Breast cancer detection

• Mammography
• Ultrasound of the breast
• Breast MRI, CT, PET-CT
• Breast tumor biopsy
• Immunohistochemical study
• Genetic counseling
• Breast cancer and pregnancy

Methods for breast cancer diagnosing

For an accurate diagnosis of breast cancer, a mammalogist should learn more about the medical history of patient’s life. Prepare to answer these questions:

• What do you worry about?
• Did your maternal relatives have breast cancer?
• If so, who? (grandmother, mother, aunt, sister)
• Do you have chronic diseases?
• Do you take oral contraceptives?
• Do you take hormonal medications?
• Is your menstrual cycle regular?
• When was the first menstruation?
• Is the sexual life regular?
• Do you have children? If so, were they breastfed?
• Did you have abortions or miscarriages?

Diagnostics includes clinical, radiological and pathomorphological approaches.

Mammography

Mammography is the primary method of diagnosing breast cancer and determining the possibility of developing a tumor.

Diagnostic bilateral mammography takes pictures (mammograms) of both breasts, establishing the size of the lumps and additional foci of the disease.

The procedure has such steps: a patient needs to undress to the waist, put off the metal jewelry and place the breast between the 2 mammography plates to take pictures of both glands at once. Images can be printed (screen-film mammography) or transferred to a computer (digital mammography).

Preparation for mammography

• Up to 35 years of age, instead of mammography ultrasound is required.
• Undergo mammography during the 1st week after the end of menstruation.
• Do not apply deodorant/antiperspirant, talc, cream, lotion around your breast and on the underarms before the procedure. Cosmetics distort the image.
• If you ever have undergone mammography, take medical images with you and show the doctor.
• If you have implants in your breast, tell your mammalogist about that.
• Inform the mammalogist about your pregnancy.

Ultrasound of the breast

Ultrasound examination of the breast supplements the results of mammography and makes it possible to assess the condition of hard-to-reach tissues more accurately. Ultrasound monitors the lymph flow features, which is especially crucial in the defeat of regional lymph nodes.

Breast MRI

MRI of the mammary gland provides a detailed examination of tumors invisible on the mammogram. MRI shows the tumor behavior after chemotherapy.

Breast CT (computed tomography)

For the diagnosis of breast cancer, computed tomography scan of the thoracic and abdominal cavities with contrast is performed. It allows establishing the presence of tumor foci.

Positron emission (computed) tomography

PET-CT is the most advanced method for diagnosing cancer. It is a combination of information on the physiological activity of the body (PET) and X-ray image (CT). The accuracy of PET-CT is 95%. It is used to detect metastatic foci. Also, the method makes it possible to recognize cancer at the initial stage.

However, these methods visualize the tumor and cannot determine its quality. To know precisely the cyst or cancer is in the picture, a patient needs to undergo a biopsy.

Breast tumor biopsy

During the biopsy, an expert involves extraction of tissues for analysis. The biopsy can determine the presence of breast cancer.

For the breast cancer detection the specialists use:

- fine-needle aspiration;

- trepanobiopsy.

Fine-needle aspiration (FNA) is provided through a thin needle to investigate lumps. FNA does not allow to determine the histological form of breast cancer and the receptor status. The accuracy of the FNA is 35-70%.

Trepanobiopsy is performed by a thick needle to analyze lumps tissues. If trepanobiopsy is not possible, the specialists carry out an aspiration biopsy under a manual, ultrasonic or stereotactic control. 90% is accuracy of trepanobiopsy.

The material taken with the help of the biopsy is examined in the laboratory, performing an immunohistochemical study.

Immunohistochemical study

To develop the appropriate treatment program, the experts determine the level of estrogen receptor (ER) and progesterone (PgR). It allows to assess the possibility of hormonal therapy.

Malignant tumor cells can contain hormone receptors to which estrogens (ER) and progesterone (PgR) are attached. This compound stimulates tumor growth.

According to a biopsy results the lump may be receptor-positive (hormone-sensitive) and contain estrogen and progesterone receptors or receptor-negative.

Most malignant breast tumors (70%) are hormone-sensitive. This means hormonal therapy is one of the best methods for their treatment.

Growth factors are proteins stimulating cell growth.

When the human epidermal growth factor attaches to HER2 receptors of malignant breast cells, it stimulates their uncontrolled growth.

The immunohistochemical study allows to reveal the level of HER2 receptors:

• 0-1 + HER2 is normal; HER2 cancer is negative;
• 2+ HER2 at the middle level;
• 3+ HER2 above the norm; HER2 cancer is positive.

If a patient has HER2 2+, s/he should undergo additional FISH (fluorescence in situ hybridization) or CISH (chromogenic in situ hybridization) tests to determine the level of the HER2/neu gene in each cell.

HER2-positive breast cancer grows very quickly. It is diagnosed in 20% of cases.

Genetic counseling

In 10 out of 100 cases, breast cancer is inherited due to the presence of BRCA1, BRCA2, CHEK2, TP53 and PTEN mutations. Analyzing anamnesis and carrying out a genetic study, a specialist will determine the propensity to breast cancer.

Breast Cancer and Pregnancy

Breast cancer during pregnancy is found in 1 case out of 3,000. However, it is harder to define disease, because of the changes in the breast during pregnancy. That is why breast cancer in pregnant women is diagnosed at later stages.

Most methods of breast cancer treatment affect the body of women and children.