Breast Cancer – Diagnosis and Investigations

Medically Reviewed by Dr. K on 25 March 2021

Breast Cancer Diagnosis

A doctor can start the breast cancer screening phase whether you detect a lump or if something shows up on a mammogram.

They’ll inquire about your personal and family history of health. They’ll then perform a breast exam and request tests such as:

Imaging tests. These can be used by your doctor to learn more about your breast health.

  • Ultrasound. This test creates an image of the breast using sound waves.
  • Mammogram. This thorough X-ray allows doctors to see lumps and other problems more clearly.
  • Magnetic resonance imaging (MRI). This body scan creates precise photographs of the internal views of your breasts using magnets connected to a computer.
  • Biopsy. The doctor takes tissue or fluid from your breast for this examination. They study it under a microscope to see whether cancer cells are present and, if so, to decide which type they are. The following are examples of common biopsy procedures:
    • Fine-needle aspiration. This is for lumps that are easier to access or that might be encased with fluid.
    • Core-needle biopsy. This procedure uses a larger needle to remove a piece of breast tissue.
    • Surgical (open) biopsy. The whole lump, as well as surrounding breast tissue, is extracted by a surgeon.
    • Lymph node biopsy. A few of the lymph nodes under the arm are removed to determine how cancer has developed.
    • Image-guided biopsy. The needle is guided by the doctor using imaging.

Your biopsy sample will be checked for the following:

  • Tumour features. Is it invasive or non-invasive, ductal or lobular in nature? Have your lymph nodes been affected? The margins or edges of the tumour are often measured, as well as their distance from the edge of the biopsy tissue, which is known as margin width.
  • Estrogen receptors (ER) and progesterone receptors (PR). This shows your doctor whether oestrogen or progesterone is causing your cancer to spread. Which has an impact on the likelihood of the cancer returning and the sort of therapy that is most likely to avoid it.
  • HER2. The gene human epidermal growth factor receptor 2 is checked for in this test. It has the ability to expedite the progression of cancer. If you have HER2-positive cancer, targeted therapy might be a choice for you.

  • Grade. This advises the doctor of how cancer cells vary from healthy cells, as well as whether they appear to be faster or slower growing.


  • Oncotype Dx. This procedure assesses 16 cancer-related genes as well as 5 reference genes to calculate the probability of a cancer recurrence within ten years of diagnosis.
  • Breast Cancer Index. This test will assist your doctor in determining how much endocrine therapy you need.
  • MammaPrint. This test utilises data from 70 genes to predict the likelihood of cancer recurrence.
  • PAM50 (Prosigna). This test analyses data from 50 genes to determine if the cancer can spread.

You may require blood tests including:

  • Full blood count (FBC). This test determines the amount of various kinds of cells in your blood, such as red and white blood cells. It tells your doctor whether your bone marrow is functioning properly.
  • Blood chemistry. This indicates how well the liver and kidneys are functioning.
  • Hepatitis tests. These tests are sometimes used to screen for hepatitis B and C. If you have an active hepatitis B infection, you may require antiviral treatment before starting chemotherapy. Chemo will allow the virus to expand and destroy your liver if you don’t treat it.


Referenced on 25.3.2021

  1. American Cancer Society: “Learn about Cancer: Breast Cancer."
  2. National Cancer Institute: “Breast Cancer."
  3. Johns Hopkins Medicine: “Adenoid Cystic Breast Cancer,” “Breast Cancer in Men.”
  4. Cleveland Clinic: “Breast Cancer.”
  5. CDC: “Breast Cancer: How Is Breast Cancer Diagnosed?” “Breast Cancer Screening Guidelines for Women,” “Breast Cancer: What Are the Risk Factors?”
  6. National Breast Cancer Foundation: “Biopsy.”
  7. American Cancer Society: “Breast Biopsy,” “Breast Cancer Risk Factors You Cannot Change,” “Can I Lower My Risk of Breast Cancer?” “Chemotherapy for Breast Cancer," “Hormone Therapy for Breast Cancer,” “Invasive Breast Cancer (IDC/ILC),” “Lifestyle-related Breast Cancer Risk Factors,” “Radiation for Breast Cancer,” “Surgery for Breast Cancer,” “Targeted Therapy for Breast Cancer,” “Treating Breast Cancer,” “What Is Breast Cancer?”
  8. “Breast Cancer Diagnosis,” “Breast Cancer: Introduction,” “Breast Cancer: Statistics.”
  9. Mayo Clinic: “Breast cancer prevention: How to reduce your risk.”
  10. Association of Directors of Anatomic and Surgical Pathology: “Breast Cancer,” “Breast Cancer In-Situ.”
  11. National Cancer Institute: “Cancer Stat Facts: Female Breast Cancer.”
  12. International Journal of Surgery: “Low-grade adenosquamous carcinoma of the breast: A diagnostic and clinical challenge."
  13. Mayo Clinic: “Breast cancer.”
  14. “Breast Cancer in Men: Statistics.”

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