If you have found a lump in your breast or had an abnormal mammogram, a breast cancer diagnosis is the next step. At Penn Medicine, our diagnostic specialists use the latest imaging, testing, and procedures to thoroughly evaluate areas of concern in the breast. We identify the characteristics of every breast cancer to create personalized treatment plans based on your unique breast cancer diagnosis.
How is breast cancer diagnosed?
A breast cancer diagnosis is performed using breast imaging after suspicious symptoms, like a breast lump, or an abnormal mammogram are reported. Types of imaging used include 3D mammograms, ultrasounds, and MRI. After imaging tests, a breast biopsy is used to confirm the findings.
We look at breast tissue from every angle before delivering a diagnosis. If you have had imaging performed somewhere else, our specialized radiologists interpret your previous scans and order additional imaging when necessary. The tools we use to diagnose breast cancer include the following.
Advanced breast imaging is used to get a better look at suspicious tissue. Our expert radiologists specialize in breast cancer and use leading-edge technology including:
- Diagnostic 3D mammogram: Specialized X-ray techniques, such as 3D imaging (digital breast tomosynthesis), may provide more detail than a standard 2D mammogram. We use 3D mammography to view the breast in individual “slices” and identify abnormal tissue.
- Ultrasound: We use ultrasound in addition to mammogram when more information is needed. This technology uses sound waves instead of radiation to create images of the breast.
- Breast MRI: Magnetic resonance imaging (MRI) uses radio waves and strong magnets to provide more information than a mammogram or ultrasound. It helps us identify breast cancer and determine a tumor’s location, size, and stage.
A breast biopsy can confirm a breast cancer diagnosis after imaging. During a biopsy, the radiologist or surgeon removes a small amount of breast tissue for inspection. Our specialized breast pathologist then thoroughly examines the tissue. We use biopsy to determine whether the breast tissue contains cancer cells and, if so, how advanced the cancer is.
Certain tumor characteristics affect the growth of breast cancer. Identifying these defining factors helps us treat cancer more effectively. The two most common characteristics we look for are:
- Hormone receptor status: If cancer is hormone-receptor positive, it means estrogen and/or progesterone help the cancer grow.
- HER2 status: HER2-positive breast cancer has an excess of human epidermal growth factor receptor 2 (HER2), grows quickly, and tends to recur (come back).
If cancer tests negative for hormone receptors and HER2, we call it triple negative breast cancer. That means the cancer does not rely on estrogen, progesterone, or HER2 protein to grow.
Genomic testing, also called gene expression profiling, looks at the patterns of various genes. Those patterns may help predict whether early-stage breast cancer is likely to recur (come back). This information also helps us determine which patients may benefit from chemotherapy following breast surgery. Once treatment is complete, the 2-PREVENT Breast Cancer Translational Center of Excellence offers research and clinical trials to help individuals identify and manage any breast cancer recurrence.
If cancer is common in your family, you may have an increased risk of hereditary breast or other types of cancer. Clinically licensed genetic counselors at the MacDonald Risk Evaluation Center help you determine if you are a candidate for genetic testing. We conduct genetic risk evaluation for cancer with or without a cancer diagnosis. If you have already been diagnosed with cancer, the results of genetic testing:
- May affect breast cancer treatment
- Establish whether you have an increased risk of developing a second cancer
- Provide your family with essential information
The two genetic mutations most often linked to hereditary breast cancer are BRCA1 and BRCA2. If you have a BRCA gene mutation or a BRCA-related cancer the Basser Center for BRCA helps you and your family navigate treatment or manage your breast cancer risk factors. We also offer education, genetic counseling, and resources for your family as well as research and clinical trials related to hereditary cancer.