Breast cancer occurs about once in every 3,000 pregnancies. It occurs most often in women aged 32 to 38 years. The cancer rarely affects the fetus itself but our actions to identify and control the cancer might, so it requires specialized care. Learn about solutions that can preserve the health of both you and your baby.
Concerns about Breast Cancer when Pregnant
Image by TheVisualMD
Breast Cancer During Pregnancy
Pregnancy and Breast Cancer Cells
Image by TheVisualMD
Pregnancy and Breast Cancer Cells
Pregnancy and Breast Cancer Cells
Image by TheVisualMD
General Information About Breast Cancer Treatment During Pregnancy
KEY POINTS
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Sometimes breast cancer occurs in women who are pregnant or have just given birth.
Signs of breast cancer include a lump or change in the breast.
It may be difficult to detect (find) breast cancer early in pregnant or nursing women.
Breast exams should be part of prenatal and postnatal care.
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
If cancer is found, tests are done to study the cancer cells.
Certain factors affect prognosis (chance of recovery) and treatment options.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluidcalled lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fight infectionand disease. Groups of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
Source: National Cancer Institute (NCI)
Additional Materials (17)
Pregnancy after Breast Cancer: Help us make it happen!
Video by Rethink Breast Cancer/YouTube
Breast Cancer During Pregnancy: One Woman's Story | Dana-Farber Cancer Institute
Video by Dana-Farber Cancer Institute/YouTube
Fertility after Breast Cancer: Joanna's Story
Video by Rethink Breast Cancer/YouTube
Fertility After Breast Cancer: Baby Time Study
Video by Rethink Breast Cancer/YouTube
Breast Cancer in Pregnancy | Gina's Story
Video by Johns Hopkins Medicine/YouTube
Breast Cancer Risks
Video by Lee Health/YouTube
Orlando Woman Cancer Free after being Diagnosed with Breast Cancer During Pregnancy
Video by AdventHealth Florida/YouTube
Pregnancy after a breast cancer diagnosis: Understanding risks
Video by MD Anderson Cancer Center/YouTube
Mother and baby healthy after breast cancer treatment during pregnancy
Video by Siteman Cancer Center/YouTube
Study Finds Pregnancy Safe After Breast Cancer
Video by Associated Press/YouTube
Breast Cancer Extended Environmental Exposures - Windows of Susceptibility: Pregnancy
Video by University of California Television (UCTV)/YouTube
Pregnant with breast cancer video
Video by NCCN/YouTube
Endocrine therapy in pregnant women with breast cancer
Video by EMG-Health/YouTube
Cancer Treatment During Pregnancy
Video by MDedge: news and insights for busy physicians/YouTube
Fertility Concerns After Breast Cancer
Video by Johns Hopkins Medicine/YouTube
Chemotherapy and pregnancy
Video by MD Anderson Cancer Center/YouTube
Breastfeeding NICU Preemies: Step 2: First Time at the Breast
Video by UC San Diego Health/YouTube
1:14
Pregnancy after Breast Cancer: Help us make it happen!
Rethink Breast Cancer/YouTube
8:37
Breast Cancer During Pregnancy: One Woman's Story | Dana-Farber Cancer Institute
Dana-Farber Cancer Institute/YouTube
3:31
Fertility after Breast Cancer: Joanna's Story
Rethink Breast Cancer/YouTube
4:25
Fertility After Breast Cancer: Baby Time Study
Rethink Breast Cancer/YouTube
2:36
Breast Cancer in Pregnancy | Gina's Story
Johns Hopkins Medicine/YouTube
1:50
Breast Cancer Risks
Lee Health/YouTube
0:55
Orlando Woman Cancer Free after being Diagnosed with Breast Cancer During Pregnancy
AdventHealth Florida/YouTube
1:01
Pregnancy after a breast cancer diagnosis: Understanding risks
MD Anderson Cancer Center/YouTube
3:34
Mother and baby healthy after breast cancer treatment during pregnancy
Siteman Cancer Center/YouTube
2:05
Study Finds Pregnancy Safe After Breast Cancer
Associated Press/YouTube
58:58
Breast Cancer Extended Environmental Exposures - Windows of Susceptibility: Pregnancy
University of California Television (UCTV)/YouTube
8:57
Pregnant with breast cancer video
NCCN/YouTube
2:51
Endocrine therapy in pregnant women with breast cancer
EMG-Health/YouTube
4:18
Cancer Treatment During Pregnancy
MDedge: news and insights for busy physicians/YouTube
2:52
Fertility Concerns After Breast Cancer
Johns Hopkins Medicine/YouTube
0:54
Chemotherapy and pregnancy
MD Anderson Cancer Center/YouTube
9:07
Breastfeeding NICU Preemies: Step 2: First Time at the Breast
UC San Diego Health/YouTube
Occurrence
Pregnant woman vector illustration in Breast cancer colors
Image by Free_SVG
Pregnant woman vector illustration in Breast cancer colors
Pregnant woman vector illustration in Breast cancer colors
Image by Free_SVG
Sometimes Breast Cancer Occurs in Women Who Are Pregnant or Have Just Given Birth
Breast cancer occurs about once in every 3,000 pregnancies. It occurs most often in women aged 32 to 38 years. Because many women are choosing to delay having children, it is likely that the number of new cases of breast cancer during pregnancy will increase.
Source: National Cancer Institute (NCI)
Additional Materials (1)
Pregnant Woman with Fetus after Conception 0 Months three quarter view
Pregnant Woman with Fetus at 3 Months three quarter view
Pregnant Woman with Fetus at 4 Months
Pregnant Woman with Fetus at 6 Months three quarter view
Pregnant Woman with Fetus at 9 Months three quarter view
Signs of Breast Cancer Include a Lump or Change in the Breast
These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:
A lump or thickening in or near the breast or in the underarm area.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast.
A nipple turned inward into the breast.
Fluid, other than breast milk, from the nipple, especially if it's bloody.
Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
Dimples in the breast that look like the skin of an orange, called peau d’orange.
Source: NIH: National Cancer Institute
Additional Materials (2)
Breast cancer - Early Signs - Overview
Early signs of possible breast cancer
Image by Raphseck
Breast Cancer in Pregnancy | Gina's Story
Video by Johns Hopkins Medicine/YouTube
Breast cancer - Early Signs - Overview
Raphseck
2:36
Breast Cancer in Pregnancy | Gina's Story
Johns Hopkins Medicine/YouTube
Difficulty Detecting Breast Cancer Early in Pregnant or Nursing Women
Pregnancy and breast cancer cells
Image by TheVisualMD
Pregnancy and breast cancer cells
Pregnancy and breast cancer cells
Image by TheVisualMD
It May Be Difficult to Detect (Find) Breast Cancer Early in Pregnant or Nursing Women.
The breasts usually get larger, tender, or lumpy in women who are pregnant, nursing, or have just given birth. This occurs because of normal hormone changes that take place during pregnancy. These changes can make small lumps difficult to detect. The breasts may also become denser. It is more difficult to detect breast cancer in women with dense breasts using mammography. Because these breast changes can delay diagnosis, breast cancer is often found at a later stage in these women.
Breast exams should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Women should also receive clinical breast exams during their regular prenatal and postnatal check-ups. Talk to your doctor if you notice any changes in your breasts that you do not expect or that worry you.
Source: National Cancer Institute (NCI)
Tests
Mammogram with Subtle Cancer
Image by Dr. Dwight Kaufman. National Cancer Institute / Unknown Photographer
Mammogram with Subtle Cancer
A mammogram showing subtle cancer.
Image by Dr. Dwight Kaufman. National Cancer Institute / Unknown Photographer
Tests That Examine the Breasts Are Used to Detect (Find) and Diagnose Breast Cancer.
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
The following tests and procedures may be used:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to look at later.
Mammogram: An x-ray of the breast. A mammogram can be done with little risk to the unborn baby. Mammograms in pregnant women may appear negative even though cancer is present. Mammography. The breast is pressed between two plates. X-rays are used to take pictures of breast tissue.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.
There are four types of breast biopsies:
Excisional biopsy: The removal of an entire lump of tissue.
Core biopsy: The removal of tissue using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.
If cancer is found, tests are done to study the cancer cells.
Decisions about the best treatment are based on the results of these tests and the age of the unborn baby. The tests give information about:
How quickly the cancer may grow.
How likely it is that the cancer will spread to other parts of the body.
How well certain treatments might work.
How likely the cancer is to recur (come back).
Tests may include the following:
Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen or progesterone receptors than normal, the cancer is called estrogen receptor positive or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone given after the baby is born may stop the cancer from growing.
Human epidermal growth factor type 2 receptor (HER2/neu) test: A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab, after the baby is born.
Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
Oncotype DX : This test helps predict whether stage I or stage II breast cancer that is estrogen receptor positive and node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
MammaPrint: This test helps predict whether stage I or stage II breast cancer that is node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to other parts of the body).
The type of breast cancer.
The age of the unborn baby.
Whether there are signs or symptoms.
The patient’s general health.
Source: National Cancer Institute (NCI)
Additional Materials (4)
Pregnant with breast cancer video
Video by NCCN/YouTube
Mammograms
Document by Office on Women's Health, U.S. Department of Health and Human Services
Understanding Breast Changes: A Health Guide for Women
Explains next steps after an abnormal mammogram result, including information about how conditions are diagnosed and treated.
Document by National Cancer Institute
Having a breast biopsy. A review of the research for women and thier families (2016 report)
This information is right for you if: -- You are a woman. The information in this summary is from
research on women. -- Your doctor has found a breast lump or shadow on your mammogram and has recommended a breast biopsy.
