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What Is Diagnostic Testing For Breast Cancer

Tests Are Used To Screen For Different Types Of Cancer When A Person Does Not Have Symptoms

Breast cancer diagnostic testing: What women should know

Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection helps a person live longer or decreases a persons chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

Breast Cancer Diagnosis: The Tests You May Get

A breast cancer diagnosis is overwhelming and often marks a period of time in which youll receive many tests. Doctors will attempt to learn as much as possible through these tests about your breast cancer type, how far it has advanced, what mutations it might contain, what the tumor cells look like, and any other clinical information that will help determine the best course of treatment. Undergoing all these tests can be very stressful, but they allow doctors to begin treating you as soon as possible.

B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions

Electronic databases, including EMBASE and MEDLINE, will be searched for clinical trials that appear to address the Key Questions. Keywords included in the search strategy encompass the concepts of breast cancer, diagnosis, noninvasive imaging, and names of the specific technologies to be evaluated. The bibliographies of recent on topic systematic and narrative reviews will be scanned for additional information. The literature searches will be updated while the report is undergoing internal review, and any key new publications identified by either the peer reviewers or the updated literature searches will be incorporated into the report before finalization.

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Diagnosis Of Liver Metastases

When breast cancer metastasizes to the liver, there are usually no initial symptoms. Therefore, liver function tests may be standard blood tests that health care providers request when doing follow-up tests for people diagnosed with breast cancer. Liver function tests involve taking blood from a vein and sending a blood sample to a laboratory to test the blood for certain levels of enzymes and proteins. Abnormal levels indicate liver damage or liver disease.

Other tests commonly used to diagnose liver metastases include imaging studies such as:

  • NMR
  • Ultrasound and/or PET scan
  • Combined PET/CT scan

Additionally, a diagnostic healthcare provider may order tissue samples from suspicious areas this is called a liver biopsy. A liver biopsy is done using an imaging tool, such as a CT scan, to instruct the doctor to insert a small needle into the skin to collect a sample of liver tissue.

Another method of obtaining liver tissue for biopsy is called laparoscopy. This involves the use of a specialized endoscope to remove suspicious tissue through a very small incision in the abdomen. Tissue samples are then examined in the laboratory to determine whether they contain breast cancer tissue. If the tissue is cancerous, it can be further tested to determine its hormone receptor and HER2 status, which can guide the use of targeted therapy.

How to Diagnose Liver Cancer

Brca1 And Brca2 Gene Mutations

Breast Cancer Diagnostics. Self Examination And Cytology ...

When it comes to breast cancer risk, the most important inherited gene changes are in the BRCA1 and BRCA2 genes. Women with one of these gene changes are said to have Hereditary Breast and Ovarian Cancer syndrome.

  • Women with a BRCA gene change have a greatly increased risk of breast cancer, as well as an increased risk of ovarian cancer, pancreatic cancer, and possibly some other cancers.
  • Men with a BRCA gene change are at increased risk of breast cancer , prostate cancer, pancreatic cancer, and possibly some other cancers.

If you have a family history of breast cancer, you have a higher risk of getting breast cancer yourself. Most women with a family history of breast cancer do not have an inherited gene change that greatly affects their risk. Still, an inherited gene change is more likely in women with a strong family history of breast cancer, especially if the family history also includes certain other cancers, such as ovarian, pancreatic, or prostate cancer. The risk of having an inherited syndrome is also affected by:

  • Which family members are affected
  • The number of family members affected
  • The age when your relatives were diagnosed

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Diagnosis Of Bone Metastases

The most common site of breast cancer metastasis is bone. This occurs in more than 50% of women with stage 4 breast cancer. Breast cancer can spread to any bone, but the most common sites include the pelvis, ribs, spine, and the long bones of the arms and legs. Tests involved in diagnosing bone metastases include:

  • bone scan
  • MRI
  • PET scan

Blood tests may also be ordered to check for bone metastases. This test will check for high levels of calcium or another substance that is often elevated due to bone metastases called ALP .

A bone biopsy may also be ordered to confirm bone metastases. This involves using a CT scan to help doctors guide a small needle into the suspected area of metastasis to remove a tissue sample. The tissue is then examined in a laboratory to determine if it is cancerous.

How to Diagnose Bone Cancer

Laboratory And Blood Tests

Lab tests to examine blood, urine and other fluid samples may be used to look for tumor markers or abnormal cells indicative of cancer.

CellSearchTM Circulating Tumor Cell Test: This diagnostic blood test detects circulating tumor cells in order to help doctors monitor metastatic breast, prostate and colorectal cancers.

Complete blood count test: Used to measure your levels of white and red blood cells and platelets as well as hemoglobin and hematocrit, a CBC test helps detect leukemia and monitor your blood counts during cancer treatment.

