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Tests and diagnosis
By Mayo Clinic staffBecause male breast cancer is rare, routine screening mammograms (mammography) generally aren't recommended for men. If, however, you have a strong family history of breast cancer, consider talking to your doctor about developing a breast-screening program.
If your doctor suspects breast cancer, to diagnose your condition he or she may conduct a number of tests including breast examination (clinical breast exam), mammograms (mammography) or other tests:
- Clinical breast exam. During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you missed and will assess how large the lumps are, how they feel, and how close they are to your skin and muscles. Your doctor will also examine the rest of your body for signs that the cancer has spread, such as an enlarged liver or lymph nodes.
- Mammogram. A mammogram uses a series of X-rays to show images of your breast tissue. This test may be even more accurate in men than in women, because men don't have dense breast tissue that can make it difficult to distinguish abnormal from normal tissue or breast cysts. During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes the X-rays. If you find the compression too uncomfortable, tell the technician.
- Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures within the body.
- Nipple discharge examination. Your doctor may collect nipple discharge if you're experiencing it. The discharge is then examined for cancerous cells.
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Biopsy. A biopsy is the only way for your doctor to know whether a lump or abnormality is cancer. Biopsies can provide important information about an unusual breast change and help determine whether treatment is needed and, if so, the type of treatment required. To obtain a tissue sample, your doctor may use one of several procedures.
Fine-needle aspiration biopsy is used for lumps you or your doctor can feel. During the procedure your doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then sends the cells to a lab for analysis.
In core needle biopsy, a radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump. A number of samples, each about the size of a grain of rice, may be taken, and a pathologist then analyzes them for malignant cells. The advantage of a core needle biopsy is that it removes tissue, rather than just cells, for analysis.
In surgical biopsy, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is larger, only a sample will be taken (incisional biopsy). The biopsy is generally performed on an outpatient basis in a clinic or hospital.
- Estrogen and progesterone receptor tests. If a biopsy reveals malignant cells, your doctor will recommend additional tests — such as estrogen and progesterone receptor tests — on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. About 90 percent of male breast cancers have estrogen receptors, and more than 80 percent have progesterone receptors. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these cells and stimulating growth.
- HER2 testing. If the biopsy shows malignant cells, your doctor may also test the sample for the presence of a protein called human epidermal growth factor receptor-2 (HER2), which promotes the growth of cancer cells. About 30 percent of male breast cancers have too much of this protein. Such cancers are usually more aggressive, growing and spreading more quickly than do other breast cancers. Once identified, this type of cancer is treated with a drug called trastuzumab (Herceptin). This medication keeps the protein from stimulating the growth of breast cancer cells.
Staging tests
If your doctor finds cancer, he or she will examine you further to determine if and how far the cancer has spread. Staging tests help determine the size and location of your cancer and whether it has spread. They also help your doctor determine the best treatment for you. Cancer is staged using the numbers 0 through IV:
- Stage 0 cancers are also called noninvasive or in situ (in one place) cancers. Although they haven't spread to other parts of your body or invaded normal breast tissue, it's important to have them removed, because they eventually can become invasive cancers. Finding and treating a cancerous lump at this stage offers the best chance for a full recovery.
- Stage I to IV cancers are invasive tumors that have the ability to spread to other areas. A stage I cancer is small and well localized and has a very successful treatment rate. But the higher the stage number, the lower the chances of cure. By stage IV, the cancer has spread beyond your breast to other organs, such as your bones, lungs or liver. Although it may not be possible to eliminate the cancer at this stage, its spread and some symptoms may be controlled with radiation, hormonal therapy, chemotherapy or all three.
Tests to determine a cancer's spread may include:
- Chest X-ray. Your doctor may take a chest X-ray to see whether the cancer has spread to your lungs.
- Computerized tomography. A CT scan is an X-ray technique that produces more-detailed images of your internal organs than do conventional X-ray exams. Conventional X-ray exams produce 2-D images. But CT uses an X-ray-sensing unit that rotates around your body and a large computer to create cross-sectional images (like slices) of the inside of your body. A CT scan can help your doctor see if cancer has spread to your liver or other organs. Some CT scans require you to ingest a contrast medium before the scan. A contrast medium blocks X-rays and appears white on images, which can help emphasize some structures in your body.
- Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images. Most MRI machines are large, cylindrical-shaped magnets. The strong magnetic field is produced by passing an electric current through wire loops or coils, which are located inside a protective housing. Other coils in the housing send and receive radio waves. When you're in the machine, your body produces very faint signals in response to the radio waves. These signals are detected by coils within the machine, or by additional coils designed to surround a specific body part needing examination. A computer then processes the signals and generates an image. The collected signals create a composite, 3-D representation of your body.
- Positron emission tomography (PET) scan. Unlike other scanning techniques, a PET scan doesn't produce clear structural images of organs. Instead, it shows images containing areas of more or less intense color to provide information about chemical activity within certain organs and tissues. Tumors often use more energy than healthy tissues do and may absorb more of a radioactive tracer, which allows the tumors to appear on the scan.
Genetic testing
The discovery of BRCA2 and other genes that may increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. A simple blood test can help identify defective BRCA genes, but it's not 100 percent accurate. And it's important to know that having a defective BRCA gene doesn't mean you'll get breast cancer. In addition, test results can't determine at what age you might develop cancer, how aggressively the cancer might progress or what your risk of death might be.
In general, testing is most beneficial if the results will help you make a decision about how you might best reduce your chance of developing breast cancer, such as modifying your lifestyle or closer screening. It may also help family members decide if they should be tested or evaluated for the presence of an abnormal gene. Be sure to thoroughly discuss all your options with a genetic counselor before any testing is done, so that you can understand the risks and the benefits of such testing.