Document by effectivehealthcare.ahrq.gov
8:57
Pregnant with breast cancer video
NCCN/YouTube
Mammograms
Office on Women's Health, U.S. Department of Health and Human Services
Understanding Breast Changes: A Health Guide for Women
National Cancer Institute
Having a breast biopsy. A review of the research for women and thier families (2016 report)
effectivehealthcare.ahrq.gov
BRCA Genetic Test
BRCA Genetic Test
Also called: BRCA Gene Mutation Analysis, BRCA1/2 Testing, BRCA Mutation Testing, BRCA Test, Breast Cancer Susceptibility Genes 1 and 2, Germline BRCA Testing
A BRCA gene test checks for certain changes (mutations) in your BRCA genes. BRCA1 and BRCA2 are called tumor suppressor genes. Certain BRCA mutations may put you at higher risk for getting breast, ovarian, prostate, and other cancers. Not everyone who has a harmful BRCA mutation will get cancer.
BRCA Genetic Test
Also called: BRCA Gene Mutation Analysis, BRCA1/2 Testing, BRCA Mutation Testing, BRCA Test, Breast Cancer Susceptibility Genes 1 and 2, Germline BRCA Testing
A BRCA gene test checks for certain changes (mutations) in your BRCA genes. BRCA1 and BRCA2 are called tumor suppressor genes. Certain BRCA mutations may put you at higher risk for getting breast, ovarian, prostate, and other cancers. Not everyone who has a harmful BRCA mutation will get cancer.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
A negative (normal) result means that the test didn't find any harmful changes in your BRCA genes. How this affects your cancer risk depends on whether you've already had cancer and whether a member of your family has a harmful BRCA variant.
Related conditions
A BRCA gene test uses a sample of your blood, saliva (spit), or cells from inside of your cheek to look for changes in your BRCA1 and BRCA2 genes that may increase your risk of cancer. Changes in your genes are called gene variants or mutations. Not all gene variants are harmful.
Genes are parts of DNA that you inherit from your parents. They carry information that controls what you look like and how your body works. BRCA genes repair damaged DNA in your cells and protect you from getting certain types of cancer. If you have a harmful variant in your BRCA genes, they may not work properly. This increases your risk of getting cancer.
The most common cancers linked to harmful BRCA variants are:
Breast cancer. BRCA is short for breast cancer gene. The increased risk for breast cancer mostly affects females. But the breast cancer risk for males who have a harmful BRCA variant is higher than for other males.
Ovarian cancer. This is cancer of the female reproductive glands where eggs form.
Prostate cancer. This is cancer of the male reproductive gland that makes fluid for semen.
Pancreatic cancer. This is cancer of the pancreas, an organ that helps you digest food and makes important hormones.
Not everyone who has a harmful variant in BRCA1 or BRCA2 will get cancer. And if you find out you have a harmful variant, you may be able to take steps to lower your risk and protect your health.
This test is used to find out if you have harmful changes in your BRCA1 or BRCA2 genes that increase your risk of getting certain cancers, especially breast, ovarian, prostate, and pancreatic cancer.
Harmful BRCA gene variants are rare. They affect only about 0.2 percent of the U.S. population. So, BRCA testing is not recommended for most people.
You and your family members are more likely to have a BRCA1 or BRCA2 variant if either side of your family has a strong history of breast or ovarian cancer. If you're concerned that you may have a harmful variant in the BRCA1 or BRCA2 gene, your health care provider or a genetic counselor can review your personal and family health history to see if you need this test.
In general, it's important to talk with a provider about BRCA testing if your personal or family health history includes:
Breast cancer, especially:
Before age 50
In both breasts
In a male
Triple negative breast cancer which has limited treatment options, including chemotherapy and/or surgery
Cancer of the ovaries, fallopian tubes (tubes connecting the ovaries to the uterus), or peritoneum (tissue that covers your belly organs).
Prostate cancer that spreads to other parts of the body (metastatic cancer).
Pancreatic cancer.
Ashkenazi (Eastern European) Jewish ancestry. BRCA variants are much more common in this group compared with the general population. They are also more common in people from other parts of Europe, including Iceland, Norway, and Denmark.
A relative already diagnosed with a harmful gene variant in BRCA1 or BRCA2.
When you think about your family health history, consider all breast, ovarian, prostate, and pancreatic cancers on both sides of your family. And consider the health of your grandparents, parents, aunts and uncles, siblings, half-siblings, nieces and nephews, and grandchildren.
A BRCA test can use either a sample of your blood, saliva, or a cheek swab.
For a blood test: A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a saliva test: You'll spit into a container or use a cotton pad to soak up some saliva.
For a cheek swab: A health care professional will wipe the inside of your cheek with a small tool to remove some cells. You may have the option of doing it yourself.
An at-home test kit is available to buy without a prescription. It allows you to collect a saliva sample to send to a lab for testing. The test checks for the three most common harmful variants in BRCA genes. But there are more than 1000 known variants. So, a home test can't rule out the possibility that you have a variant. Ask your provider whether an at-home test is right for you.
For a blood test: You don't need any special preparations.
For a saliva test: A half hour before the test, you may need to stop eating, drinking, or smoking. Follow all the instructions your provider gives you or the instructions in an at-home kit.
For a cheek swab: You may be asked to rinse your mouth before the test.
With any type of genetic test, you may want to meet with a genetic counselor first to see if testing is right for you. Your counselor can explain the pros and cons of learning more about your cancer risk. After your test, a counselor can help with the medical and emotional impact that your results may have on you and your family.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
There are no risks linked to providing a saliva sample or having a cheek swab.
Your provider or genetic counselor will need to explain how your results affect your risk for certain cancers. That's because the meaning of your test results depends on the exact type of variant you have and your personal and family health history.
In general, your results may be reported using these terms:
A negative (normal) result means that the test didn't find any harmful changes in your BRCA genes. How this affects your cancer risk depends on whether you've already had cancer and whether a member of your family has a harmful BRCA variant.
An uncertain result may also be called a "variant of uncertain significance (VUS)". It means that a variant in your BRCA genes was found, but researchers don't know whether that variant causes cancer.
A positive result may also be called a "likely pathogenic variant." It means that you have a harmful gene variant that is known to increase the risk of certain cancers. But the test cannot tell whether you will develop cancer.
If your results show that you have a harmful variant in your BRCA genes, talk with your provider about ways to lower your cancer risk. You may discuss:
Your schedule for cancer screening tests. Should you get tested for cancer sooner and more often than usual? These are important questions for all adults who have a harmful BRCA variant.
Taking certain medicines and/or having surgery to reduce the risk of cancer. Surgery may include removing both breasts and/or the ovaries and fallopian tubes.
BRCA Genetic Test: MedlinePlus Medical Test [accessed on Dec 26, 2023]
BRCA Mutations: Cancer Risk and Genetic Testing Fact Sheet - National Cancer Institute [accessed on Dec 26, 2023]
BRCAssure BRCA1 and 2 Analysis [accessed on Dec 26, 2023]
BRCA Gene Mutation Testing - Testing.com. Nov 9, 2021 [accessed on Dec 26, 2023]
BRCA1 and BRCA2 gene testing: MedlinePlus Medical Encyclopedia [accessed on Dec 26, 2023]
Additional Materials (13)
Chances of Developing Breast Cancer by Age 70
Specific inherited mutations in the BRCA1 and BRCA2 genes increase the risk of breast and ovarian cancers.
Image by National Cancer Institute (NCI)
Sensitive content
This media may include sensitive content
BRCA-1 and BRCA-2 Genes, Breast Examination
Mammograms use low-dose X-rays to create images of the breast on film. Screening mammograms typically image the breast from above and from an angled side view. Yearly mammograms are recommended for women 40 and over. Women at high risk should have an MRI scan and a mammogram every year, beginning at age 30. Mammograms can also be used for diagnosis of cancer and to guide biopsy of suspicious lesions. The National Cancer Institute estimates that women with certain mutations in the BRCA1 and BRCA2 genes have a 60% lifetime risk of breast cancer, which is five times higher than the general population. Only 0.2% of women have these specific mutations. Women who test negative for high-risk mutations in the BRCA1 and BRCA2 genes still have a 12% lifetime risk of breast cancer and a 1.4% lifetime risk of ovarian cancer, which means the most of these cancers are caused by factors other than BRCA genes.
Image by TheVisualMD
Sensitive content
This media may include sensitive content
Breast Self-Exam (BSE)
When done correctly and regularly, breast self-exam (BSE) can help save lives. Women who perform BSE are more likely to be diagnosed with smaller tumors, and cancer is less likely to have spread to their underarm lymph nodes. An important part of BSE is self-awareness. Women should be aware of what their breasts normally feel and look like so that they notice any change, and they should bring that change to the attention of their doctor immediately.
Image by TheVisualMD
Sensitive content
This media may include sensitive content
BRCA: Breasts
In the 1990s, researchers discovered that certain inherited mutations of the genes increased a woman's risk of developing breast or ovarian cancer. But genes are not destiny; early detection, preventive surgery and drug therapies can also play roles.
Image by TheVisualMD
What is a BRCA Gene Mutation?
Video by Centers for Disease Control and Prevention (CDC)/YouTube
BRCA1 and BRCA2 Mutation Testing in Young Women With Breast Cancer
Video by JAMA Network/YouTube
BRCA1 and BRCA2 Mutation Testing in Young Women With Breast Cancer
Video by TheJAMAReport/YouTube
BRCA Genes and Breast Cancer
Video by Centers for Disease Control and Prevention (CDC)/YouTube
Understanding BRCA Mutations and Risk
Video by Dr. Susan Love Foundation/YouTube
BRCA Genes
The BRCA genes are tumor suppressor genes pictured here on their respective chromosomes. BRCA 1 has the cytogenetic location 17q21 or the q arm of Chromosome 17 at position 21. BRCA 2 has the cytogenetic location 13q12.3 or the q arm of Chromosome 13 at position 12.3. Both genes produce proteins that help repair damaged DNA, keeping the genetic material of the cell stable. A damaged BRCA gene in either location can lead to increased risk of cancer, particularly breast or ovarian in women.
