procedure. First, an injection of local
anesthesia is given to numb the breast. The
surgeon or radiologist uses a thin needle with
a hollow center to remove a sample of cells
from the suspicious area. In most cases, he or
she can feel the lump and guide the needle to
the right place.

In cases where the lump cannot be felt, the

surgeon or radiologist may need to use
imaging studies to guide the needle to the right
location. This is called ultrasound-guided
biopsy when ultrasound is used, or stereotactic
needle biopsy when mammogram is used.
With ultrasound-guided biopsy, the doctor will
watch the needle on the ultrasound monitor to
guide it to the area of concern. With
stereotactic mammography, mammograms are
taken from different angles to pinpoint the
location of the breast mass. The doctor then
inserts the hollow needle to remove the cell
sample.
Core needle biopsy
Core needle biopsy uses a larger hollow
needle than fine needle aspiration does. If you
have this type of biopsy, you’ll be lying down.
After numbing the breast with local anesthesia,
the surgeon or radiologist uses the hollow
needle to remove several cylinder-shaped
samples of tissue from the suspicious area. In
most cases, the needle is inserted about 3 to 6
times so that the doctor can get enough
samples. Usually core needle biopsy does not
leave a scar.

If the lesion cannot be felt through the skin, the

surgeon or radiologist can use an image-
guided technique such as ultrasound-guided
biopsy or stereotactic needle biopsy. A small
metal clip may be inserted into the breast to
mark the site of biopsy in case the tissue
proves to be cancerous and additional surgery
is required. This clip is left inside the breast
and is not harmful to the body. If the biopsy
leads to more surgery, the clip will be removed
at that time.
In addition to offering quick results without
significant discomfort and scarring, both fine
needle aspiration and core needle biopsy give
you the opportunity to discuss treatment
options with your doctor before having any
surgery. In some cases, needle biopsy can be
performed right in the doctor’s office, unless
your doctor needs the help of imaging
equipment to guide the biopsy. However,
needle biopsy has a higher risk of a “false
negative” result — a result suggesting that
cancer is not present when it really is. This is
likely because needle biopsy removes a
smaller amount of tissue than surgical biopsy
does and may not pick up the cancer cells.
Your doctor may recommend a surgical biopsy
in follow up to, or instead of, a needle biopsy.
Together you can decide what is best for your
situation.

Vacuum-assisted breast biopsy

Vacuum-assisted breast biopsy, also known by
the brand names Mammotome or MIBB (which
stands for Minimally Invasive Breast Biopsy),
is a newer way of performing breast biopsy.
Unlike core needle biopsy, which involves
several insertions of a needle through the skin,
vacuum-assisted biopsy uses a special probe
that only has to be inserted once. The
procedure also is able to remove more tissue
than core needle biopsy does.

For vacuum-assisted breast biopsy, you’ll lie

face down on an exam table with special round
openings in it, where you place your breasts.
First, an injection of local anesthesia is given
to numb the breast. Guided by mammography
(stereotactic-guided biopsy) or ultrasound, the
surgeon or radiologist places the probe into
the suspicious area of the breast. A vacuum
then draws the tissue into the probe. A rotating
cutting device removes a tissue sample and
then carries it through the probe into a
collection area. The surgeon or radiologist can
then rotate the probe to take another sample
from the suspicious lesion. This can be
repeated 8 to 10 times so that the entire area
of concern is thoroughly sampled.
In some cases, a small metal clip is placed into
the biopsy site to mark the location, in case a
future biopsy is needed. This clip is left inside
the breast and causes no pain or harm. If the
biopsy leads to more surgery, the clip will be
removed at that time.

Vacuum-assisted biopsy is becoming more

common, but it is still a relatively new
procedure. If you are having this form of
biopsy, make sure that the surgeon or
radiologist is experienced at using the
equipment.

Incisional biopsy
Incisional biopsy is more like regular surgery.
After using local anesthesia to numb the
breast and giving you an injection to make you
drowsy, the surgeon uses a scalpel to cut
through the skin to remove a piece of the
tissue for examination.

As with needle biopsy, if the surgeon cannot

feel the lump or suspicious area, he or she
may need to use mammography or ultrasound
to find the right spot. Your surgeon also may
use a procedure called needle wire
localization. Guided by either mammography
or ultrasound, the surgeon inserts a small
hollow needle through the breast skin into the
abnormal area. A small wire is placed through
the needle and into the area of concern. Then
the needle is removed. The doctor can use the
wire as a guide in finding the right spot for
biopsy.

Your doctor may recommend incisional biopsy

if a needle biopsy is inconclusive — that is, the
results are unclear or not definite — or if the
suspicious area is too large to sample easily
with a needle. As with needle biopsy, there is
some possibility that incisional biopsy can
return a false negative result. However, you do
get the results fairly quickly. Given that it is a
surgical procedure, incisional biopsy is more
invasive than needle biopsy, it leaves a scar,
and it may require more time to recover.
Excisional biopsy
Excisional biopsy, the most involved form of
biopsy, is surgery to remove the entire area of
suspicious tissue from the breast. In addition
to removing the suspected cancer, the
surgeon generally will remove a small rim of
normal tissue around it as well, called a
margin.

As with incisional biopsy, if the surgeon cannot

feel the lump or suspicious area, he or she
may need to use mammography or ultrasound
to find the right spot. Your surgeon also may
use needle wire localization to mark the right
area for biopsy.