Flow cytometry: As a tool to detect cancers such as leukemia and lymphoma, flow cytometry may be used to evaluate cells in bone marrow, lymph nodes or blood samples. Its also useful in detecting abnormal amounts of DNA in cancerous cells, which may point to a recurrence.

MammaPrint + BluePrint® test: These breast cancer recurrence tests help predict the likelihood that your cancer will come back.

Oncotype DX® test: This test is useful in determining whether chemotherapy may be of benefit to breast cancer patients.

Tumor marker tests: Certain substances known as tumor markers are present in the blood when you have cancer. Tumor marker tests are often used in combination with a biopsy to help diagnose cancer.

Prostate specific antigen test: Men with prostate cancer often have elevated levels of the hormone PSA in their blood.

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Breast Cancer Diagnosis And Screening

LECIA M. APANTAKU, M.D, Finch University of Health Sciences/The Chicago Medical School, North Chicago, Illinois

Am Fam Physician. 2000 Aug 1 62:596-602.

Approximately 180,000 new cases of breast cancer are diagnosed annually, accounting for about 48,000 deaths per year in the United States. The screening guidelines for the diagnosis of breast cancer are continually changing. Because of increased awareness of the signs and symptoms of breast cancer and the use of screening mammograms, breast cancers are increasingly being diagnosed at earlier stages. Annual mammograms and clinical breast examinations are recommended for women older than 40 years. Women older than 20 years should be encouraged to do monthly breast self-examinations, and women between 20 and 39 years of age should have a clinical breast examination every three years. These guidelines are modified for women with risk factors, particularly those with a strong family history of breast cancer. Ultrasonographic studies are most useful to evaluate cystic breast masses. For solid masses, diagnostic biopsy techniques include fine-needle aspiration, core biopsy and excisional biopsy.

Genetic Counseling And Testing For Breast Cancer Risk

Breast Cancer | Screening vs. Diagnostic Mammogram | Woman’s Hospital — Baton Rouge, La.

Some people inherit changes in certain genes that increase their risk of breast cancer . Genetic testing can look for mutations in some of these genes. While it can be helpful in some cases, not everyone needs to be tested, and each person should carefully consider the pros and cons of testing. Its very important to understand what genetic testing can and cant tell you before these tests are done.

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Stage Of Breast Cancer

When breast cancer is diagnosed, your doctors will give it a stage. The stage describes the size of the cancer and how far it has spread, and is used to predict the outlook.

Ductal carcinoma in situ is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:

  • stage 1 the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
  • stage 2 the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
  • stage 3 the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
  • stage 4 the tumour is of any size and the cancer has spread to other parts of the body

This is a simplified guide. Each stage is divided into further categories: A, B and C. If you’re not sure what stage you have, talk to your doctor.

Diagnosis Of Brain Metastases

An MRI is ordered when a healthcare provider suspects brain cancer. MRI studies often involve contrast solutions. The contrast medium solution is injected intravenously and travels through the vein to the brain. This makes the images in the study easier to decipher. An MRI study detects whether abnormal findings in the brain are actually metastatic breast cancer.

A brain biopsy can be ordered to confirm the diagnosis of metastatic brain cancer, but this is rare. In this case, surgeons must make an opening in the skull by drilling a small hole in the skull, then use imaging studies to guide a hollow needle to remove some tissue from the brain tumor. The tissue is then examined by a laboratory pathologist .

How to Diagnose a Brain Tumor

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Testing For Brca And Other Gene Mutations

Some expert groups have developed guidelines for which women should consider genetic counseling and possibly testing for BRCA and other gene mutations. These guidelines can be complex, and not all doctors agree with them, but in general they include two main groups of people:

Women who have already been diagnosed with breast cancer: Most doctors agree that not all women with breast cancer need genetic counseling and testing. But counseling and testing is more likely to be helpful if:

  • You were diagnosed with breast cancer at a younger age
  • You have triple-negative breast cancer
  • You have been diagnosed with a second breast cancer
  • You are of Ashkenazi Jewish descent
  • You have a family history of breast cancer , ovarian cancer, pancreatic cancer, or prostate cancer

Other groups of people: Genetic counseling and testing might also be recommended for other people who are at higher risk for inherited gene mutations, including:

  • People with a known family history of a BRCA gene mutation
  • Women diagnosed with ovarian cancer or pancreatic cancer, or men diagnosed with breast cancer, pancreatic cancer, or high-grade or metastatic prostate cancer
  • People with a family history of breast cancer at a younger age, more than one family member with breast cancer, or breast cancer in a male family member
  • People with a close family member with a history of ovarian cancer, pancreatic cancer, or metastatic prostate cancer

The Harms Of Mammography Include The Following:

How Breast Cancer Is Diagnosed

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result is usually followed by more tests , which also have risks.

When a breast biopsy result is abnormal, getting a second opinion from a different pathologist may confirm a correct breast cancer diagnosis.