Image by Tessssa13/Wikimedia
BRCA-1 and BRCA-2 Genes, Breast Cancer
More than 225,000 cases of invasive breast cancer are diagnosed annually in the U.S. and 40,000 die from the disease. In recent years, however, great strides have been made in early diagnosis and treatment. Imaging techniques have been refined to spot ever-tinier tumors, biomarkers have been developed to reflect physiological changes produced by cancer, and genetic tests such as those for the BRCA1 and BRCA2 genes have been devised to identify increased familial risk of breast cancer. The majority of breast cancers start in the mammary ducts; most of the remainder arise in the lobules. Breast cancers are divided into in situ and invasive cancers. In situ cancers remain confined to the duct or gland where they began. Invasive cancers break through the walls of the duct or gland and penetrate into the surrounding tissue.
Image by TheVisualMD
BRCA1 and BRCA2 gene mutations: autosomal dominant (AD) inheritance pattern
In hereditary breast cancer, the way that cancer risk is inherited depends on the gene involved. For example, mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to increase a person's chance of developing cancer. Although breast cancer is more common in women than in men, the mutated gene can be inherited from either the mother or the father.
Image by YassineMrabet / NIH
BRCA1 and BRCA2 are genes that produce proteins that help repair damaged DNA.
The breast cancer susceptibility genes BRCA-1 and BRCA-2 normally help prevent cancer by repairing damaged DNA. Certain inherited mutations in these genes, however, can impair this function and result in a greatly increased risk of breast cancer or ovarian cancer (there are hundreds of different BRCA mutations, but are very rare or not linked with an increased risk of cancer). Of 200,000 women diagnosed each year with breast cancer and 20,000 diagnosed with ovarian cancer, 5-10% are due to BRCA mutations.
Image by TheVisualMD
Chances of Developing Breast Cancer by Age 70
National Cancer Institute (NCI)
Sensitive content
This media may include sensitive content
BRCA-1 and BRCA-2 Genes, Breast Examination
TheVisualMD
Sensitive content
This media may include sensitive content
Breast Self-Exam (BSE)
TheVisualMD
Sensitive content
This media may include sensitive content
BRCA: Breasts
TheVisualMD
1:28
What is a BRCA Gene Mutation?
Centers for Disease Control and Prevention (CDC)/YouTube
4:39
BRCA1 and BRCA2 Mutation Testing in Young Women With Breast Cancer
JAMA Network/YouTube
2:20
BRCA1 and BRCA2 Mutation Testing in Young Women With Breast Cancer
TheJAMAReport/YouTube
3:12
BRCA Genes and Breast Cancer
Centers for Disease Control and Prevention (CDC)/YouTube
3:52
Understanding BRCA Mutations and Risk
Dr. Susan Love Foundation/YouTube
BRCA Genes
Tessssa13/Wikimedia
BRCA-1 and BRCA-2 Genes, Breast Cancer
TheVisualMD
BRCA1 and BRCA2 gene mutations: autosomal dominant (AD) inheritance pattern
YassineMrabet / NIH
BRCA1 and BRCA2 are genes that produce proteins that help repair damaged DNA.
TheVisualMD
Breast Biopsy
Breast Biopsy
Also called: Biopsy of the Breast
A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.
Breast Biopsy
Also called: Biopsy of the Breast
A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal biopsy means that no cancer or abnormal cells were found.
Related conditions
A breast biopsy is a procedure that removes a sample of breast tissue so that it can be checked for signs of disease. A doctor called a pathologist looks at the tissue under a microscope to diagnose breast cancer and other breast diseases.
Breast cancer is cancer that forms in the milk ducts (tubes that carry milk to the nipple) and the lobules (the small lobes of breast tissue that make milk). Breast cancer is much more common in women, but men can get it, too. Not much is known about breast cancer risk in transgender people. If you are transgender, talk with your provider about your risk.
There are different ways to do a breast biopsy. Some methods remove breast tissue with a needle and others use a small incision (cut) in your skin to remove part or all of the suspicious tissue.
Most people who need a breast biopsy don't have cancer.
Other names: core needle biopsy; core biopsy, breast; fine-needle aspiration; open surgery biopsy
A breast biopsy is the only way to find out whether a suspicious change in your breast is cancer. You may have a biopsy after other breast tests, such as a physical breast exam or a mammogram, show signs that could be breast cancer.
You may need a breast biopsy if:
You or your health care provider felt a lump, thickening, or other change in your breast.
A mammogram, ultrasound, or MRI test shows a lump, calcium deposits, or other signs that might mean cancer.
The skin on your breast or nipple is red, scaly, or swollen, or your nipple is pulled inward.
You have a discharge of abnormal fluid coming from your nipple.
If your provider suggests that you have a breast biopsy, it doesn't mean you have breast cancer. Most breast lumps and other changes that are checked with biopsies turn out to be benign, which means they are not cancer.
There are three main types of breast biopsy procedures. They are usually done on an outpatient basis, which means you go home the same day:
Fine needle aspiration biopsy uses a very thin needle to remove a sample of breast cells or fluid. The biopsy takes about 15 minutes.
Core needle biopsy uses a wide needle to remove one or more small tissue samples about the size of a grain of rice. Sometimes a small vacuum probe is used instead of a needle. The device gently suctions some tissue and removes it with a small rotating blade. A core needle biopsy takes between 15 minutes and an hour, depending on how it's done.
Surgical biopsy (or open biopsy) is surgery to remove all or part of a lump. The biopsy usually takes about an hour.
Biopsies are often done using mammography, ultrasound, MRI, or x-rays to help see exactly where to take the tissue sample. Your procedure will vary depending on which method is used to guide the biopsy, but the general steps are usually the same.
For a fine needle aspiration biopsy or a core needle biopsy:
Your provider will clean the skin on your breast and give you a shot of medicine to numb the area, so you won't feel any pain. The shot may sting briefly.
You may be sitting or lying down. If images are used to guide the biopsy, you may lie on your side, back, or belly with your breast over an opening on the table.
For a fine needle aspiration biopsy, your provider will insert the needle into the biopsy site and remove a sample of cells or fluid. For a core biopsy, a tiny cut may be made to insert a wide needle or a vacuum device. You may feel a little pressure when the sample or samples are removed.
Pressure will be applied to area until the bleeding stops.
Your provider will cover the biopsy site with a sterile bandage. If you had a small incision, small strips of medical tape may be used to close the wound.
For a surgical biopsy:
You'll lie on an operating table. You may have an IV (intravenous line) in your arm or hand that may be used to give you medicine to relax. The skin over the biopsy area will be cleaned.
To prevent pain, you'll have either:
A shot of medicine to numb your breast. The shot may sting briefly.
General anesthesia, which is medicine given through an IV to make you sleep.
When you are numb or asleep, the surgeon will make a small cut in your breast tissue to remove part or all of the lump. In certain cases, tissue around the lump may also be removed. This may help avoid the need for more surgery if cancer cells are found in the lump.
The cut in your skin will be closed with small strips of medical tape or stitches and covered with a sterile bandage.
The type of biopsy you have will depend on:
The size and location of the suspicious tissue in your breast
How many areas of your breast are involved
How abnormal the tissue looks on a mammogram or other image
Your general health and preferences
Ask your provider about why you need a biopsy and which type is right for you.
Your provider will give you instructions for how to prepare for your biopsy. If you take any blood thinners, including aspirin, you may need to stop taking them before your biopsy. Tell your provider about all the medicines and supplements you take. Don't stop or start taking anything without talking with your provider first.
If you're having general anesthesia, you will probably need to fast (not eat or drink) for several hours before surgery. If you have general anesthesia or medicine to relax, you may be groggy after the procedure, so plan to have someone take you home.
It's common to have some bruising and temporary discomfort after a breast biopsy. Possible risks include:
Infection, which can be treated with antibiotics
Bleeding
Your provider will give you instructions for how to care for biopsy area and manage any discomfort. If you're having general anesthesia, talk with your provider about how it may affect you. General anesthesia is very safe even for most people with other health conditions.
It may take several days to a week to get your biopsy results. The results are called a pathology report. The report is written for your provider and will include a lot of medical terms. Your provider can explain what your report means.
The most important part of your report will be the diagnosis. In general, your results will be one of these categories:
Normal. No cancer or abnormal cells were found.
Abnormal breast changes that aren't cancer and don't increase your risk for breast cancer. Some of these conditions often get better on their own and others may need treatment.
Abnormal breast changes that increase your risk for breast cancer. These cells are not cancer, but if you have them, you are more likely to develop cancer.
If you had a needle biopsy that diagnosed a condition that increases your breast cancer risk, you may need a surgical biopsy to remove all the abnormal tissue. To find out what you can do to reduce your breast cancer risk, you will likely see a doctor who specializes in breast cancer.
Breast cancer. If your biopsy finds cancer cells, your report will include details about how fast the cancer cells are growing, how much they look like normal cells, and other information to help plan the most effective treatment for your type of cancer. Usually, a doctor who specializes in breast cancer will provide your care.
