Breast Cancer Tests
Diagnostic Tests and Screening
Highlights of our screening and diagnosis services include:
- 3-D mammography to better detect and locate breast cancer.
- Genetic screening, testing and counseling for women with high breast cancer risk, including testing for BRCA1 and BRCA2 mutations.
- MRI (magnetic resonance imaging) and ultrasound for people with dense breasts or elevated risk.
- Stereotactic biopsy, which uses computer-assisted imaging to accurately guide the removal of suspicious tissue.
Investigational diagnostic testing, not yet available to the general public, is offered through enrollment in one of our clinical trials.
Many of these tests are conveniently offered at the Women’s Center at our Duarte Campus and at the Lennar Foundation Cancer Center in Orange County. Learn more about breast cancer screening from City of Hope's Laura Kruper, M.D., the co-director of the breast cancer program.
How is Breast Cancer Detected?
Once you notice changes in your breast, or as part of a routine breast screening, your doctor may use the following tests to look for breast cancer:
- Physical exam
- Clinical breast examination
- Mammogram: An X-ray of the breast
- Ultrasound: Imaging the breast using high-energy sound waves
- MRI: Imaging the breast using radio waves, magnetic fields and computer imaging; more powerful and detailed than a mammogram, this test is recommended for women with above-average breast cancer risk
- Biopsy: Surgical removal of suspicious tissues for further examination
- Genetic screening: Women with elevated risk factors (such as a family history of breast cancer) may undergo genetic screening to see if they have mutations that put them at higher risk for developing the disease.
If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:
- Receptor testing: These tests examine the cancerous tissue to see if the growth of the cancer is driven by hormones, estrogen and progesterone, or the growth factor called HER2/neu, or if it is nonresponsive to all three (also known as triple-negative breast cancer). The results can then be used to determine what hormone or drug therapies are most effective against the disease.
- Genetic testing: When a family’s history suggests that an individual may be at high risk for breast cancer, they are often urged to seek counseling about whether to get tested for gene mutations that might further raise the risk for them and other relatives. Tests consist of analyzing a blood or saliva sample for any genetic abnormalities. If abnormalities are detected, a genetic counselor can offer possible next steps, including increased screening, risk-reducing hormonal therapy, or, in some cases, risk-reducing surgery.
- BRCA1 and BRCA 2 - About 5 to 10 percent of breast cancer cases are thought to result from gene defects – or mutations – that are passed down from a parent. The most common and highest-risk types are inherited mutations in the BRCA1 and BRCA2 genes. Usually, these genes help prevent cells from growing abnormally. However, mutated versions of these genes cannot stop abnormal growth, which can lead to cancer. Cancers linked to BRCA1 and BRCA2 mutations are more often found in younger women and in both breasts. There is also a higher risk of developing other cancers, particularly ovarian cancer.
- CT (computed tomography) or CAT scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and number. Special dyes may be used to enhance this scan.
- Lymph node biopsy: Removal and examination of lymph nodes near the breast to see if cancer has spread.
- Axillary lymph node dissection: There are three levels of axillary lymph nodes — the nodes in the underarm or "axilla" area of a woman’s body. In a traditional axillary lymph node dissection, the first two levels of nodes are surgically removed. Once removed, they are dissected and examined to determine whether cancer has spread and to what extent. For women with invasive breast cancer, this procedure accompanies a mastectomy. For those undergoing a lumpectomy, it may be done during or after the procedure.
- Sentinel lymph node biopsy: Another method of determining if cancer has spread to the lymph nodes is a sentinel lymph node biopsy. First, the surgeon identifies the sentinel lymph node (or nodes) closest to the tumor by injecting a dye or radioactive substance into the tissue near the tumor. During surgery, the marked lymph nodes will be removed and checked for the presence of cancer cells.
- Chest X-ray: An X-ray of the chest area to determine the size, location and number of tumors
- Bone scan: A procedure using a small amount of radioactive material to determine if breast cancer cells have spread to the bones
- Positron emission tomography (PET) scan: A test that uses a small amount of radioactive glucose material and a PET scanner to locate cancer cells throughout the body.
Based on the results of these tests, the breast cancer is then staged according to its size, the number of lymph nodes affected and whether it has spread to nearby or distant organs.
Care for Women at High Risk for Breast Cancer
Reasons for being at high risk for breast cancer can include a family history of breast or breast and ovarian cancer, a precancerous biopsy (atypia, ductal carcinoma in situ or lobular carcinoma in situ) or a gene mutation associated with breast and/or ovarian cancer.
At the High Risk Breast Clinic at City of Hope in South Pasadena, people with a familial history of breast cancer can meet with a compassionate team of experts to determine their best options for surveillance and risk reduction. Depending on each person’s family history and risk, we may recommend genetic testing, specialized breast imaging or specific measures of risk reduction like chemoprevention. Patients may also be eligible to participate in clinical trials involving breast cancer prevention.
Geriatric Breast Cancer Care
A diagnosis of cancer is difficult at any age, but older patients face unique challenges, including increased risk of drug reactions and the presence of additional health conditions. Serious health conditions that are more common in adults over 65 and factor into cancer care include high blood pressure, heart disease, lung disease, diabetes, kidney disease and arthritis. These chronic health problems may affect or be affected by breast cancer treatment in the following ways: reactions between cancer drugs and other medications; cancer or cancer treatment making chronic health problems worse; chronic health problems interrupting cancer treatment or forcing a change in cancer treatment; and slower recovery from cancer treatment due to another health problem.
City of Hope has developed a questionnaire that assesses older patients’ functional age so that cancer-treatment recommendations can be tailored to each individual. In addition to consulting with doctors, pharmacists and other medical professionals while receiving cancer treatments, older patients should seek support from family members and social service agencies when needed to help manage cancer care, other medical conditions and activities of daily living.
Young Adult Breast Cancer Care
While most breast cancers are found in women age 50 or older, according to the Centers for Disease Control about 11 percent of all new cases of breast cancer in the United States are found in women younger than 45 years of age. Younger women may be at higher risk for the disease if they have close relatives who were diagnosed with breast or ovarian cancer (particularly at age 45 or younger), have changes in certain breast cancer genes (BRCA1 and BRCA2), are of Ashkenazi Jewish heritage, were treated with radiation therapy to the breast or chest in childhood or early adulthood, or previously have had breast cancer or other breast health problems.
Diagnosing breast cancer in women under 40 years -old is often more difficult because their breast tissue is generally more dense than that of older women. The disease may also be more aggressive in younger women, and therefore difficult to treat. Women who are diagnosed with breast cancer at a younger age are more likely to have an altered BRCA1 or BRCA2 gene.
Younger women who have breast cancer can face additional challenges, including issues related to sexuality, fertility and pregnancy after breast cancer treatment. As with older women, treatment is based on the extent of the person's disease, the woman's general health and personal circumstances.
Who Should get Screened for Breast Cancer?
The current American Cancer Society screening recommendations for women with average breast cancer risk are:
- Women between ages 40 to 44 should consider beginning annual mammograms.
- Women between ages 45 to 54 should get annual mammograms.
- Women age 55 or older should switch to mammograms every two years, or have the choice to continue annual screening.
For women with high breast cancer risk, the American Cancer Society recommends:
- Beginning annual screening mammograms at an earlier age
- Screening with MRI in addition to annual mammograms