Breast cancer diagnosis and staging

We use the latest imaging technology including 3D mammography or tomosynthesis to help us properly diagnose breast cancer.

Diagnostic breast imaging may include ultrasound of the breast and possibly the lymph nodes under the arm. A breast MRI may be used to get additional information.

Leading-edge technology means better diagnostic accuracy

Because no two people develop breast cancer in the same way, we offer a wide array of leading-edge technology to properly evaluate your situation. We use that information to create personalized treatment options. Any combination of these tests and procedures helps us diagnose and classify (stage) cancer:

Breast ultrasound. Uses sound waves to make an image of areas inside the body; shows whether a lump is solid or a fluid-filled cyst. Ultrasound can be used to evaluate the breast tissue as well as the lymph nodes in the armpit area.

Mammogram. A form of X-ray that examines breast tissue for abnormal areas. Digital mammography is faster and uses less radiation than film mammography, and it records images directly to a computer, which means images can be stored and sent electronically so your entire care team can view them. Digital mammograms are generally more effective at detecting cancer in younger women, women with dense breasts, and pre-menopausal women. 3-D mammography, available at UCHealth since 2012, creates three-dimensional images of the breast and helps find cancers that may be missed by other devices

MRI (magnetic resonance imaging). Uses a magnetic field instead of X-rays to provide detailed images of body structures. For women with high genetic risk of breast cancer, screening trials show that combining breast MRI with mammography is the most effective way to find breast tumors.

Breast biopsy

We remove cells or tissues for viewing under a microscope to check for signs of cancer. The types of biopsy used to diagnose breast issues include:

  • Fine needle aspiration (FNA). We remove individual cells for viewing under a microscope. Often, you receive the results for this test at UCHealth on the same day you visit our clinic.
  • Core biopsy. We remove a tissue sample about the size of pencil lead. Results typically take two to five days. Core needle biopsy is the preferred biopsy technique to evaluate abnormal findings on a mammogram or ultrasound.
  • Excisional biopsy. Surgical removal of a tissue sample from an area in question. Results typically take five to seven days. Excisional biopsies are rarely performed as the first step since needle biopsies provide highly accurate information and are less invasive than surgery.
  • Genetic test. We analyze a sample of blood or saliva. This helps us detect BRCA 1 and BRCA 2 early.

Staging. Once you have been diagnosed with breast cancer, our specialists need to know where it may have spread. This is the “stage” of the cancer. The lower the number, the less it has spread. Knowing the stage allows your medical team to determine the best possible treatment plan for you.

UCHealth follows the American Joint Committee on Cancer (AJCC) cancer staging system. The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This ensures that the results of treatment for all people can be compared and understood.

Your doctor will determine the stage of your cancer. Breast cancer staging looks at the size of the tumor in the breast and whether it has traveled to lymph nodes or other parts of the body. More recently, staging includes looking at the grade of the tumor and the biology of the tumor. Every breast cancer is examined for estrogen and progesterone receptors and HER2/neu. These receptors provide important information about the prognosis of the breast cancer and allowed a more personalized and tailored treatment.

Stage 0

Non-invasive breast cancers, such as ductal carcinoma in situ (DCIS). There is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started or getting through to or invading neighboring normal tissue.

Stage I

Invasive breast cancer where cancer cells are breaking through to or invading normal surrounding breast tissue. Stage I is divided into subcategories IA and IB.

  • IA: the tumor measures up to 2 cm and the cancer has not spread outside the breast; no lymph nodes are involved.
  • IB: there is no tumor in the breast; instead, small groups of cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes, or there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells—larger than 0.2 mm but not larger than 2 mm—in the lymph nodes.

Stage II

Stage II is invasive breast cancer, and is divided into subcategories IIA and IIB.

