Breast Cancer Tests


At City of Hope, our state-of-the art breast imaging technologies and laboratory techniques allow our cancer care team to accurate diagnose and successfully treat breast cancer. Your doctor may use tests look for breast cancer after a routine screening, such as a mammogram, or if you have noticed changes in your breast or are experiencing breast pain. An integral part of diagnosing breast cancer begins with your doctor asking questions about your health history and family medical history, your symptoms and your risk factors.

Screening for Breast Cancer

Regular screening is one of the best ways to find breast cancer early. Early detection can make treatment easier and more effective. 

Who Should Be Screened?

According to the current screening recommendations for women with an average breast cancer risk:

  • Women aged 40 to 44 should consider beginning annual mammograms.
  • Women aged 45 to 54 should get annual mammograms.
  • Women aged 55 or older can switch to mammograms every two years or continue annual screenings.

Women with high breast cancer risk should:

  • Begin annual mammograms at age 30.
  • Have magnetic resonance imaging (MRI) screenings in addition to annual mammograms.
Reasons for being at a high risk for breast cancer can include a family history of breast or breast and ovarian cancer, a precancerous biopsy or a gene mutation associated with breast and/or ovarian cancer. 

High-Risk Breast Clinic

If you think you may be a high-risk patient, the High-Risk Breast Clinic at City of Hope South Pasadena can help. Our team of physicians, nurse practitioners and certified genetic counselors are available to talk about risk reduction and surveillance, based on your family history and other risk factors. The clinic offers access to genetic testing, specialized breast imaging and targeted risk reduction methods like chemoprevention. Patients may also be eligible to participate in clinical trials involving breast cancer prevention. For more information, call us at (626) 316-1434

Diagnostic Tests and Tools for Breast Cancer

There are many different tests and screening procedures to help diagnose breast cancer.

  • Physical exam
  • Clinical breast examination
  • Mammogram: An X-ray to learn more about changes to the breast, which may include pain, a lump, nipple discharge or thickening or change in shape or size.
  • Ultrasound: Imaging the breast using high-energy soundwaves. This exam is often used alongside a mammogram.
  • Magnetic resonance imaging (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
  • Nipple discharge exam: Fluid may be collected from nipple discharge and analyzed in the lab. Most nipple secretions are not cancer. An injury, infection or benign (non-cancerous) tumor may cause discharge.
  • Genetic screening: Women with elevated risk (such as a family history of breast cancer) may undergo genetic screening to see if they have mutations that put them at higher risk of developing the disease.
  • Biopsy: A surgical removal of suspicious tissues for examination. The type of biopsy done will depend on the location and size of the breast lump or change.
    • Fine needle aspiration biopsy uses a very thin needle to remove a small sample of fluid or tissue from a lump. It can help tell whether the lump is solid or a cyst (a fluid-filled sac that’s usually not cancer).
    • Core needle biopsy uses a large needle to remove small cylinders of tissue (cores), without needing an incision.
    • Surgical biopsy, also called an open biopsy, involves a surgeon removing all or part of a lump or other area through an incision into the breast. There are 2 types of surgical biopsy: in an incisional biopsy, a small part of the lump is removed; in an excisional biopsy, the entire lump is removed. 
    • Lymph node biopsy checks the lymph nodes under the armpit for cancer cells. This may be done if the lymph nodes look swollen or enlarged on imaging tests. 

Special tools and methods may be used to guide needles during a biopsy. These include:

  • Stereotactic biopsy: This method finds the exact location of a breast lump or area by using a computer and mammogram to create a 3-D picture of the breast. A sample of tissue is removed with a needle.
  • Mammotome breast biopsy system or ATEC (automated tissue excision and collection): This is also called vacuum-assisted biopsy. A thin, hollow tube is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a small rotating knife inside the tube removes the tissue.
  • Ultrasound-guided biopsy: This method uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass. The images help guide the needle biopsy.

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 it responds to estrogen and progesterone hormones or to the HER2/neu growth factor. It may also be non-responsive to all three (this is known as triple negative breast cancer). The results can be used to determine what hormone or drug therapies may be most effective.
  • Genetic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations (such as the BRCA1 and BRCA2 genes), which can be used to determine the best course of treatment.
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images at different angles to form a computer-generated image. This can help determine tumor size, location and number. 
  • Lymph node biopsy: Removing and examining the lymph nodes near the breast can show whether the cancer has spread.
  • Chest X-ray: This procedure can help determine the size, location and number of tumors
  • Bone scan: This procedure uses a small amount of radioactive material to determine if breast cancer cells have spread to the bones.
  • Positron emission tomography (PET) scan:  This test uses a small amount of radioactive material and a PET scanner to locate breast cancer cells throughout the body.

The results of these tests help your cancer care team determine what stage the breast cancer is at based on its size, and whether it has lymph nodes affected and whether it has spread to the lymph nodes or distant organs.