Category: Breast Cancer
Breast cancer is a prevalent disease affecting a significant number of women worldwide, with over two million cases diagnosed annually.
Netdoctorweb, with the help of leading medical specialists, will tell you how the stage of the disease is determined, who may be eligible for organ-conserving surgery, and how genetic tests help doctors adjust therapy.
How can breast cancer be detected?
Asymptomatic cancer can be shown by mammography, an X-ray of the breast. This is a screening method that women are advised to do every two years starting at age 50. Mammography is also used to clarify the diagnosis when a woman comes to the doctor already with symptoms.
There are various symptoms that one might experience if they have a breast issue. These can encompass a lump or discomfort in the breast, alterations in its shape or size, redness or flaking of the skin, the presence of enlarged lymph nodes under the arm, an inverted nipple, or the occurrence of discharge from the nipple.
Should I go for an ultrasound instead of a mammogram?
No, it’s not worth it. Ultrasound can only help determine the type of lump (eg, whether it is benign or not) that is felt during a physical examination or found on a mammogram. But MRI of the mammary glands can be performed on young women as a screening.
To evaluate the risks for oncological disease, the doctor may ask about a personal and family history of mammary glands, fallopian tube, ovarian or peritoneal cancer, check for possible inherited mutations (such as BRCA), and whether the patient had radiation therapy to the chest between the ages of 10 and 30 years. For women not at risk, the benefit of MRI screening is currently being studied.
During a mammogram, a suspicious lump was found. What will happen next?
Doctors will conduct additional tests, such as breast ultrasound, and recommend a biopsy to clarify the diagnosis. During a biopsy, the doctor uses a thin needle to remove a sample of tissue from the lump. The procedure is performed under local anesthesia, and in some cases under the control of ultrasound, MRI or X-ray (if it is difficult for the doctor to feel and understand the location of the suspicious formation).
After a biopsy, tumor cells can be immediately tested for the presence of estrogen and progesterone receptor proteins and the amount of HER2 protein (second epidermal growth factor receptor). Depending on the results of these tests, the patient may be offered different types of treatment. In addition, there are genetic platforms that allow the assessment of rare mutations in tumor tissue (for this, complete sequencing of the tumor genome is performed).
Sometimes this helps to find a mutation for which there is already a specific drug. But for now, this method is more often used only when the tumor does not respond to standard treatment. Up to 10% of breast cancer cases are due to hereditary defects in the BRCA genes. Women should be tested to identify these mutations, but not only because of possible adjustments in treatment. Gene mutations may indicate a high risk of developing breast and ovarian cancer in close relatives of the patient (daughter or sister); awareness and early screening (and, if necessary, treatment) help reduce these risks.
In addition, genetic tests, such as Oncotype DX, can be used in some cases to assess the risk of relapse and select individual treatment. In this case, a number of tumor genes are assessed. Such a study may be recommended for women with a positive hormone receptor status and a negative HER2 status. This test can predict whether breast cancer will return in 10 years, and other tests can help determine whether chemotherapy is needed in the early stages.