  • IIA: no tumor can be found in the breast, but cancer—larger than 2 mm—is found in one to three axillary lymph nodes or in the lymph nodes near the breast bone; the tumor measures 2 cm or smaller and has spread to the axillary lymph nodes; the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes. Other factors may apply.
  • IIB: the tumor is larger than 2 cm but no larger than 5 centimeters; small groups of breast cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes; the tumor is larger than 2 cm but no larger than 5 cm; cancer has spread to one to three axillary lymph nodes or to lymph nodes near the breastbone; the tumor is larger than 5 cm but has not spread to the axillary lymph nodes. Other factors may apply.

Stage III

Stage III is invasive breast cancer, and is divided into subcategories IIIA, IIIB, and IIIC.

  • IIIA: no tumor is found in the breast or the tumor may be any size, and cancer is found in four to nine axillary lymph nodes or in the lymph nodes near the breastbone; the tumor is larger than 5 centimeters cm; small groups of breast cancer cells—larger than 0.2 mm but not larger than 2 mm—are found in the lymph nodes and the tumor is larger than 5 cm; cancer has spread to one to three axillary lymph nodes or to the lymph nodes near the breastbone. Other factors may apply.
  • IIIB: the tumor may be any size and has spread to the chest wall and/or skin of the breast and caused swelling or an ulcer and may have spread to up to nine axillary lymph nodes, or may have spread to lymph nodes near the breastbone. Other factors may apply.
  • IIIC: there may be no sign of cancer in the breast, or if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast and the cancer has spread to 10 or more axillary lymph nodes; the cancer has spread to lymph nodes above or below the collarbone; the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone. Other factors may apply.

Stage IV

Cancer has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

Source: American Cancer Society

Hormone receptors

As part of your testing, you’ll be checked to see if your breast cancer cells have “hormone receptors” — proteins that receive signals that tell the cancer cells to grow — for the two hormones estrogen and progesterone. Breast cancer cells can contain receptors for one, both, or neither of these hormones.

  • Estrogen receptor. If the breast cancer has receptors for estrogen, it’s called estrogen receptor positive (or ER positive.) If the breast cancer doesn’t have receptors for estrogen, it’s called estrogen receptor negative (or ER negative.)
  • Progesterone receptor. If breast cancer has receptors for progesterone, it’s called progesterone receptor positive (or PR positive.) If breast cancer doesn’t have receptors for progesterone, it’s called progesterone receptor negative (or PR negative.)

Breast cancer that has one or both receptors is called hormone-receptive positive (also called hormone-positive or HR+). Breast cancer that contains neither the estrogen nor the progesterone receptor is called hormone-receptor negative (also called hormone-negative or HR-).

Treatments. For ER positive, HR positive or breast cancer that’s positive for both estrogen and progesterone receptors, treatment could include hormone therapy — drugs that lower estrogen levels or block estrogen receptors. For HR negative, ER negative and PR negative breast cancers, hormone therapy drugs are not effective treatment. Instead, treatments including surgery, radiation therapy, and chemotherapy may be used.

HER2/neu positive. HER2/neu is a gene in breast cells that produces a protein called HER2 that normally controls growth in healthy breast cells. When too much of this protein is produced, it often results in a cancer called HER2 positive. HER2 positive breast cancer is typically treated with therapy drugs that help block HER2 receptors.

Luminal tumors (A&B)

  • Luminal A tumors are hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), HER2 negative. Luminal A cancers grow slower than Luminal B cancers and tend to have a better prognosis.
  • Luminal B tumors breast cancer are hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), and either HER2 positive or HER2 negative. Luminal B cancers generally grow faster than luminal A cancers and they tend to have a slightly worse prognosis.

Triple negative breast cancer

Some breast cancers are called triple negative because they don’t have receptors for estrogen, progesterone, or HER2. Because they don’t respond to drugs that target estrogen, progesterone, or HER2 receptors, they can be harder to treat. Chemotherapy is the main treatment option.

Neoadjuvant therapy

When treatment is given before surgery, it’s called neoadjuvant therapy. It can help down stage the disease in the breast and minimize surgical impact and can take the form of chemotherapy, HER2-targeted therapy or hormone therapy.