Breast Cancer

For early detection and timely treatment of breast cancer, it is necessary that every woman knows how to self-examine their breasts and reach out to a doctor on time.The diagnosis of breast cancer begins with a physical examination at the doctor’s clinic followed by some kind of breast imaging, usually a mammogram if your doctor suspects a lump, swelling or unnatural discharge from the breasts. Here Dr. Vedant Kabra Head, Department of Surgical Oncology, Manipal Hospitals Dwarka, Delhi tells us how breast cancer is diagnosed and how to read the reports.

‘The primary diagnosis of breast cancer is usually confirmed by a needle biopsy, which can be performed at the outpatient clinic in 15 minutes after a mammogram is done. Sometimes an MRI and ultrasound are also needed and should preferably be done before the biopsy is performed as a biopsy may interfere with interpretation of imaging results. Thus it’s a combination of triple assessment –  clinical examination, imaging and biopsy – that helps in diagnosing breast cancer, says Dr Kabra. Here are six breast cancer symptoms you should never ignore.

Patients with larger lumps, those having enlarged glands in armpit or symptoms suggestive of distant organ involvement (bone pain, breathlessness, headache, enlarged liver etc.) need additional tests torule out the spread of disease toother organs. Read to know what to expect after a breast cancer treatment.

Breast Imaging

After the preliminary physical examination at the doctor’s office a mammogram, ultrasound (USG) or MRI of the breasts are done to check for the severity of the cancer. All these imaging modalities are graded in BI-RADS (Breast Imaging Reporting and Data Systems) categories depending upon the level of suspicion on these imaging. Here is what BI-RADS grading means:

  • BI-RADS 0 : This grading means information is incomplete and further imaging either in form of special views of a mammogram or a different imaging like USG or MRI is required (if the only mammogram is done). This category is usually given the breast appears dense on the mammogram.
  • BI-RADS 1: This is the safest you can get, it means studies are normal.
  • BI-RADS 2: This grade suggests that findings are benign.
  • BI-RADS 3: This grading indicates that findings are probably benign. But the patient still needs a short-term follow up with repeat imaging, usually after three to six months. The probability of cancer is less than two percent thus biopsy is needed in a small number of such patients
  • BI-RADS 4: This grading indicates a suspicious abnormality. The probability of cancer is between two to 95 percent depending upon subcategory (4a, b, c or d) with an average of around 30 percent. Almost all patients in this category would need biopsy to confirm or rule out cancer
  • BI-RADS 5: This grading refers to strong suspicion of cancer. The probability is more than 95 percent.
  • BI-RADS 6: This indicates that the cancer is already diagnosed.

Not with standing the categorisation, a biopsy is a final word in confirming cancer because sometimes a BIRADS 5 abnormality on imaging may be due to some non-cancerous disease.

How is a biopsy done ?

After the mammogram or other imaging tests are done and show suspicious results, a biopsy might be done to be certain about the diagnosis. A biopsy (usually done after a mammogram and before the surgery) gives information about the type of cancer to decide the type of therapy needed (chemo, hormone, targeted) based on certain markers like Estrogen Receptor (ER), Progesterone Receptor (PgR)  and a special marker called HER2neu.

The final biopsy is done after surgical removal of the tumour and helps to stage the disease more accurately. It is important to differentiate between stage and grade of a tumour. The stage is dependent on and signifies the extent of a tumour like the size of a tumour, involvement of and the number of lymph nodes or other organs. Breast cancer can be staged from 0 (non-invasive cancer with a nearly 100 percent cure) to IV (cancer that has spread to distant organs or areas and cannot be cured though in certain patients can be controlled for many years). Grade signifies the rate of growth of a tumour or, in other words, aggressiveness of a tumour. There are three grades of a tumour (I-III). A Stage I a tumour can be of grade III or a Stage IV tumour may also be of Grade I.