Breast cancer staging and diagnosis

Staging is the process of determining the extent of a cancer and its spread in the body. It is used to determine the appropriate therapy and to predict chances of survival for the patient. To determine if the cancer has spread, several different imaging techniques are used. These include mammograms, CT scans, PET scans etc. More information on screening can be found on healthcarevilla.com.

Staging system is used to summarize the extent and spread of cancer in a standard way. It can then be used to determine the treatment most appropriate for the type of cancer a patient has. The major prognostic factors used by the American Joint Committee on Cancer to divide breast cancer into clinical stages are as follows:

·         Stage 0: ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) (5 year survival rate: 92%).

·         Stage I: invasive carcinoma 2 cm or less in diameter (including  carcinoma in situ with microinvasion) without lymph node involvement (or only metastasis <0.02 cm in diameter) (5 year survival rate: 87%).

·         Stage II: invasive carcinoma 5 cm or less in diameter with up to 3 involved axillary nodes or invasive carcinoma greater than 5 cm without lymph node involvement (5 year survival rate: 75%).

·         Stage III: invasive carcinoma 5 cm or less in diameter with four or more involved axillary lymph nodes; invasive carcinoma greater than 5 cm in diameter with nodal involvement; invasive carcinoma with ten or more involved axillary nodes; invasive carcinoma with involvement of ipsilateral internal mammary lymph nodes; or invasive carcinoma with skin involvement, chest wall fixation, or clinical inflammatory carcinoma (5 year survival rate: 46%)

·         Stage IV: any breast cancer with distant metastasis (5 year survival rate: 13%).

Breast cancers with similar stages often require similar treatments.

Although breast cancer can be diagnosed by its signs and symptoms, the American Cancer Society has put forward the following recommendations:

1)      Women age 40 and older should have a screening mammogram every year and should continue to do so as long as they are in good health. The use of screening mammography has made it possible to detect many of the cancers before they cause any symptoms. However, as in many tests, mammograms have limitations and may miss some cancers.

2)      Women should have a clinical breast exam (CBE) as part of regular health exams by a health care professional about every 3 years for women in their 20s and 30s and every year for women 40 years of age and over. CBE are an important tool to detect changes in the breasts and also trigger a discussion with the health care professionals about early cancer detection and risk factors.

3)      Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health care professional. The goal is to feel comfortable with the way the woman's breasts feel and look and, therefore, detect changes.

4)      Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15% to 20%) should talk to their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.

Other tests include CT scans, ultrasounds, ductograms and biopsy. Newer emerging procedures are also considered helpful in providing a diagnosis: Scintimammography, also known as nuclear medicine breast imaging, is an examination that may be used to investigate a breast abnormality that has been discovered on mammography. Scintimammography is also known as Breast Specific Gamma Imaging (BSGI). The procedure is noninvasive and involves the injection of a radiotracer, or drug that emits radioactivity, into the patient. Digital tomosynthesis creates a 3-dimensional picture of the breast using x-rays. However, currently this procedure is available only for research purposes.