Receiving unexpected news about the possibility of cancer can be very scary. Fortunately, doctors find most cases of breast cancer before symptoms appear. A diagnosis usually comes after a screening mammogram shows a suspicious area, or you or your doctor find a lump during a breast exam. The next step is a series of tests to learn more about the cancer in order to guide your treatment plan. Diagnostic Testing The first step is diagnostic testing. This can be a diagnostic mammogram, breast ultrasound, breast MRI (magnetic resonance imaging), or other testing. A diagnostic mammogram looks at multiple views of the suspicious area and may include magnified views. Breast ultrasounds and breast MRIs give your doctor different and sometimes more detailed views of the area compared to a screening mammogram. After diagnostic testing, your doctor may determine the area is not worrisome or the area is likely benign (not cancer) and only requires a follow-up mammogram in four to six months. Alternatively, your doctor may decide the suspicious area needs a biopsy. Biopsy A biopsy is the only way to tell for sure if an area is cancerous or not. The biopsy procedure will depend on the size of the area, where it is in your breast, how many areas need to be biopsied, and other factors. Doctors can take a biopsy with these techniques: Fine needle aspiration uses a very thin needle to withdraw a small amount of tissue. Core needle or vacuum-assisted biopsy uses a larger needle to remove a tube-shaped core of tissue. Surgical or open biopsy is the surgical removal of all or part of the area. This technique is not as common as the others. Your doctor may perform a lymph node biopsy if you have enlarged lymph nodes to see if the cancer has spread. Otherwise, your doctor will likely do a sentinel node biopsy and remove nearby lymph nodes when you have surgery to remove the tumor. A pathologist analyzes the cells from the breast and lymph node biopsy to determine whether either tissue is cancerous. Breast Cancer Analysis and Staging Pathology tests as well as imaging procedures determine the type, grade and stage of breast cancer. This helps identify the best treatment options and develop a prognosis. Breast cancer types include: Carcinoma, adenocarcinoma or sarcoma. Most breast cancers are carcinomas or adenocarcinomas. In situ or invasive. Invasive or infiltrating cancers have invaded other breast tissues or lymph nodes, while in situ (in place) cancers have not. Ductal, lobular or other. Cancer can arise in the milk ducts (ductal), milk glands (lobular), or stroma (other breast tissues). Breast cancer tumors also have characteristics, including estrogen and progesterone receptor status and HER2 status. These characteristics influence your treatment choices. Finally, breast cancers receive a grade from one to three. The grade depends on how closely the cells still look to normal breast tissue cells. The grade also depends on how quickly the cancer cells are dividing. Lower grade cancers look more like normal cells, are slow growing, are less likely to spread, and tend to have a better prognosis. All of this information helps determine the cancer’s stage from 0, I, II, III or IV. Breast cancer staging helps determine prognosis and guides treatment. Generally, lower stages have better prognoses and survival rates than higher stages. Learn About Your Diagnosis and Treatment Options After your diagnosis, educate yourself so you can be confident about your decisions. Ask a close friend or family member to learn with you, attend your appointments, and be your advocate. A second set of ears and another point of view is invaluable when you are dealing with your new diagnosis. Find the right cancer center, oncologist, and surgeon for you. Look for doctors who are affiliated with a National Cancer Institute-designated Cancer Center, board certified in their specialty, and experienced in treating breast cancer. Then, make a consultation appointment and ask about support groups. Most cancer centers can put you in contact with survivors to learn about their experiences. Before making a final decision, consider getting a second opinion. Second opinions can validate your original plan and reinforce your confidence in your first doctor. They can give you more insight into your cancer and your treatment options. You can search www.healthgrades.com for an oncologist, as well as search for doctors who treat breast cancer specifically. Treatment Your treatment options will depend on your cancer type, its stage, and your personal preference. Surgery is usually an option for most stages. However, your stage can influence whether or not you are a candidate for breast-conserving surgery. Breast-conserving surgery is either a lumpectomy or partial mastectomy, where the surgeon takes a small section of breast tissue. Mastectomy is another surgical option and there are a few different types: Simple or total mastectomy removes all breast tissue, including the skin and nipple, but leaves underarm lymph nodes and underlying chest muscle intact. Skin-sparing mastectomy is a simple mastectomy, but it leaves the overlying skin (except the nipple) intact. A variation is a nipple-sparing mastectomy, which leaves the nipple along with the overlying skin. Modified radical mastectomy is a simple mastectomy, but also removes the underarm lymph nodes. Radical mastectomy removes all breast tissue, underarm lymph nodes, and underlying chest muscle. Talk to your surgeon about breast reconstruction surgery. Some surgeons perform reconstruction during the same procedure, while others recommend separate procedures. Other forms of treatment include radiation, chemotherapy, hormone receptor therapy, and targeted immune therapy for HER2. Treatments after surgery are adjuvant therapy to kill any stray cancer cells and keep the cancer from returning. Treatments can also be neoadjuvant, which is treatment before surgery to shrink the tumor size and decrease the extent of surgery. After Treatment Once you’ve completed treatment, it’s important to keep your follow-up appointments. In general, you’ll see your doctor every three to six months initially. Then your appointments will be less frequent, until they are yearly at five years post-treatment. Talk to your doctor about quality of life issues during these appointments. These include fatigue, insomnia, maintaining a healthy weight, intimacy, menopause, and having children after breast cancer. Eating healthy food, limiting alcohol, and continuing your normal health screenings are all important for long-term recovery. Your doctor will also monitor you for signs that the cancer has returned. If your doctor suspects a problem, you may need imaging exams, bone scans, biopsies, or other tests. Fear of cancer returning is a common worry for breast cancer survivors. Many women find help dealing with these feelings through support groups. Recurrent cancer treatment will depend on the cancer’s location and your previous treatments.