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Tests and diagnosis

By Mayo Clinic staff

If your doctor suspects recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, you'll likely need further imaging tests and a biopsy.

The following tests may be used to help diagnose recurrent breast cancer:

  • Breast ultrasound. Ultrasound uses sound waves to produce images of the inside of the body. For women who've had lumpectomy, breast ultrasound may be used to evaluate an abnormality seen on a mammogram or found during a physical exam of your breast.
  • Magnetic resonance imaging (MRI). MRI uses a magnet and radio waves to make images of the inside of your body. MRI may be able to detect abnormal areas within the breast, chest wall, lymph node areas, and blood vessels and nerves around the breast and armpit. The MRI by itself can't tell the difference between cancer and a benign process, but it can help your doctor determine the best areas for a biopsy or further testing. Not all women with a local recurrence benefit from having an MRI. Discuss your specific situation with your doctor.
  • Computerized tomography (CT). A CT scan is a type of computerized X-ray that provides more-detailed pictures than do ordinary X-rays. CT scans of your chest, abdomen, pelvis, bones and head can help look for evidence of cancer that's spread to your internal mammary lymph nodes or to distant sites, such as the bones, lung or liver.
  • X-rays. Chest X-rays may detect a recurrence in your lungs, while bone X-rays may be able to detect cancer in your bones.
  • Bone scan. A bone scan can provide an image of your whole skeleton and may detect cancer recurrence in your bones. During a bone scan, a small, safe amount of radioactive material (tracer) is injected into your bloodstream. The tracer binds to your bone cells. Areas with cancer absorb more of the tracer and "light up" on the scan.
  • Positron emission tomography (PET). A PET scan also uses radioactive material injected into your body to produce an image. Tumors often absorb greater amounts of the material and show up more prominently on the scan. A PET scan or hybrid PET/CT scan of your whole body may be used to look for areas of cancer recurrence.

Biopsy
A biopsy — a small sample of tissue removed for analysis in the laboratory — is needed to confirm the diagnosis of recurrent breast cancer. The tissue specimen will be tested for the presence of estrogen and progesterone receptors. A breast cancer that makes receptors for the female hormones estrogen and progesterone (hormone receptor positive cancer) can be treated with hormone therapy. The hormone receptor status of your cancer may change with a recurrence.

The tissue is also tested for extra amounts of the HER2 protein, which some breast cancers overproduce. Cancers that are HER2 positive can be treated with biotherapies that target this protein.

Blood tests
A complete blood count and liver function tests can help evaluate how your body is doing and may help guide future treatments. Doctors often use blood tests that measure breast cancer tumor markers to follow the course of cancer. But tumor markers aren't specific for a cancer recurrence. These tests aren't recommended for looking for a recurrence, as they aren't always reliable.

Complications Preparing for your appointment
References
  1. Oh S et al. Quality of life of breast cancer survivors after a recurrence: A follow-up study. Breast Cancer Res Treat. 2004; 87:45-57.
  2. Hayes DF. Overview of Treatment for Locally Advanced, Recurrent, and Metastatic Breast Cancer. http://uptodateonline.com/index. Accessed Nov. 12, 2008.
  3. American Cancer Society, Living With Uncertainty: The Fear of Cancer Recurrence. http://www.cancer.org/docroot/MLT/content/MLT_4_1x_Living_With_Uncertainty_-_The_Fear_of_Cancer_Recurrence.asp. Accessed May 19, 2009.
  4. Punglia RS et al. Local therapy and survival in breast cancer. N Engl J Med. 2007; 356:2399-2405.
  5. UpToDate, Hirsch A, Management of Locoregional Recurrence of Breast Cancer after Breast-Conserving Therapy, July 31, 2007, accessed November 12, 2007, http://uptodateonline.com/utd/content/topic.do?topicKey=breastcn/23524&view=print.
  6. UpToDate, Hirsch A, Management of Locoregional Recurrence of Breast Cancer after Mastectomy, May 10, 2007, accessed November 12, 2007, http://uptodateonline.com/utd/content/topic.do?topicKey=breastcn/28927&view=print.
  7. Debled M et al. Prognostic factors of early distant recurrence in hormone receptor-positive, postmenopausal breast cancer patients receiving adjuvant tamoxifen therapy: Results of a retrospective analysis. Cancer. 2007; 109:2197-2204. Accessed May 19, 2009.  http://www3.interscience.wiley.com/cgi-bin/fulltext/114214630/PDFSTART
  8. Geiger AM et al. Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer. 2007; 109:966-974. http://www3.interscience.wiley.com/cgi-bin/fulltext/114082491/PDFSTART Accessed May 19, 2009.
  9. Freedman GM et al. Identifying breast cancer patients most likely to benefit from aromatase inhibitor therapy after adjuvant radiation and tamoxifen. Cancer. 2006; 107:2552-2558.
  10. Hayes DF et al. Follow-up of patients with early breast cancer. N Engl J Med. 2007; 356:2505-2513. http://content.nejm.org/cgi/content/full/356/24/2505. Accessed May 19, 2009.
  11. National Breast Cancer Coalition, Gene-Expression Profile Testing, March 2007, accessed October 30, 2007, http://www.stopbreastcancer.org//index.php?option=com_content&task=view&id=161&Itemid=178.
  12. American Cancer Society, Breast Cancer Recurrence Test Gets FDA Nod, February 7, 2007, accessed May 8, 2008, http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Breast_Cancer_Recurrence_Test_Gets_FDA_Nod.asp.
  13. U.S. Food and Drug Administration, FDA Clears Breast Cancer Specific Molecular Prognostic Test, February 6, 2007, accessed October 5, 2007, http://www.fda.gov/bbs/topics/NEWS/2007/NEW01555.html.
  14. Buchanan CL, Locoregional Recurrence after Mastectomy: Incidence and Outcomes, Journal of the American College of Surgeons, October 2006, 469-474.
  15. Coombes RC, Survival and Safety of Exemestane versus Tamoxifen after 2-3 Years' Tamoxifen (Intergroup Exemestane Study): A Randomised Controlled Trial, The Lancet, February 17, 2007, 559-570.
  16. Thiebaut ACM, Dietary Fat and Breast Cancer: Contributions From a Survival Trial, Journal of the National Cancer Institute, December 20, 2006, 1753-1755.
  17. Pierce JP, Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer: The Women's Healthy Eating and Living (WHEL) Randomized Trial, JAMA, July 18, 2007, 289-298.

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May 27, 2009

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