Breast Biopsy: MedlinePlus Medical Test [accessed on Mar 22, 2022]
Having a Breast Biopsy | Effective Health Care (EHC) Program [accessed on Mar 22, 2022]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (13)
PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement
Video by PreOp.com Patient Engagement - Patient Education/YouTube
How a core breast biopsy is taken
Video by Bupa Health UK/YouTube
Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital
Video by UPMC/YouTube
What It’s Like to Get a Breast Biopsy
Video by RAYUS Radiology™/YouTube
Ultrasound-guided core-needle breast biopsy
Video by Institute for Cancer Genetics and Informatics/YouTube
Having a breast biopsy. A review of the research for women and thier families (2016 report)
This information is right for you if: -- You are a woman. The information in this summary is from
research on women. -- Your doctor has found a breast lump or shadow on your mammogram and has recommended a breast biopsy.
Document by effectivehealthcare.ahrq.gov
Ultrasound Guided Breast Biopsy 1
Ultrasound image of possible breast tumor before biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.
Image by TheVisualMD
Ultrasound Guided Breast Biopsy 2
Ultrasound image of possible breast tumor showing core needle penetrating suspicious breast lesion during biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.
Image by TheVisualMD
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Needle Biopsy
Adult Black female breast visible. Physician's hands are seen performing a needle biopsy to determine nature of lump either fluid-filled cyst or solid tumor.
Image by National Cancer Institute / Linda Bartlett (Photographer)
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Biopsy
A Caucasian woman patient is being operated on. Her nipple is being incised by the surgeon. The male surgeon and an operating room attendant are visible. A surgical biopsy is being performed to determine exact nature of solid tumor.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Breast Biopsy
Image Caption : Needle Breast Biopsy
Image by BruceBlaus
Mammotome
Mammotome probe - biopsy
Image by Waglione/Wikimedia
This browser does not support the video element.
Breast Cancer Biopsy
If a woman has symptoms of breast cancer (such as a lump), or if a suspicious area is found in an imaging exam, the next step is to physically examine the breasts by noting any changes in their appearance and palpating the breast and the underarm region. A complete physical exam may be done as well. If symptoms or results of these exams suggest cancer might be present, then further tests will be done. (Note: The following diagnostic procedures are common to the US; procedures may vary in other countries.)
Video by TheVisualMD
2:22
PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement
Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital
UPMC/YouTube
3:57
What It’s Like to Get a Breast Biopsy
RAYUS Radiology™/YouTube
1:29
Ultrasound-guided core-needle breast biopsy
Institute for Cancer Genetics and Informatics/YouTube
Having a breast biopsy. A review of the research for women and thier families (2016 report)
effectivehealthcare.ahrq.gov
Ultrasound Guided Breast Biopsy 1
TheVisualMD
Ultrasound Guided Breast Biopsy 2
TheVisualMD
Sensitive content
This media may include sensitive content
Needle Biopsy
National Cancer Institute / Linda Bartlett (Photographer)
Sensitive content
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Biopsy
National Cancer Institute / Linda Bartlett (Photographer)
Breast Biopsy
BruceBlaus
Mammotome
Waglione/Wikimedia
0:56
Breast Cancer Biopsy
TheVisualMD
Mammogram
Mammogram
Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography
A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.
Mammogram
Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography
A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.
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Use the slider below to see how your results affect your
health.
1
2
3
4
5
6
Your result is Negative.
This score confirms that your mammogram results are negative, indicating that the breast tissue shows no signs of a mass or calcifications. However, it’s important to continue regular screening mammograms.
Related conditions
A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.
A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called "benign," but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.
Screening mammograms are done for women who have no symptoms of breast cancer. It usually involves two x-rays of each breast. Screening mammograms can detect lumps or tumors that cannot be felt. They can also find microcalcifications or tiny deposits of calcium in the breast, which sometimes mean that breast cancer is present.
Diagnostic mammograms are used to check for breast cancer after a lump or other symptom or sign of breast cancer has been found. Signs of breast cancer may include pain, thickened skin on the breast, nipple discharge, or a change in breast size or shape. This type of mammogram also can be used to find out more about breast changes found on a screening mammogram, or to view breast tissue that is hard to see on a screening mammogram. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician can magnify a problem area to make a more detailed picture, which helps the doctor make a correct diagnosis.
A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:
Long-distance consultations with other doctors may be easier because the images can be shared by computer.
Slight differences between normal and abnormal tissues may be more easily noted.
The number of follow-up tests needed may be fewer.
Fewer repeat images may be needed, reducing exposure to radiation.
A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. Women ages 50 to 74 years should get a mammogram every 2 years. Women younger than age 50 should talk to a doctor about when to start and how often to have a mammogram.
Mammograms can not find all problems. So, every woman should work with her doctor to check her breasts. Call your doctor or clinic if you notice any change in your breasts like:
a lump
thickening
liquid leaking from the nipple or changes in how the nipple looks
You will need to take off your shirt and bra and stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture. Most often, two pictures are taken of each breast — one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish.
First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:
If you are still having menstrual periods, try to avoid making your mammogram appointment during the week before your period. Your breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better.
If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
Don't wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
If you have had mammograms at another facility, have those x-ray films sent to the new facility so that they can be compared to the new films.
Tell the clinic if you have physical disabilities that may make it hard for you to sit up, lift your arms, or hold your breath.
Talk with the staff about how they will handle issues of modesty that you may have due to your religion.
Because mammography uses x-rays to produce images of the breast, patients are exposed to a small amount of ionizing radiation. For most women, the benefits of regular mammograms outweigh the risks posed by this amount of radiation. The risk associated with this dose appears to be greater among younger women (under age 40). However, in some cases, the benefits of using mammography to detect breast cancer under age 40 may outweigh the risks of radiation exposure. For example, a mammogram may reveal that a suspicious mass is benign and, therefore, doesn’t need to be treated. Additionally, if a tumor is malignant and is caught early by mammogram, a surgeon may be able to remove it before it spreads and requires more aggressive treatment such as chemotherapy.
Routine screening mammography is not done during pregnancy or while breastfeeding.
You will usually get the results within a few weeks, although it depends on the facility. A radiologist reads your mammogram and then reports the results to you and your doctor. If there is a concern, you will hear from the mammography facility earlier. Contact your health care provider or the mammography facility if you do not receive a report of your results within 30 days.
Breast tissue that shows no signs of a mass or calcifications is considered normal. Most abnormal findings on a screening mammogram turn out to be benign (not cancer) or nothing to worry about. New findings or changes must be further evaluated.
What can mammograms show?
The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.
Possible mammogram findings include:
Lumps (mass or tumor). Lumps come in different sizes and shapes. Fluid-filled cysts are usually smooth and rounded, with clear, defined edges and are not cancer. Lumps that have a jagged outline and an irregular shape are of more concern.
Calcifications. There are two types of breast calcifications, or calcium deposits:
Macrocalcifications, which look like small white dots on a mammogram. They are often caused by aging, an old injury, or inflammation and are usually benign.
Microcalcifications, which look like white specks on a mammogram. If found in an area of rapidly dividing cells or grouped together in a certain way, they may be a sign of DCIS or breast cancer.
Dense breast tissue: A dense breast has relatively less fat and more glandular and connective tissue. This mammogram finding is both common and normal, especially among younger women and women who use menopausal hormone therapy. Dense breast tissue can make a mammogram more difficult to interpret because both dense breast tissue and breast tumors appear as solid white areas in the image.
What happens if my mammogram is normal?
Continue to get mammograms according to recommended time intervals. Mammograms work best when they can be compared with previous ones. This allows the radiologist to compare them to look for changes in your breasts.
What happens if my mammogram is abnormal?
An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems. Doctors may order some of these tests:
Diagnostic mammogram, to focus on a specific area of the breast
Ultrasound, an imaging test that uses sound waves to create a picture of your breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.
What is the Breast Imaging Reporting and Database System (BI-RADS®)?
The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.
Breast Imaging Reporting and Database System (BI-RADS)
Category
Assessment
Follow-up
0
Need additional imaging evaluation
Additional imaging needed before a category can be assigned
1
Negative
Continue regular screening mammograms
2
Benign (noncancerous) finding
Continue regular screening mammograms
3
Probably benign
Receive a 6-month follow-up mammogram
4
Suspicious abnormality
May require biopsy
5
Highly suggestive of malignancy (cancer)
Requires biopsy
6
Known biopsy-proven malignancy (cancer)
Biopsy confirms presence of cancer before treatment begins
BI-RADS also includes four categories of breast density that may be reported. The radiologist who reads the mammogram chooses the category that best describes the level of breast density seen on the mammogram film. The categories, from the least amount of breast density to the highest, are as follows:
The breasts are almost entirely fatty
There are scattered areas of dense glandular tissue and fibrous connective tissue (together known as fibroglandular density)
The breasts are heterogeneously dense, which means they have more of these areas of fibroglandular density. This may make it hard to see small masses in the breast tissue on a mammogram.
The breasts are extremely dense, which makes it hard to see tumors in the breast tissue on a mammogram.
Many states in the U.S. have enacted laws requiring mammography providers to tell women if they have dense breasts (i.e., breasts that are heterogeneously or extremely dense on a mammogram) and to inform them of risks associated with having dense breasts. In addition to making mammograms harder to read, dense breasts are a risk factor for breast cancer.
Although they are not perfect, mammograms are the best method to find breast changes that cannot be felt. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.
As with any medical test, mammograms have limits. These limits include:
They are only part of a complete breast exam. Your doctor also should do a clinical breast exam. If your mammogram finds something abnormal, your doctor will order other tests.
Finding cancer does not always mean saving lives. Even though mammography can detect tumors that cannot be felt, finding a small tumor does not always mean that a woman's life will be saved. Mammography may not help a woman with a fast growing cancer that has already spread to other parts of her body before being found.
