FAQs about Diagnosis

This content has been reviewed and approved by

William J. Gradishar, MD FACP
Director, Breast Medical Oncology, Professor of Medicine
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

My mammogram is abnormal, and my doctor is sending me to a surgeon. What should I do?

An abnormal mammogram must be investigated further. Sometimes additional views of the area in question are taken or an ultrasound may be ordered. In this case, your surgeon will decide the next best course of action. If, for example, he or she feels a lump in the breast, the next step will be to take a biopsy. Only the results of the biopsy will tell what type of abnormality it is and what further treatment or diagnostic tests may be necessary.

Women who have a diagnosis of breast cancer in one breast have a slightly increased risk (about 1 percent to 2 percent a year) of developing breast cancer on the other side. If your first cancer was positive for hormone receptors (estrogen or progesterone), then antihormonal therapy for your first breast cancer will decrease the likelihood of developing a cancer on the opposite side. Tamoxifen has been known to decrease the risk of developing cancer in the opposite breast in women who take it for their first breast cancer.

Newer drugs—called aromatase inhibitors, such as Arimidex^® (anastrozole), Femara^® (letrozole), and Aromasin^® (exemestane)—cause reduction of cancer by approximately 50 percent in participants in adjuvant large randomized trials that used these agents. The other important factor is that after your first cancer, you will be going for regular checkups and mammograms. Even if you do develop another cancer, it is likely to be detected early and treated with a high likelihood of a cure.

If your first cancer is hormone receptor-positive and you take antihormonal therapy, your likelihood of developing a second cancer is reduced. By going to your physician regularly and undergoing regular physical exams and mammograms, chances are that a second cancer will be detected early.

Most woman who have cancer on one side will not develop cancer on the other side. In fact, the risk of that occurring is only 1 percent to 2 percent per year of follow-up. Rarely, women who are extremely concerned about cancer in the other breast elect to have their other breast removed as a precaution. This may be considered a drastic step. Monthly breast self-examinations are very important, and you should notify your physician if you discover any changes in your breast.

Breast cancer cells can have certain proteins on their surface that govern their growth behavior. These characteristics can help your doctor guide your treatment.

Hormone receptors are found in about two-thirds of younger women who have not undergone menopause and up to three-fourths of older women who have gone through menopause. Having these receptors not only indicates relatively less aggressive breast cancer in general, but it also provides a target for therapy.

In premenopausal woman (generally under 50), tamoxifen or other ovarian function-blocking medication is recommended with or without other therapies, and with or without chemotherapy. In postmenopausal women with estrogen receptor-positive and early-stage breast cancer, antihormonal therapy with tamoxifen, or the newer class of drugs—called aromatase inhibitors—is the mainstay of treatment, with or without chemotherapy. There are other proteins, such as HER2, that can be targeted with Herceptin^® (trastuzumab) to provide a benefit.

Breast cancer cells can have certain proteins on their surface, which determine how they grow and how your doctor will treat your cancer. Human epidermal growth factor receptor 2 (HER2) belongs to a family of proteins that plays an important role in responding to the growth signals from the body. When this message to grow is amplified in the cancer cells, it leads to increased rate of growth, more aggressive behavior of the cancer, and an increased likelihood of the cancer spreading to other parts of the body. 

The good news is that there is a new antibody—called Herceptin^® (trastuzumab)— that can be effective in treating HER2 positive breast cancer. This drug has recently been shown to cut the risk of recurrent cancer after initial treatment with surgery by one-half in four large randomized clinical trials involving a combined total of more than 14,000 patients. Even in patients who have advanced disease, trastuzumab added to chemotherapy can significantly improve survival time.

Breast cancer cells can have certain proteins on their surface that govern their growth. The presence of these proteins can help your doctor determine the best treatment for you. Absence of this protein from the cell's surface classifies the tumor as HER2 negative and means your cancer is less aggressive than HER2-positive cancer.

This does not mean that you do not need treatment for your cancer; just that your prognosis may be better than a HER2-positive patient. In general, however, now that HER2-positive patients can receive trastuzamab or lapatanib, it may have altered the natural history of their disease.

I was told my cancer is hormone receptor-negative. What does that mean?

Breast cancer cells can have certain proteins on their surface that govern their growth behavior and can help your physician guide your treatment. The absence of hormone receptors on your cells means that you will not respond to antihormone therapy. However, you should find out about the HER2 status of the tumor. If you are HER2 positive, you may be a candidate for an antibody therapy trastuzumab.

Trastuzumab is a very well-tolerated drug, given weekly or every 3 weeks. It has minimal side effects (chills or fever), and those usually appear only with the first dose. However, there is a 1 percent to 4 percent risk of developing congestive heart failure beyond the first dose. Therefore, routine monitoring of your heart function every few months is recommended, particularly in the early stages of your treatment. 

Not all abnormalities on mammograms indicate that you have cancer. In fact, very few of them are. Sometimes, your radiologist or doctor can look at the appearance of an abnormality on your mammogram and be pretty sure that it does not appear malignant.

They are the best judges. If you are worried, you can show your mammogram to another radiologist who specializes in reading mammograms and get a second opinion to see if additional tests are needed. If your biopsy does show cancer, you also might want to consider a second opinion.

Grading is a way to describe the aggressiveness of the tumor. A sample of your tumor is examined under a microscope by a pathologist who looks at how quickly the cells seem to be dividing and how abnormal the cells look. Grading is generally on a scale of 1 to 3. The higher the grade, the more aggressive and abnormal the tumor is.

Therefore, grade 3 means that your tumor appears more aggressive than a grade 1 or 2 tumor. Remember, however, that grade is not the only parameter to be considered. The overall picture of your cancer and other factors are also taken into consideration when determining the best therapy and prognosis associated with your cancer.

These include tumor size, number of involved lymph nodes, and the presence or absence of certain types of receptors on the tumors surface, such as hormone receptors and HER2 receptors. You should discuss your tumor grade in more detail with your doctor and try to get an overall sense of your stage and prognosis, as well as your treatment options.

My tumor appears to be 5 centimeters in size on the mammogram. Is that big or small for a tumor? 

Size is relative. A 5-centimeter tumor may be considered above average size, but at the same time, more and more smaller tumors in the United States are being diagnosed because of widespread use of mammography. However, a 5-centimeter tumor is by no means considered incurable.

Depending on your breast size and location of the tumor, you may undergo a lumpectomy, which will save you from losing your breast. Your treatment may then include radiation, especially if you had chemotherapy before your surgery to shrink your tumor.

You should discuss your treatment options with your doctor, who will also take into consideration other factors, such as tumor location, breast size, involvement of lymph nodes, and whether or not your cancer has spread beyond the breast tissue. Your therapy will depend on additional testing for estrogen receptors, progesterone receptors, HER2 receptors, etc.