Most abnormal test results turn out not to be cancer. False-positive results are more common in the following:

False-positive results are more likely the first time screening mammography is done than with later screenings. For every ten women who have a single mammogram, one will have a false-positive result. The chance of having a false-positive result goes up the more mammograms a woman has. Comparing a current mammogram with a past mammogram lowers the risk of a false-positive result.

The skill of the radiologist also can affect the chance of a false-positive result.

False-positive results can lead to extra testing and cause anxiety.

If a mammogram is abnormal, more tests may be done to diagnose cancer. Women can become anxious during the diagnostic testing. Even if it is a false-positive test and cancer is not diagnosed, the result can lead to anxiety anywhere from a few days to years later.

False-negative test results can delay diagnosis and treatment.

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A Criteria For Inclusion/exclusion Of Studies In The Review

We will use the following formal criteria to determine which studies will be included in our analysis.

  • The study must have directly compared the test of interest to core-needle biopsy, open surgery, or patient followup in the same group of patients.Although it is possible to estimate diagnostic accuracy from a two-group trial, the results of such indirect comparisons must be viewed with great caution. Diagnostic cohort studies, wherein each patient acts as her own control, are the preferred study design for evaluating the accuracy of a diagnostic test.12 Studies may have performed biopsy procedures on all patients, or may have performed a biopsy on some patients and followed the other patients with clinical examinations and mammograms. Fine-needle aspiration of solid lesions is not an acceptable reference standard for the purposes of this assessment.13-16Retrospective cohort studies that enrolled all or consecutive patients were considered acceptable for inclusion. However, retrospective case-control studies and case reports were excluded. Retrospective case-control studies have been shown to overestimate the accuracy of diagnostic tests, and case reports often report unusual situations or individuals that are unlikely to yield results that are applicable to general practice.12,17 Retrospective case studies were also excluded because the data such studies report cannot be used to accurately calculate the overall diagnostic accuracy of the test.17
  • If The Biopsy Is Positive: More Testing

    If the pathology report reveals cancer, the doctors will first want to determine what stage your breast cancer is and what grade the tumor is.

    The type of tests a woman will undergo next depends on what the cancerous cells look like. Those tests include blood tests, additional biopsies, a bone scan, a chest X-ray, breast ultrasound, or other specialized imaging or chemical testing.

    One common imaging test is computerized tomography, or a CT scan, that takes cross-sectional X-rays of the body. Another common imaging is positron emission tomography, or PET scans, that look at cell activity. A PET scan involves injecting a person with a tiny amount of sugar substance and radioactive material so cameras can observe highlighted areas in the breast on a computer screen.

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    Some Risk Factors For Breast Cancer

    The following are some of the known risk factors for breast cancer. However, most cases of breast cancer cannot be linked to a specific cause. Talk to your doctor about your specific risk.

    Age. The chance of getting breast cancer increases with age. Nearly 80 percent of breast cancers are found in those over the age of 50.

    Personal history of breast cancer. An individual who has had breast cancer in one breast is at an increased risk of developing cancer in the other breast.

    Family history of breast cancer. A higher risk of breast cancer is associated with having an immediate relative with breast cancer, especially at a young age . Having other relatives with breast cancer may also raise the risk.

    Genetic factors. Certain genetic mutations, including changes to the BRCA1 and BRCA2 genes, are associated with a higher risk of developing breast cancer at some point. Other gene changes may raise breast cancer risk as well. For more information, ask your doctor about comprehensive biomarker testing, which may include genetic testing for inherited cancer risk.

    Childbearing and menstrual history. Research suggests a link between reproductive and menstrual history and the risk of breast cancer. Higher risk factors include:

    • Early onset menstruation
    • Late onset menopause
    • Never having children, childbirth later in life or not breastfeeding

    Hormone use. Menopausal hormone therapy and certain types of birth control may have hormones that are risk factors for breast cancer.

    Are Mammograms Covered By Insurance

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    Screening mammograms used for preventive care are generally covered by insurance. But because a diagnostic mammogram is used to diagnose something, you may have to pay a copay or coinsurance, depending on your insurance plan.4 to check your benefits, especially your preventive benefits, and learn about your plan coverage for this type of screening.

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    Breast Cancer Screening And Diagnosis

    When you see a pink ribbon, do you automatically think of breast cancer? Many organizations have done a great job raising awareness for the most common type of cancer among women.1 In fact, maybe you know at least one person who has been diagnosed. It can be scary stuff. So, its important to know the ways we can check our bodies and stay on top of our health. The phrase better safe than sorry may ring true when it comes to taking a preventive approach to finding cancer.

    The key to early detection and diagnosis is knowing which breast cancer tests and screenings are available, and which one may be best for you. You can think of breast cancer tests in two ways: preventive and diagnostic .


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