False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don't happen often. Younger women are more likely to have a false negative mammogram than are older women. The dense breasts of younger women make breast cancers harder to find in mammograms.
False positives can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women, women who have had breast biopsies, women with a family history of breast cancer, and women who are taking estrogen, such as menopausal hormone therapy.
Mammograms (as well as dental x-rays and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause cancer. The benefits nearly always outweigh the risk. Talk to your doctor about the need for each x-ray. Ask about shielding to protect parts of the body that are not in the picture. You should always let your doctor and the technician know if there is any chance that you are pregnant.
https://www.womenshealth.gov/a-z-topics/mammograms [accessed on Feb 16, 2019]
https://www.nibib.nih.gov/science-education/science-topics/mammography [accessed on Feb 16, 2019]
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https://www.cancer.gov/types/breast/breast-changes#ui-id-4 [accessed on Feb 16, 2019]
https://www.fda.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117967.htm [accessed on Feb 16, 2019]
https://medlineplus.gov/ency/article/003380.htm [accessed on Feb 16, 2019]
https://www.healthline.com/health/birads-score [accessed on Feb 16, 2019]
https://www.acr.org/-/media/ACR/Files/RADS/BI-RADS/Mammography-Reporting.pdf [accessed on Feb 16, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (48)
Mammography Fact Sheet
Mammography is an x-ray imaging method used to examine the breast for the early detection of cancer and other breast diseases. It is used as both a diagnostic and screening tool.
Document by www.nibib.nih.gov
Mammograms
Document by Office on Women's Health, U.S. Department of Health and Human Services
Top Four Mammogram Myths
Knowing the truth about mammograms could help save your life, or the life of someone you love. Over 60% of breast cancer cases are diagnosed before they spread. Nearly 90% of women who find and treat their breast cancer are cancer-free at five years. Mammograms can help reduce the number of deaths from breast cancer among women ages 40 to 70.
Image by The U.S. Food and Drug Administration
Screening for Cancer
Common Screening Tests and American Cancer Society Recommendations
Image by TheVisualMD
Sensitive content
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Mammography
A woman getting a mammogram, showing a cone in position on her right breast.
Image by National Cancer Institute / Unknown Illustrator
Mammography
Image by BruceBlaus
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Mammogram
An adult female is assisted in a mammogram machine by an African-American technician.
Image by National Cancer Institute / Alan Hoofring (Illustrator)
Woman Having Mammogram
Photograph of woman having mammogram. Mammograms are considered the gold standard for breast cancer screening. Mammography requires the breasts to be compressed between plates while the image is captured. Typically, two views are taken of the breast: cranial-caudal (top to bottom) and mediolateral oblique (angled side view).
Image by TheVisualMD
Mammography
Mammogram being conducted
Image by CDC
Woman Receives Mammogram
An African-American female technician positions a Caucasian woman at an imaging machine to receive a mammogram.
Image by National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
A Caucasian female technician positions an Asian woman at an imaging machine to receive a mammogram.
Image by National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
A Caucasian female technician positions a Hispanic woman at an imaging machine to receive a mammogram.
Image by National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
An Asian female technician positions an African-American woman at an imaging machine to receive a mammogram.
Image by National Cancer Institute / Rhoda Baer (Photographer)
Mammography Patient
A female technician prepares to give an older Caucasian female patient a mammogram. the patient is preparing for the exam next to machine with technician in background adjusting controls.
Image by National Cancer Institute / Bill Branson (Photographer)
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Mammography
A woman's breast being compressed to get the optimum mammographic image.
Image by National Cancer Institute / Bill Branson (Photographer)
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Mammography
A Caucasian female patient, while sitting, is receiving a mammogram with a technician is standing in the background. The conical tip is compressing the right breast and the left breast is visible. Note the older machine.
Image by National Cancer Institute / Unknown Photographer
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Mammography
A Caucasian female patient receives a lateral mammogram treatment. She is lying on her left side with the left breast compressed and she is holding her right breast out of the way so as to not block the x-ray. Note the older methods of the diagnostic procedure.
Image by National Cancer Institute / Unknown Photographer
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Mammography
A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle that compresses the breast. The patient's face is turned towards the technician, away from the camera, and her right shoulder and breast are exposed.
Image by National Cancer Institute / Bill Branson (Photographer)
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Mammography
A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera, with her right shoulder and breast are exposed.
Image by National Cancer Institute / Bill Branson (Photographer)
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Mammography Patient
A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera. Her right shoulder is raised obscuring the breast.
Image by National Cancer Institute / Bill Branson (Photographer)
Male Breast Cancer
Senior Airman Elisabeth Stone compresses a male patient's breast tissue during a baseline screening of mammogram at Joint Base Elmendorf-Richardson, Alaska
Image by Staff Sgt. Sheila deVera
Doctor Viewing Mammogram
A doctor examines mammograms on a view box.
Image by National Cancer Institute / Bill Branson (photographer)
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Mammogram Showing Dense And Fatty Breasts
Title Mammogram Showing Dense And Fatty Breasts Description A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.
Image by Dr. Kathy Cho. NIH Radiology / National Cancer Institute
Abnormal Mammogram
This abnormal mammogram is not necessarily cancerous. Also seen are calcifications through ductal patterns. Patient would be avised to have follow-up at 3-month intervals.
Image by National Cancer Institute / Unknown Photographer
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Mammogram vs. MRI
A mammography on left and a Magnetic resonance image (MRI) on right. Breast imaging technology has changed over the years. Note MRI's enhancement ability to confirm diagnosis.
Image by Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer
Bilateral digital mammography images of the breasts
Bilateral digital mammography images of the breasts; mediolateral oblique view.
Normal (left) versus cancerous (right) mammography image.
Normal (left) versus cancerous (right) mammography image.
Image by National Cancer Institute
Duct ectasia of breast
Detail of a mammography showing liponecrosis (round/oval calcifications) and plasma cell mastitis with typical rod-like calcifications
Image by Hellerhoff
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Mammogram - Normal
Breast tomosynthesis (3D Mammography) of the left craniocaudal.
Image by National Cancer Institute (NCI)
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Mammogram - Normal
Breast tomosynthesis (3D Mammography) of the left craniocaudal projection.
Image by National Cancer Institute (NCI)
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Mammogram - Normal
Breast tomosynthesis (3D Mammography) of the left craniocaudal reconstruction.
Image by National Cancer Institute (NCI)
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Mammogram - Normal
Breast tomosynthesis (3D Mammography) of the left mediolateral oblique projection.
Image by National Cancer Institute (NCI)
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Mammogram Showing Dense And Fatty Breasts
A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.
Image by Dr. Kathy Cho. NIH Radiology / Unknown Photographer
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Thermography of breast
Image by FDA
Mammograms vs Breast Ultrasounds
Video by Lee Health/Vimeo
Breast Density: Higher Risk & New Screening Options
Video by Breast Cancer School for Patients/YouTube
This browser does not support the video element.
Mammography: NCI B-roll [video]
NCI B-roll of female patient (simulated) receiving a digital mammogram. This video is intentionally silent. This footage, which was filmed at Sibley Memorial Hospital (a Johns Hopkins affiliate institution), includes images of a technician setting up the equipment, a Caucasian female being positioned to receive a mammogram, and mammography images of of dense breasts and fatty breasts. Downloadable video files are 960x540 at 30 fps. This image is part of the NCI B-Roll Videos collection.
View video using embedded player on this page or at youtube.com.
Video by National Cancer Institute (NCI)
What to Expect -- Digital Mammography
Video by Hologic, Inc./YouTube
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Mammography
Breast radiologist Dr.Gillian Newstead of the University of Chicago Medical Center explains the process of a typical mammogram screening.
Video by TheVisualMD
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Breast Density
Women with dense breast tissue often require a further look with ultrasound for screening. University of Chicago Medical Center breast radiologist Dr. Gillian Newstead and a breast cancer survivor with dense breast tissue explain.
Video by TheVisualMD
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Breast Cancer Screening & Diagnosis
Breast cancer is one of the most common cancers among women in the U.S., with about 1 in 8 women developing the disease within her lifetime. Breast cancer is an uncontrolled growth of breast cells that has the potential to spread into the breast and possibly to other parts of the body. Early detection through screening saves the lives of thousands of women every year. If there is a history of breast cancer in the family, women should consider the BReast CAncer susceptibility test (or BRCA) to identify a gene that may indicate an increased risk of developing the disease. Women forty and over should be screened for abnormalities yearly to detect and evaluate changes in breast tissue. If an abnormality is found, a biopsy and pathological exam are necessary for a definitive diagnosis and prognosis. After diagnosis, your doctor may want to learn more about your specific cancer through immunohistochemistry (IHC) and HER2 protein tests. IHC testing can help determine if a specific abnormality is present in the cancer cells. HER2 tests can tell your physician if the breast cancer is turned on by the HER2 gene, and can help determine the best course of treatment. Knowing what type of breast cancer is involved, what stage the cancer is, and the characteristics of that specific cancer, allows a woman's physician to determine best possible therapy for her individual case.
Video by TheVisualMD
A closer look at modern mammography
Video by Siemens Healthineers/YouTube
Mammogram
A mammographic image is displayed on state of the art mammography monitors at the David Grant USAF Medical Center. (U.S. Air Force photo/Staff Sgt. Liliana Moreno)
Image by U.S. Air Force photo/Staff Sgt. Liliana Moreno
Nipple Aspirate Test No Substitute for Mammogram
Some companies are marketing a new test—the nipple aspirate test—as the latest and greatest tool in early breast cancer screening. But FDA warns that the nipple aspirate test is no substitute for a mammogram.
