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Breast Cancer Diagnosis

Some breast cancers have no signs or symptoms but are found during a routine exam, such as a mammogram or a clinical breast exam. Other times, changes in the breast are symptoms of breast cancer:

  • A lump in the breast
  • A lump under the arm
  • Changes or thickening in the breast tissue
  • Change in the nipple
  • Changes in the skin, including dimpling, persistent redness or scaliness

Some of these symptoms may not be caused by cancer at all, but come from other breast conditions. No matter what, if you notice any unusual changes in either breast, be sure to check with your personal physician.

If your doctor is concerned about something during a routine exam, you will need additional tests. The tests can determine if the problem is cancer, and if so, find out what kind it is and if it has spread. Each of the following tests gives different information, so you may have some of these but not all of them.

Types of Tests

Clinical breast exam: During a routine exam, your doctor looks at and feels your breasts to see if there are any areas of concern.

Imaging exams:

  • Mammogram: Two images are taken of each breast (side-to-side and top-to-bottom) to look for anything out of the ordinary. Kaiser Permanente offers digital mammograms, which take less time and offer exceptional image quality with less radiation. If a routine screening mammogram shows anything of concern, you will be scheduled for a follow-up (diagnostic) mammogram.
  • Ultrasound: An ultrasound takes an image of the breast using sound waves. This shows areas near the chest wall and whether a breast lump is solid or filled with fluid (a cyst).
  • CT scan (computerized tomography): An X-ray image shows if cancer is close to the chest wall.
  • Magnetic resonance imaging (MRI): This uses magnetic fields and radio waves to show images of the breast that can't be seen using other methods.

Pathology tests:

  • Biopsy: A specialist in breast conditions will take a small tissue or fluid sample from the breast.
  • Aspiration: A very fine needle is used to take a sample of fluid from a lump, such as a cyst.

A pathologist (specialist in studying tissue) will look at the fluid or tissue taken during an aspiration or biopsy to confirm if it contains cancer cells. Your doctor or other member of your care team will let you know what the pathologist finds.

If the pathologist finds cancer cells, your doctor might want more testing done to help your care team recommend the best treatment plan for you.

These additional pathology tests take time — anywhere from a few days to a couple of weeks. We know that waiting for the results can cause anxiety. But this step is critical in planning your treatment.

Genetic testing: Some people inherit a mutation of the BRCA (breast cancer) gene. This mutation increases the likelihood for developing breast cancer and also for ovarian cancer.
Depending on your personal and family history, your doctor might refer you to the Genetics Department at Kaiser Permanente's Medical Centers for evaluation and testing.

The BRCA blood test determines your genetic risk for developing cancer in your other breast and ovaries. Testing can help find out if your family members have a greater risk of breast and ovarian cancer.

At the evaluation, the genetic counselor will discuss the likelihood that you have a BRCA mutation, and the logistics, cost, and implications of testing

Stages of Breast Cancer

Staging measures the size of the tumor, whether it has spread to nearby lymph nodes, and whether it has spread (metastasized) to other parts of the body. Breast cancer is staged from 0 to 4.

Stage 0

  • Cancer is confined either to the lining of the breast duct or to the lobules, a small section of the breast where milk is made.  
  • It has not spread to other tissues of the breast (non-invasive). This is called carcinoma in situ.

Stage 1

  • A small tumor (about the size of peanut or smaller) is found in the breast, and/or
  • Small clusters of cancer cells are found in the lymph nodes under the arm.

Stage 2

  • No tumor is found in the breast, but cancer is found in the lymph nodes under the arm, or
  • A small tumor is found in the breast and has spread to the lymph nodes under the arm, or
  • A larger tumor is found in the breast and either has or has not yet spread to the lymph nodes.

Stage 3

  • Cancer has spread beyond the breast to nearby tissue and lymph nodes but has not yet spread to other parts of the body.

Stage 4

  • Cancer has spread from the breast or lymph nodes to other parts of the body such as the bones, lungs, or liver or lymph nodes outside the underarm area. This is metastasized cancer.

After determining the stage of cancer, your oncologist will recommend and discuss a treatment plan with you. Many people like to take some time to think about what the doctor recommends before starting treatment.

Your doctors and cancer care team at Kaiser Permanente medical offices can answer any questions that might arise during and after testing and diagnosis. You can reach them by secure e-mail, phone, or in-person.