Excisional biopsy is the surest way to establish

a definite diagnosis without getting a false
negative result. Also, having the entire lump
removed may provide you with some peace of
mind. However, excisional biopsy is more like
regular surgery, and it will leave a scar and
require more time to recover. Like incisional
biopsy, excisional biopsy is performed with
local anesthesia.
Breast MRI (Magnetic
Resonance Imaging)
MRI, or magnetic resonance imaging, is a
technology that uses magnets and radio
waves to produce detailed cross-sectional
images of the inside of the body. MRI does not
use x-rays, so it does not involve any radiation
exposure. Breast MRI has a number of
different uses for breast cancer, including:

 screening high-risk women (women known

to be at higher than average risk for breast
cancer, either because of a strong family
history or a gene abnormality)

 gathering more information about an area

of suspicion found on a mammogram or
ultrasound

 monitoring for recurrence after treatment

 Unlike a mammogram, which uses x-rays

to create images of the breast, breast MRI
 uses magnets and radio waves to produce
detailed 3-dimensional images of the
breast tissue. Before the test, you may
need to have a contrast solution (dye)
injected into your arm through an
intravenous line. Because the dye can
affect the kidneys, your doctor may
perform kidney function tests before giving
you the contrast solution. The solution will
help any potentially cancerous breast
tissue show up more clearly. Some people
experience temporary discomfort during
the infusion of the contrast solution.
 Cancers need to increase their blood
supply in order to grow. On a breast MRI,
the contrast tends to become more
concentrated in areas of cancer growth,
showing up as white areas on an otherwise
dark background. This helps the radiologist
determine which areas could possibly be
cancerous. More tests may be needed
after breast MRI to confirm whether or not
any suspicious areas are actually cancer.
 or the breast MRI, you will need to pull
down your hospital gown to your waist or
open it in front to expose your breasts.
Then you lie on your stomach on a padded
platform with cushioned openings for your
breasts. Each opening is surrounded by a
breast coil, which is a signal receiver that
works with the MRI unit to create the
images. The platform then slides into the
center of the tube-shaped MRI machine.
You won’t feel the magnetic field and radio
waves around you, but you will hear a loud
thumping sound. You will need to be very
still during the test, which takes around 30
to 45 minutes. If you’re claustrophobic,
being confined within an MRI machine for a
long period of time can be difficult. Some
facilities have an open MRI machine to
avoid this problem, or you may be given a
mild sedative.
 Because the technology uses strong
magnets, it is essential that you remove
anything metal — jewelry, snaps, belts,
earrings, zippers, etc. — before the test.
 The technologist also will ask you if you
have any metal implanted in your body,
such as a pacemaker or artificial joint.

Chest X-Rays
Before beginning treatment for invasive breast
cancer, you likely will have a chest x-ray to
check and see whether the cancer has spread
to the lungs. The test also may be used to
assess the heart and lungs before you receive
general anesthesia or chemotherapy.

During treatment for breast cancer, chest x-

rays may be used in the following situations:

 If a person has advanced breast cancer

that has spread to the lungs, a chest x-ray
is used to check on how the disease is
responding to treatment.

 For people who develop a fever during

chemotherapy, chest x-rays are used to
check for the presence of pneumonia.
  If a person experiences new shortness of
breath in the first few months after radiation
therapy, with or without a cough, her doctor
may order a chest x-ray to see if the
radiation caused any inflammation of the
lungs.

Mammograms
Mammograms are probably the most important
tool doctors have not only to screen for breast
cancer, but also to diagnose, evaluate, and
follow people who’ve had breast cancer. Safe
and reasonably accurate, a mammogram is an
x-ray photograph of the breast. The technique
has been in use for about 40 years.

Screening mammograms are typically done

every year to check the breasts for any early
signs of breast cancer. Diagnostic
mammograms are different from screening
mammograms in that they focus on getting
more information about a specific area (or
areas) of concern — usually due to a
suspicious screening mammogram or a
suspicious lump. Diagnostic mammograms
take more pictures than screening
mammograms do. A mammography technician
and a radiologist would coordinate to get the
images your doctor needs to address that
concern. The technician may need to magnify
a suspicious area to produce a more detailed
picture that will help your doctor make the
diagnosis.

Ultrasound
Ultrasound is an imaging test that sends high-
frequency sound waves through your breast
and converts them into images on a viewing
screen. The ultrasound technician places a
sound-emitting probe on the breast to conduct
the test. There is no radiation involved.

Ultrasound is not used on its own as a

screening test for breast cancer. Rather, it is
used to complement other screening tests. If
an abnormality is seen on mammography or
felt by physical exam, ultrasound is the best
way to find out if the abnormality is solid (such
as a benign fibroadenoma or cancer) or fluid-
filled (such as a benign cyst). It cannot
determine whether a solid lump is cancerous,
nor can it detect calcifications.

f you’re under age 30, your doctor may

recommend ultrasound before mammography
to evaluate a palpable breast lump (a breast
lump that can be felt through the skin).
Mammograms can be difficult to interpret in
young women because their breasts tend to be
dense and full of milk glands. (Older women’s
breasts tend to be more fatty and are easier to
evaluate.) In mammograms, this glandular
tissue looks dense and white — much like a
cancerous tumor. Some doctors say that
locating an abnormality in the midst of dense
gland tissue can be like finding a polar bear in
a snowstorm. Most breast lumps in young
women are benign cysts, or clumps of normal
glandular tissue.
Doctors also can use ultrasound to guide
biopsy needles precisely to suspicious areas in
the breast.