Image by The U.S. Food and Drug Administration
Do More Screening Tests Lead to Better Health? Choosing Wisely
Video by DocMikeEvans/YouTube
New Guidelines for Mammograms
Video by Lee Health/Vimeo
Mammogram questions | Mercy Health
Video by Bon Secours Mercy Health/Vimeo
Getting Screened for Breast Cancer
Video by Lee Health/Vimeo
Mammography Fact Sheet
www.nibib.nih.gov
Mammograms
Office on Women's Health, U.S. Department of Health and Human Services
Top Four Mammogram Myths
The U.S. Food and Drug Administration
Screening for Cancer
TheVisualMD
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Mammography
National Cancer Institute / Unknown Illustrator
Mammography
BruceBlaus
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Mammogram
National Cancer Institute / Alan Hoofring (Illustrator)
Woman Having Mammogram
TheVisualMD
Mammography
CDC
Woman Receives Mammogram
National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
National Cancer Institute / Rhoda Baer (Photographer)
Woman Receives Mammogram
National Cancer Institute / Rhoda Baer (Photographer)
Mammography Patient
National Cancer Institute / Bill Branson (Photographer)
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Mammography
National Cancer Institute / Bill Branson (Photographer)
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Mammography
National Cancer Institute / Unknown Photographer
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Mammography
National Cancer Institute / Unknown Photographer
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Mammography
National Cancer Institute / Bill Branson (Photographer)
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Mammography
National Cancer Institute / Bill Branson (Photographer)
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Mammography Patient
National Cancer Institute / Bill Branson (Photographer)
Male Breast Cancer
Staff Sgt. Sheila deVera
Doctor Viewing Mammogram
National Cancer Institute / Bill Branson (photographer)
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Mammogram Showing Dense And Fatty Breasts
Dr. Kathy Cho. NIH Radiology / National Cancer Institute
Abnormal Mammogram
National Cancer Institute / Unknown Photographer
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Mammogram vs. MRI
Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer
Bilateral digital mammography images of the breasts
Normal (left) versus cancerous (right) mammography image.
National Cancer Institute
Duct ectasia of breast
Hellerhoff
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Mammogram - Normal
National Cancer Institute (NCI)
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Mammogram - Normal
National Cancer Institute (NCI)
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Mammogram - Normal
National Cancer Institute (NCI)
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Mammogram - Normal
National Cancer Institute (NCI)
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Mammogram Showing Dense And Fatty Breasts
Dr. Kathy Cho. NIH Radiology / Unknown Photographer
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Thermography of breast
FDA
1:51
Mammograms vs Breast Ultrasounds
Lee Health/Vimeo
8:30
Breast Density: Higher Risk & New Screening Options
Breast Cancer School for Patients/YouTube
2:39
Mammography: NCI B-roll [video]
National Cancer Institute (NCI)
4:07
What to Expect -- Digital Mammography
Hologic, Inc./YouTube
0:37
Mammography
TheVisualMD
0:43
Breast Density
TheVisualMD
4:57
Breast Cancer Screening & Diagnosis
TheVisualMD
3:37
A closer look at modern mammography
Siemens Healthineers/YouTube
Mammogram
U.S. Air Force photo/Staff Sgt. Liliana Moreno
Nipple Aspirate Test No Substitute for Mammogram
The U.S. Food and Drug Administration
10:18
Do More Screening Tests Lead to Better Health? Choosing Wisely
DocMikeEvans/YouTube
1:41
New Guidelines for Mammograms
Lee Health/Vimeo
1:08
Mammogram questions | Mercy Health
Bon Secours Mercy Health/Vimeo
1:45
Getting Screened for Breast Cancer
Lee Health/Vimeo
Cancer Antigen 27.29 Test
Cancer Antigen 27.29 Test
Also called: CA 27-29 Tumor Marker, Truquant BR, CA-Breast, Cancer Antigen-Breast
The cancer antigen 27-29 (CA 27-29) test is mostly performed in women who have been diagnosed with breast cancer in order to monitor the response to treatment and to help watch for recurrence of the disease (return of cancer after treatment).
Cancer Antigen 27.29 Test
Also called: CA 27-29 Tumor Marker, Truquant BR, CA-Breast, Cancer Antigen-Breast
The cancer antigen 27-29 (CA 27-29) test is mostly performed in women who have been diagnosed with breast cancer in order to monitor the response to treatment and to help watch for recurrence of the disease (return of cancer after treatment).
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Use the slider below to see how your results affect your
health.
U/mL
38.6
Your result is Normal.
Having a normal CA 27-29 result doesn't mean you don't have breast cancer because some women with early breast cancer have a normal CA 27-29 level. This might also mean that your cancer is receding.
Related conditions
Cancer antigen 27-29 (CA 27-29) is a protein that can be found on the surface of certain cancer cells, especially in those of the breasts. Therefore, this antigen can be used as a tumor marker (meaning that if you have high levels of it, there is a good chance that you have cancer).
This test measures the levels of CA 27-29 in a sample of your blood.
Since not all women with breast cancer will have an increased CA 27-29 level, this test is not useful in all cases, and should not be used as a screening tool to detect breast cancer in healthy women.
Hence, your doctor might want to test your CA 27-29 levels to monitor your response to treatment after the diagnosis of breast cancer has already been made, and to control whether the disease has recurred.
A small amount of blood will be drawn from a vein in your arm by using a needle.
No fasting is needed. Your doctor may recommend you not to take multivitamins or dietary supplements containing biotin (vitamin B7) for 12 hours prior to the test.
Only the risks related to blood extraction, which are temporary discomfort, bruising, little bleeding, and risk of infection in the place where the needle was inserted.
Normal values of CA 27-29 are less than 38.6 units/mL. However, reference ranges can slightly vary from laboratory to laboratory.
Usually, the more advanced the breast cancer is, the higher the CA 27-29 level will be. The highest levels of CA 27-29 are often seen when the disease has already spread to other tissues (metastasized).
Besides breast cancer, CA 27-29 levels can be mild to moderately increased in other conditions, including:
Colon cancer
Pancreatic cancer
Ovarian cancer
Liver cancer
Liver disease (hepatitis, cirrhosis)
Kidney disorders
Benign breast disease
Ovary cysts
Having normal or elevated CA 27-29 levels does not discard or confirm the presence of cancer as this antigen should not be interpreted alone, but rather taking into consideration other tests and procedures.
Some women with breast cancer can have normal CA 27-29 levels because it may be too early in the disease process for this antigen to be detected, or the woman may fall in the category of individuals with advanced breast cancer whose tumor do not shed CA 27-29.
140293: Cancer Antigen (CA) 27.29 | LabCorp [accessed on Oct 02, 2018]
CA 27-29 - Health Encyclopedia - University of Rochester Medical Center [accessed on Oct 25, 2018]
Tumor Marker for Breast Cancer | OncoLink [accessed on Oct 25, 2018]
Cancer Antigen 27.29 Test for Breast Cancer [accessed on Oct 25, 2018]
Cancer Antigen 27.29 [accessed on Oct 25, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
CA 15-3 Test
CA 15-3 Test
Also called: CA 15-3 Tumor Marker, Cancer Antigen 15-3, Cancer Antigen-Breast
CA 15-3 testing is mostly used in women who have been diagnosed with invasive breast cancer to monitor the response to treatment and to help watch for recurrence of the disease.
CA 15-3 Test
Also called: CA 15-3 Tumor Marker, Cancer Antigen 15-3, Cancer Antigen-Breast
CA 15-3 testing is mostly used in women who have been diagnosed with invasive breast cancer to monitor the response to treatment and to help watch for recurrence of the disease.
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Use the slider below to see how your results affect your
health.
(i.U.)/mL
30
Your result is Normal.
Normal results vary based on the laboratory and the method used.
Related conditions
Suggests limited tumor burden (less cancer is present)
Suggests breast-cancer patient is responding well to treatment
Cancer antigen 15-3 (CA 15-3) is a protein that is produced by normal breast cells, and its production increases when cancerous breast tumors are present. Therefore, this antigen can be used as a tumor marker (meaning that if you have high levels of it, there is a good chance that you have cancer).
This test measures CA 15-3 levels in a sample of your blood.
Since not all women with breast cancer will have an increased CA 15-3 level, this test is not useful in all cases and should not be used as a screening tool to detect breast cancer in healthy women.
Hence, your doctor might want to test your CA 15-3 levels to monitor your response to treatment after the diagnosis of advanced breast cancer has already been made and to control whether the disease has recurred.
A small amount of blood will be drawn from a vein in your arm by using a needle.
No fasting is needed. Your doctor may recommend you not to take multivitamins or dietary supplements containing biotin (vitamin B7) for 12 hours prior to the test.
Only the risks related to blood extraction, which are temporary discomfort, bruising, little bleeding, and risk of infection in the place where the needle was inserted.
Normal values of CA 15-3 are less than 30 units/mL. However, reference ranges can slightly vary from laboratory to laboratory.
Usually, the more advanced the breast cancer is, the higher the CA 15-3 level will be. The highest levels of CA 15-3 often are seen when the disease has already spread to other tissues (metastasized).
Nevertheless, besides breast cancer, CA 15-3 levels can be mild to moderately increased in other conditions, including:
Colon cancer
Lung cancer
Pancreatic cancer
Ovarian cancer
Prostate cancer
Liver cancer
Liver disease (hepatitis, cirrhosis)
Benign breast disease
Having normal or elevated CA 15-3 levels does not discard or confirm the presence of cancer as this antigen should not be interpreted alone, but rather taking into consideration other tests and procedures.
Some women with breast cancer can have normal CA 15-3 levels because it may be too early in the disease process for this antigen to be detected, or the woman may fall in the category of individuals with advanced breast cancer whose tumor do not shed CA 15-3.
