Understanding Breast Cancer

Learn more about the importance of breast cancer screening and how breast cancer is diagnosed, staged, and treated so you can make informed decisions about your care.

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Breast Cancer Screening and Diagnosis

Symptoms of breast cancer are not always obvious until the disease has reached an advanced stage. This is why it is essential to discuss your family history with your doctor and determine the appropriate time to begin breast cancer screening.

According to the American Cancer Society, screening recommendations are based on whether a woman is at average or high risk of developing breast cancer. Average-risk women may start breast cancer screening with a mammogram as early as age 40, while high-risk women should typically begin screening earlier. A mammogram is an X-ray image of breast tissue that can identify breast cancer at an early stage, even before physical symptoms develop. When available, a 3D mammogram is recommended because it gives better clarity in the images.

Other imaging tests, such as breast MRI and breast ultrasound, may be ordered if an abnormal area is detected on your mammogram. If imaging tests suggest breast cancer, a biopsy will be performed to confirm the diagnosis.

You may be referred to a surgeon or breast disease specialist for a biopsy. An image-guided biopsy is performed to remove a sample of the lesion and analyze it.

A pathologist will examine the tissue or fluid removed from your breast for cancer cells. If cancer cells are found, the pathologist can identify the type of breast cancer.

Lab Testing of Breast Tissue for Hormones, HER2, and Genetic Mutations

If you are diagnosed with breast cancer, your doctor may request additional testing, such as biomarker testing and genomic testing on the breast tissue that has been removed. This testing helps determine whether the breast cancer cells have certain receptors, proteins, or mutations:

Hormone receptor tests: Some breast tumors require hormones to grow. These tumors have receptors for estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, hormone therapy is typically recommended as a treatment option.
HER2/neu test: The HER2/neu protein is found on some cancer cells. This test determines whether the tissue has an excess of HER2/neu protein or too many copies of its gene. If the breast tumor exhibits too much HER2/neu, targeted therapy may be a suitable treatment option.
Genetic testing: This testing can identify specific gene mutations that contribute to breast cancer, allowing for treatment with specific targeted therapies. Additionally, you may qualify for testing to check for inherited genetic mutations.
Multigene tests: These tests evaluate the activity of multiple genes simultaneously in tissue samples. They may help predict whether cancer will spread to other parts of the body or recur. Several types of multigene tests have been studied in clinical trials, including:

Oncotype DX: This test predicts whether early-stage breast cancer that is estrogen receptor-positive and node-negative will spread. If the risk of spreading is high, chemotherapy may be recommended to reduce this risk.
MammaPrint: This laboratory test examines the activity of 70 different genes in breast cancer tissue from women with early-stage invasive breast cancer that has not spread to lymph nodes or has affected three or fewer lymph nodes. The activity levels of these genes help predict whether breast cancer will spread or come back. If the test indicates a high risk of spreading or recurrence, chemotherapy may be suggested to lower that risk.

Results from these tests may take several weeks to come back, and they help your doctor decide on the best treatment options for you.

Staging Breast Cancer

If the biopsy results indicate that you have breast cancer, your oncologist will need to determine the extent (stage) of the disease. The staging process assesses how advanced the cancer is, including its location and whether or how far it has spread. Understanding the stage helps the oncologist choose the best breast cancer treatment options for you.

Determining if Cancer Has Spread to Lymph Nodes

If the oncologist suspects cancer has spread to the lymph nodes, the breast cancer surgeon will evaluate them to see if they are affected. This is referred to as lymph node involvement. To determine if cancer cells are present in the lymph nodes, one or several underarm lymph nodes may be removed for examination under a microscope. This procedure may be performed at the same time as breast cancer removal surgery or as a separate operation.

The most common type of lymph node biopsy is called a sentinel lymph node biopsy, which uses a dye to identify the lymph node closest to the cancer. This lymph node and a few others in this area are then removed for testing to be certain whether cancer has spread outside of the breast. In some cases, an axillary lymph node dissection is used, removing from 10-40 lymph nodes from the armpit area for testing.

