Breast Cancer Screening and Diagnostic Tests

Remote video URL

Laura Kruper, M.D., co-director of City of Hope's breast cancer program , talks about current breast cancer screening guidelines for women at normal and high risk for the disease.

What are the current screening guidelines for breast cancer?

The American Cancer Society screening recommendations for women with average breast cancer risk are:

  • Women between 40 to 44 years old should consider beginning annual mammograms
  • Women between 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 age 30
  • Screening with magnetic resonance imaging (MRI) in addition to annual mammograms

How is breast cancer detected and diagnosed?

An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state-of-the art breast imaging technologies and laboratory techniques to guide your personalized treatment.

If you notice changes in your breast, experiencing breast pain, or as part of a routine breast screening, your doctor may use tests to look for breast cancer. An integral part of diagnosing breast cancer begins with your doctor asking questions about your health history, your symptoms, risk factors, and family history of disease.

What tests might I need?

You may have one or more of the following tests:  

  • Physical exam
  • Clinical breast examination
  • Mammogram: An x-ray of the breast to learn more about changes to the breast. Changes may include pain, a lump, nipple discharge or thickening or change in shape or size of the breast.
  • Ultrasound: Imaging the breast using high-energy sound waves to make images of body tissues on a computer screen. This exam is often used along with 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 then sent to the lab to look for cancer cells. Most nipple secretions are not cancer. An injury, infection, or benign (non-cancerous) tumor may cause discharge.
  • 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
  • Biopsy: surgical removal of suspicious tissues for further examination. There are several types of breast biopsy. The type of biopsy done will depend on the location and size of the breast lump or change.
    • Fine needle aspiration biopsy. A very thin needle is placed into the lump or other area to remove a small sample of fluid or tissue. A fine needle aspiration biopsy may be used to help find out if a breast change is a cyst (a fluid-filled sac that's usually not cancer) or a solid lump.
    • Core needle biopsy. A large needle is guided into a lump or other area to remove small cylinders of tissue (cores). No incision is needed.
    • Surgical biopsy. This is also called an open biopsy. A surgeon removes part or all of a lump or other area through an incision into the breast. There are 2 types of surgical biopsy. During an incisional biopsy, a small part of the lump is removed. During an excisional biopsy, the entire lump is removed. If the lump is very small and deep and hard to locate, the wire localization method may be used during surgery. A wire is placed into the lump under X-ray guidance. The surgeon then follows this wire to help locate the breast lump.
    • Lymph node biopsy. If lymph nodes under the armpit are swollen or look enlarged on imaging tests, the doctor will want to check them for cancer cells. A needle biopsy may be done to take out and check cells from the lymph node.

Special tools and methods may be used to guide the needles and to assist with biopsy procedures. These include:

  • Stereotactic biopsy. This method finds the exact location of a breast lump or area by using a computer and mammogram results to create a three-dimensional (3D) 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 type of 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 to 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 the hormones estrogen and progesterone or the growth factor called HER2/neu, or if it is non-responsive 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: 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 better treatments
  • 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, 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 the cancer has spread.
  • Chest x-ray: An x-ray of the chest area to determine 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 material and a PET scanner to locate breast cancer cells throughout the body.

Based on the results of these tests, the breast cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs.

Tests for High-Risk Breast Cancer Patients

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 (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, women will meet with our team of physicians, nurse practitioners and certified genetic counselors to determine their best options for surveillance and risk reduction. Depending on each woman’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. 
If you think you may be a high-risk patient, call the  City of Hope High Risk Breast Clinic in South Pasadena for more information at 800-826-4673 or make an appointment online.

Request a Consultation

If you have been diagnosed with breast cancer, are at a high risk for developing breast cancer or are looking for a second opinion consultation about your treatment, you may request an  appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

Partners Clinic

Breast cancer affects the whole family, causing stress in relationships, among family members, and in your work and home life. A united team can help effectively manage these disruptions. The Partners Clinic is a novel program unique to City of Hope that offers patients and their families an opportunity to grow closer as they solve problems together.

Designed specifically for newly diagnosed breast cancer patients and their partners or families, the clinic offers communication training and gender-based problem-solving led by board-certified counseling experts. This session, which occurs at the initial surgical visit, provides patients and their families with the necessary tools to communicate honestly and directly with each other. It actively encourages the sharing of emotional concerns and fears in a way that helps everyone manage their unique situations.

Contact the Sheri & Les Biller Patient and Family Resource Center for more information: 626-218-2273