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (5)
Cancer
Cancer is a group of diseases characterized by uncontrolled cell growth.
Image by National Human Genome Research Institute (NHGRI)
CA 15-3: Breast Tumor Size When Found by Imaging or Touch
The foods in the image represent the average size of breast cancer tumors when discovered by mammogram, by regular breast self-exam, or by accident. Breast calcifications too small to be felt can be seen as white spots on a mammogram, as shown by the sesame seeds (far left). The blueberry represents the average size of a lump detected by routine mammogram (.43 inches/1.1 cm). The hazelnut shows average tumor size when discovered in a first mammogram (.59 inches/1.5 cm). The grape represents average tumor size when detected by regular breast self-exam (.83 inches/2.1 cm), and the strawberry shows average tumor size when found accidentally (1.42 inches/3.6 cm).
Image by TheVisualMD
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CA 15-3: Breast Tissue and Lymph Node Network
Breast tissue isn't found only in the breast itself: It extends from the breastbone to the armpit, and from below the collarbone to the level of the sixth or seventh rib. The breast contains lymphatic vessels that drain into a network of lymph nodes. These nodes are located around the edges of the breast, in the underarm area, and near the collarbone. Breast cancer often spreads first to the underarm lymph nodes. That's why breast self-examination should include feeling and checking the appearance of the underarm area, with arm only slightly raised.
Image by TheVisualMD
What Are Tumor Markers for Breast Cancer?
Video by Breast Cancer Answers®/YouTube
Biomarker Testing
Video by Merck/YouTube
Cancer
National Human Genome Research Institute (NHGRI)
CA 15-3: Breast Tumor Size When Found by Imaging or Touch
TheVisualMD
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CA 15-3: Breast Tissue and Lymph Node Network
TheVisualMD
2:42
What Are Tumor Markers for Breast Cancer?
Breast Cancer Answers®/YouTube
1:36
Biomarker Testing
Merck/YouTube
HER2 Tumor Marker Testing
HER2 Tumor Marker Testing
Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests
HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.
HER2 Tumor Marker Testing
Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests
HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.
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Use the slider below to see how your results affect your
health.
{score}
2
3
Your result is HER2-negative.
0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2-negative and will not respond to HER2-targeted therapy. Your provider will discuss other treatment options.
Related conditions
{"label":"HER2 gene amplification reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"negative","label":{"short":"HER2-negative","long":"HER2-negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A HER2-negative result means that you don't have too many <em>HER2<\/em> genes in your cancer cells. HER2-targeted therapy won't help your cancer, so your provider will discuss other treatment options.","conditions":[]},{"flag":"positive","label":{"short":"HER2-positive","long":"HER2-positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A HER2-positive result means that your cancer cells have too many <em>HER2<\/em> genes. HER2-targeted therapy is likely to help your cancer.","conditions":["HER2-targeted therapy"]}],"value":0.5,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
Your result is HER2-negative.
HER2 genes in your cancer cells. HER2-targeted therapy won't help your cancer, so your provider will discuss other treatment options.
Related conditions
Tumor marker tests look for substances, called tumor markers, that are often made by cancer cells or normal cells in response to cancer. The test results can provide important information, such as how fast a cancer may grow and which treatments are most likely to work.
HER2 is a type of tumor marker. It stands for human epidermal growth factor receptor 2. It's also called HER2/neu. HER2 is a protein involved in normal cell growth. Some types of cancer cells make larger than normal amounts of HER2, including certain cancers of the breast, stomach, and esophagus.
Cancers with large amounts of HER2 protein tend to grow quickly and spread to other parts of the body. Certain medicines, called HER2 targeted therapy, can block or slow HER2 proteins and help control these cancers. But these medicines won't help cancers that don't have high levels of HER2 proteins. So, HER2 tumor marker testing is necessary to find out if targeted therapy will be helpful.
A HER2 tumor marker test usually uses a sample of tumor tissue to measure either:
The amount of HER2 protein on the surface of cancer cells
How many copies of the HER2 gene are inside the cancer cells
Genes are parts of DNA in your cells that you inherit from your parents. HER2 genes have instructions for making the HER2 protein. Normally, you have two HER2 genes in each cell, one from each parent. But certain cancers have extra copies of the HER2 gene, which leads to too much HER2 protein on the cancer cells.
A HER2 tumor marker test looks to see whether certain cancers are:
HER2 positive, which means the cancer has high levels of the HER2 protein or HER2 genes. These cancers are likely to respond to HER2 targeted therapy.
HER2 negative, which means your cancer cells have little to no HER2 protein or a normal number of HER2 genes. This type of cancer may grow more slowly than HER2-positive cancer. It is also less likely to come back after treatment or spread to other parts of the body. HER2 targeted therapy will not work for this type of cancer, but other treatment options may help.
There are different HER2 tumor marker tests for checking HER2 proteins and HER2 genes. Usually, a protein test is done first because those tests are faster and less expense. Blood tests to measure HER2 usually aren't recommended. That's because it's not clear how blood test results can plan cancer treatment.
HER2 tumor marker tests are mostly used to find out whether certain cancers are HER2 positive or negative. This information shows how fast cancer may grow and whether medicine to target HER2 proteins may be helpful.
HER2 tumor marker testing is mainly used for cancers that start in the:
Breast (most common)
Stomach
Esophagus
Ovaries
Bladder
Pancreas
You may need HER2 tumor marker testing to help guide cancer treatment decisions if you have:
Breast cancer that has:
Just been diagnosed and is growing in the normal breast tissue around the tumor. This is called "invasive" cancer.
Spread beyond your breast and is growing in other parts of your body. This is called metastatic cancer. The cancer growing outside of your breast should be tested to see if it's HER2 positive, even if your breast tumor was already tested.
Come back after treatment, usually after a period of time when no cancer could be found in your body. This is called recurrent cancer. The new tumor should be tested to see if it's HER2 positive even if your first tumor was tested. That's because cancer cells can change over time.
Stomach or esophageal cancer that:
Can't be removed using surgery.
Has come back after treatment.
Cancer of the pancreas, bladder, ovaries, or certain other cancers that may have high levels of HER2 which may be treated with medicines that target HER2.
Most HER2 testing uses a sample of tumor tissue. The tissue will be removed during a procedure called a biopsy. There are many ways to do a biopsy. The type of biopsy you have depends on where the tumor is located. In general, a biopsy may be done using:
A hollow needle inserted through your skin. Imaging tests, such as ultrasound, may be used to guide the needle:
A fine needle aspiration biopsy uses a very thin needle to remove a sample of cells and/or fluid.
A core needle biopsy uses a larger needle to remove a sample.
Surgery. A surgeon may remove a sample of the tumor (incisional biopsy) or the entire tumor (excisional biopsy).
Endoscopy. This procedure uses a scope to look inside your body. Special tools may be used with a scope to remove a tissue sample. An endoscopy may be used for a biopsy of a tumor in your stomach or esophagus.
Preparations for your test depend on how your tissue sample will be taken. Ask your health care provider how to prepare for your test.
If you are getting medicine to relax or sleep during the procedure, you will probably need to fast (not eat or drink) for several hours before surgery. You will also need to have someone take you home, because you may be sleepy after the procedure.
Risks depend on how your tissue sample is taken. In general, if you are having a biopsy, you may have a little bruising or bleeding where the tissue was removed. Ask your provider to explain any risks from the test you're having.
The results of HER2 tumor marker tests are reported differently, depending on the type of test you had. The main HER2 tumor marker tests are:
IHC (immunohistochemistry staining assay) to measure the amount of HER2 protein on cancer cells
FISH (fluorescence in situ hybridization) to check for extra copies of HER2 genes in cancer cells
IHC test results for cancer of the breast, stomach, or esophagus show the amount of HER2 protein as a score:
0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2 negative and will not respond to HER2 targeted therapy. Your provider will discuss other treatment options.
2+ means that the amount of HER2 protein is borderline. This may be reported as "equivocal." It means the test result is not clear. You may need to have a different type of HER2 tumor marker test. The test may be done on the same tissue sample, or you may need to provide a new sample.
3+ means that your cancer cells have too much HER2 protein. Your cancer is HER2 positive and is likely to respond to HER2 targeted therapy.
FISH results for cancer of the breast, stomach, or esophagus will be reported as either:
HER2 negative, which means that you don't have too many HER2 genes in your cancer cells. HER2 targeted therapy won't help your cancer, so your provider will discuss other treatment options.
HER2 positive, which means that your cancer cells have too many HER2 genes. HER2 targeted therapy is likely to help your cancer.
Talk with your provider to learn what your results mean for your treatment.
HER2 Tumor Marker Test: MedlinePlus Medical Test [accessed on Dec 22, 2023]
Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]
Additional Materials (6)
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Diagnosing Breast Cancer
Breast imaging and early detection of breast cancer have evolved immensely over the last 25 years, leading to increased survival rates and improved quality of life for millions of women with breast cancer. This video takes you through the process of screening and diagnosis using various imaging modalities, including mammogram, ultrasound and MRI.
Video by TheVisualMD
DNA Methylation and Cancer
Video by Armando Hasudungan/YouTube
How to Recognize Breast Cancer Symptoms
Video by Howcast/YouTube
Sensitive content
This media may include sensitive content
Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
Most breast cancers begin in the lobules or ducts of the breast, which produce breast milk and carry it to the nipples after pregnancy. Invasive cancers spread outside of the lobules and ducts and penetrate into the surrounding breast tissue. From there, cancer cells may travel to lymph nodes in the armpit area. In stage IV breast cancer, cancer cells have spread into other parts of the body, such as the lungs or bones. HER2-positive breast cancer is aggressive and is likely to spread quickly. It is also resistant to hormone therapy. However, treatment with the drugs trastuzumab and/or lapatinib may help women who test positive for HER2.