Additional tests for staging breast cancer are performed to see if the cancer has spread outside of the tumor in the breast. These tests can include a CT scan, MRI, PET scan, and bone scans.

Breast Cancer Staging TNM System

Breast cancer staging involves evaluating the location, size of the tumor, and whether the cancer has spread to the lymph nodes. This is done using the TNM system, which includes two types of staging: pathologic staging, based on the examination of tissue removed during surgery, and clinical staging, derived from the results of physical exams, biopsies, and imaging tests.

Both staging systems focus on seven key pieces of information:

T = Tumor size
N = Lymph node status (the number and location of lymph nodes with cancer)
M = Metastases (whether or not the cancer has spread to other parts of the body)

Breast Cancer Stages

The following grouping by T, N, and M, according to the stage, is provided by the American Society of Clinical Oncology.

Stage 0 Breast Cancer

Also known as non-invasive breast cancer. The disease is confined to the ducts of the breast tissue and has not spread to the surrounding tissue of the breast.
Tis, N0, M0

Stage I

Stage IA Breast Cancer: The tumor is small and invasive, measuring 2 cm or smaller, and has not spread to the lymph nodes.
T1, N0, M0
Stage IB Breast Cancer: Cancer has spread to the lymph nodes, and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There may be no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller.
T0 or T1, N1mi, M0

Stage II

Stage IIA Breast Cancer: Any one of the following conditions applies:

There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant parts of the body.
The tumor is 20 mm or smaller and has spread to the axillary lymph nodes.
The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes.
T0, N1, M0 or T1, N1, M0 or T2, N0, M0

Stage IIB Breast Cancer: Either of these conditions is true:

The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes.
The tumor is larger than 50 mm but has not spread to the axillary lymph nodes.
T2, N1, M0 or T2, N0, M0

Stage III

Stage IIIA Breast Cancer: Either of the following conditions applies:

The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes. It has not spread to other parts of the body.
A tumor larger than 50 mm that has spread to 1 to 3 axillary lymph nodes.
T0, T1, T2, or T3; N2; M0 or T3, N1, M0

Stage IIIB Breast Cancer: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not spread to other parts of the body.
T4, N0, N1 or N2, M0
Stage IIIC Breast Cancer: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body.
Any T, N3, M0

Stage IV Breast Cancer

Also known as metastatic breast cancer, this stage indicates that the tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or the chest wall.
Any T, Any N, M1

Recurrent Breast Cancer

Recurrent breast cancer refers to cancer that returns after a period when it could not be detected following treatment. Even if the cancer appears to be eliminated, undetected cancer cells can remain somewhere in your body after treatment. It may return in the breast or chest wall or return in any other part of the body, such as the bones, liver, lungs, or brain.

Recurrent breast cancer may be described as local, regional, or distant.

Breast Cancer Tumor Grade

Grade refers to how different the cancer cells look from healthy cells, and whether they appear slower-growing or faster-growing. If the cancer looks similar to healthy tissue and has different cell groupings, it is considered "well-differentiated" or a "low-grade tumor." If the cancerous tissue looks significantly different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." Higher-grade tumors tend to be more advanced and/or grow more rapidly.

There are three grades:

Grade 1 (well-differentiated): Total score of 3 to 5
Grade 2 (moderately differentiated): Total score of 6 to 7
Grade 3 (poorly differentiated): Total score of 8 to 9

Find a Breast Cancer Specialist in the Syracuse Area

At Hematology-Oncology Associates of CNY, we are committed to providing expert, patient-centered breast cancer care. Our multidisciplinary team of specialists ensures that each patient receives a personalized treatment plan based on the latest advancements in breast cancer care.

Our cancer centers provide care for patients in Central New York, in the Syracuse area, in Onondaga County, Cayuga County, Cortland County, Herkimer County, Jefferson County – including Watertown, Madison County – including Oneida, Oneida County – including Utica and Verona, and Oswego County – including Fulton and Oswego.