How a breast cancer diagnosis occurs
The following is a summary of how a breast cancer diagnosis occurs in stages in a New Zealand context.
People might think that a cancer diagnosis is a single event but instead diagnosis occurs in a progression of steps following a range of tests.
Different hospitals and specialists do things slightly differently. At this point in time, there is no easy blood test for breast cancer; tissue must be removed in order for it to be analysed.
Step #1
This sounds simple but a woman either finds a lump in her breast or under her arm (for early stage breast cancer) OR the lump is detected through breast screening (mammogram, ultrasound and/or a manual examination by a specialist). E.g. my first breast lump was found by my Doctor during a routine breast check. My second breast lump was found via an annual mammogram.
Step #2
The Radiographer carrying out the mammogram or ultrasound will not usually give advice on the breast lump during screening. Their report will go to your Doctor and if there is a concern, you will be referred to a Breast Surgeon for further investigation. E.g. my Doctor rang on the day of the mammogram to advise me of an ‘issue’ and that she was referring me to a Breast Surgeon.
Step #3
The Breast Surgeon will do an examination and case history. Sometimes, from mammogram and ultrasound imaging, a Breast Surgeon can tell if it is cancer straight away. Usually, the Breast Surgeon will recommend a biopsy of the breast lump. A biopsy is a minor operation to remove tissue from an area of concern in the body. Some women have been given a cancer diagnosis during the biopsy process. The biopsy results are given to the Breast Surgeon.
Diagnosis #1
If cancer is found during the biopsy, the Breast Surgeon will advise you that “you have cancer”. NB sometimes the biopsy results can be inconclusive and further testing is required.
The Surgeon will then refer the patient for a range of tests to see if the cancer has spread to other parts of the body (e.g. chest x-ray, CT scan, bone scan etc).
If there is cancer, the Surgeon would usually recommend that the lump or breast be removed. Lymph nodes under the arm may also be removed for testing if the Surgeon suspects that the cancer has spread outside the breast.
Diagnosis #2
Once the tumour (and lymph nodes) have been removed, the Pathologist will analyse the tissue to determine the cancer type and characteristics and send that report to the Breast Surgeon. Usually a week or two post-surgery, the Breast Surgeon will give the patient full results which may include an additional diagnosis if there is evidence of cancer in the lymph nodes or other parts of the body.
Other tests may be required if the cancer has spread further (metastasised) outside the breast.
Breast cancer characteristics describe the relative seriousness of the cancer and the characteristics are used to plan a treatment regime tailored to the exact personality of the cancer. Characteristics include:
- whether the cancer is invasive or non-invasive (growing within or beyond the breast tissue)
- the size of the tumour
- cancer type (there are many types of breast cancer).
- tumour grade – there are three grades of breast cancer (indicating how quickly the cancer is developing)
- cancer stage – there are four stages of breast cancer (from early to late stage cancer)
- lymph node involvement (were cancer cells found in the lymph nodes and if so, how many?)
- whether the cancer cells are estrogen or progesterone receptors (if hormone positive, the cancer is more likely to respond to hormone therapy) and
- what the HER2 status is (HER2 is a growth factor protein that tells breast cancer cells to grow).
More information on these characteristics can be found on http://www.breastcancer.org/, http://www.cancernz.org.nz/ and http://www.nzbcf.org.nz/.
Full pathology report
At this point, we would usually say that we have details of the full cancer diagnosis. Your Guide to the Breast Cancer Pathology Report has a good explanation and summary section (from http://www.breastcancer.org).
Diagnosis is not a simple process and can be quite tricky for others to understand. It can feel like you keep getting more and more bad news, sometimes over what seems like a long time. But there will be a point where you have reached the last of the bad news. In late July, I finally found out that the cancer had HER2 positive characteristics when I was discussing chemotherapy with the Oncologist (that was after an initial diagnosis in April). It threw me a little as the surgery was in May and it took that long for the results to come through. There are many surprises along this journey!
“The information in your pathology report often comes in bits and pieces. Just after surgery, the cancer cells are first looked at under the microscope. Results from additional studies that require special techniques may take longer. So you may have one, two, or three lab reports from one surgery. Together, the lab reports make up your pathology report. Try to keep all your reports in one place, so that when you go for your treatment evaluations, the doctors will have all the information they need ” Marisa Weiss MD, Breastcancer.org.
Support
It is important to get the support that you need at this time. A cancer diagnosis is often a shock and a traumatic event. Talk to friends, family, a counsellor or a Cancer Society Nurse and make it a little bit easier for yourself.