Image by TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface
HER2 is a cell surface receptor that responds to chemicals called growth factors. Normally, there are few HER2 receptors on the surface of the cell. But when a mutated gene causes the overproduction of HER2, it can spur the growth of tumors. The test called immunohistochemistry (IHC) measures the amount of HER2 protein present and can help with determining the patient's prognosis.
Image by TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2
In about one out of five breast cancers, a protein called human epidermal growth factor receptor 2 (HER2) is overproduced due to a gene mutation. High levels of HER2 on cell surfaces spur the growth of cancerous tumors and also make the cancer less responsive to hormone therapy. This type of breast cancer usually occurs in younger women.
Image by TheVisualMD
4:47
Diagnosing Breast Cancer
TheVisualMD
5:17
DNA Methylation and Cancer
Armando Hasudungan/YouTube
3:01
How to Recognize Breast Cancer Symptoms
Howcast/YouTube
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This media may include sensitive content
Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface
TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2
TheVisualMD
MammaPrint Test
MammaPrint Test
Also called: 70-Gene Signature, MammaPrint Test for Early-Stage Invasive Breast Cancer
MammaPrint is a test that identifies the gene expression profile of 70 genes in a breast tumor sample in individuals with high clinical risk of cancer recurrence to help determine whether chemotherapy treatment is needed.
MammaPrint Test
Also called: 70-Gene Signature, MammaPrint Test for Early-Stage Invasive Breast Cancer
MammaPrint is a test that identifies the gene expression profile of 70 genes in a breast tumor sample in individuals with high clinical risk of cancer recurrence to help determine whether chemotherapy treatment is needed.
{"label":"MammaPrint reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"abnormal","label":{"short":"High risk","long":"High risk","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"This means that your risk of cancer recurrence is high (approximately 29%). Therefore, you may benefit from treatment with adjuvant chemotherapy.","conditions":["Breast cancer","Metastasis","Chemotherapy"]},{"flag":"normal","label":{"short":"Low risk","long":"Low risk","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"This means that your risk of cancer recurrence is low. Hence, you may not need chemotherapy and may be spared from the side effects this treatment produces.","conditions":["Breast cancer"]}],"value":1.5,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"abnormal":0},{"normal":0}]
Use the slider below to see how your results affect your
health.
Your result is Low risk.
This means that your risk of cancer recurrence is low. Hence, you may not need chemotherapy and may be spared from the side effects this treatment produces.
Related conditions
Breast cancer
MammaPrint is a lab test that is used to help predict whether breast cancer will come back or spread to other parts of the body. The test looks at the activity level of 70 different genes in breast cancer tissue of people with early-stage (stage I, II, or IIIA) invasive breast cancer that is less than 5 cm and is either node-negative or has spread to 1 to 3 lymph nodes.
If the test shows that there is a high risk that the cancer will spread or come back, treatment with chemotherapy may be needed to lower the risk. Also called 70-gene signature.
Your doctor may want to use the MammaPrint test to help predict how high is your risk of breast cancer recurrence (come back) and to determine whether to use adjuvant chemotherapy or not.
Nevertheless, not everyone needs to get this test, and is mainly indicated in the following cases:
If you are under 55 years of age and you have a lymph node-negative breast cancer (N0).
If you have a high clinical risk of breast cancer recurrence, and your tumor is estrogen receptor-positive or progesterone receptor-positive, and HER2-negative.
After using anesthesia, a biopsy procedure (taking a small piece of the affected tissue) can be performed to collect a sample of the breast tumor. In other cases, the whole tumor may be surgically removed. Then, the collected piece will be sent to a pathologist for its evaluation.
You may be asked to refrain from eating, but usually, no further preparations are needed. Follow any instructions provided by your healthcare practitioner.
Biopsies are considered to be low-risk procedures; however, as with most procedures, a biopsy also carries the risk of pain on the site, bleeding, and infection. You may also present a bad reaction to the anesthesia.
The MammaPrint test result can indicate that either you have:
High risk = Poor prognosis: this means that your risk of cancer recurrence is high. Therefore, you may benefit from treatment with adjuvant chemotherapy.
Low risk = Good prognosis: this means that your risk of cancer recurrence is low. Hence, you may not need chemotherapy and may be spared from the side effects this treatment produces.
MammaPrint should not be performed in individuals who have a low clinical risk for recurrence.
The MammaPrint result is not intended to be used as a diagnosis tool, nor to predict or monitor response to treatment in breast cancer.
Breast Cancer Treatment (PDQ®)—Patient Version - National Cancer Institute [accessed on Oct 03, 2018]
MammaPrint Test | Breastcancer.org [accessed on Oct 03, 2018]
MammaPrint Test | Agendia [accessed on Oct 03, 2018]
MammaPrint Test Addressed in ASCO Breast Cancer Guideline Update | ASCO [accessed on Oct 03, 2018]
Validation and clinical application of MammaPrint® in patients with breast cancer - ScienceDirect [accessed on Oct 03, 2018]
Medscape: Medscape Access [accessed on Oct 03, 2018]
Identifying patients at high risk of breast cancer recurrence: strategies to improve patient outcomes [accessed on Oct 03, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Estrogen and Progesterone Receptor Tests
Estrogen and Progesterone Receptor Tests
Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status
Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.
Estrogen and Progesterone Receptor Tests
Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status
Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.
{"label":"ER\/PR status reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"negative","label":{"short":"ER\/PR-negative","long":"ER\/PR-negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"An ER\/PR-negative (also called a hormone receptor-negative or HR-) result means that your breast tumor does not have receptors for either estrogen (ER) or progesterone (PR). This means that you are not likely to benefit from treatment with hormonal therapy. About 25% of breast cancers have no hormone receptors.","conditions":[]},{"flag":"positive","label":{"short":"ER\/PR-positive","long":"ER\/PR-positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"An ER\/PR-positive (also called a hormone receptor-positive or HR+) result means that your breast tumor has receptors for estrogen (ER) and\/or progesterone (PR). Therefore, you are likely to benefit from treatment with hormonal therapy. About 65% of breast cancers are both ER\/PR-positive.","conditions":["Hormone therapy for breast cancer"]}],"value":0.5,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
Your result is ER/PR-negative.
An ER/PR-negative (also called a hormone receptor-negative or HR-) result means that your breast tumor does not have receptors for either estrogen (ER) or progesterone (PR). This means that you are not likely to benefit from treatment with hormonal therapy. About 25% of breast cancers have no hormone receptors.
Related conditions
Estrogen receptor/progesterone receptor (ER/PR) tests are used to help guide breast cancer treatment. Receptors are proteins that attach to certain substances. ER/PR tests look for receptors that attach to the hormones estrogen and progesterone in a sample of breast cancer tissue. Estrogen and progesterone play key roles in a woman's sexual development and reproductive functions. Men also have these hormones, but in much smaller amounts.
About 70 percent of all breast cancers in women have receptors that attach to estrogen and/or progesterone. About 80 percent to 90 percent of breast cancers in men have these receptors. Breast cancers with estrogen and/or progesterone receptors include the following types:
ER-positive (ER+): Cancers that have estrogen receptors (ER)
PR-positive (PR+): Cancers that have progesterone receptors (PR)
Hormone receptor-positive (HR+): Cancers that have one or both types of these receptors.
Breast cancers without ER or PR receptors are known as HR-negative (HR-).
ER/PR tests will show whether there are ER and/or PR receptors on your breast cancer cells. Test results are frequently referred to as the hormone receptor status. If your hormone receptor status shows you have one or both of these receptors on your cancer cells, you may respond well to certain types of treatments.
ER/PR tests are used to guide treatment for breast cancer patients.
You may need this test if you've been diagnosed with breast cancer. Knowing your hormone receptor status will help your health care provider decide how to treat it. If you have ER-positive, PR-positive, or HR-positive cancer, drugs that lower hormone levels or stop the hormones from fueling cancer growth can be very effective. If you have HR-negative cancer, these types of drugs won't work for you.
Your provider will need to take a sample of breast tissue in a procedure called a breast biopsy. There are three main types of breast biopsies:
Fine needle aspiration biopsy, which uses a very thin needle to remove a sample of breast cells or fluid
Core needle biopsy, which uses a larger needle to remove a sample
Surgical biopsy, which removes a sample in a minor, outpatient procedure
Fine needle aspiration and core needle biopsies usually include the following steps:
You will lay on your side or sit on an exam table.
A health care provider will clean the biopsy site and inject it with an anesthetic, so you won't feel any pain during the procedure.
Once the area is numb, the provider will insert either a fine aspiration needle or core biopsy needle into the biopsy site and remove a sample of tissue or fluid.
You may feel a little pressure when the sample is withdrawn.
Pressure will be applied to the biopsy site until the bleeding stops.
Your provider will apply a sterile bandage at the biopsy site.
In a surgical biopsy, a surgeon will make a small cut in your skin to remove all or part of a breast lump. A surgical biopsy is sometimes done if the lump can't be reached with a needle biopsy. Surgical biopsies usually include the following steps.
You will lie on an operating table. An IV (intravenous line) may be placed in your arm or hand.
You may be given medicine, called a sedative, to help you relax.
You will be given local or general anesthesia, so you won't feel pain during the procedure.
For local anesthesia, a health care provider will inject the biopsy site with medicine to numb the area.
For general anesthesia, a specialist called an anesthesiologist will give you medicine so you will be unconscious during the procedure.
Once the biopsy area is numb or you are unconscious, the surgeon will make a small cut into the breast and remove part or all of a lump. Some tissue around the lump may also be removed.
The cut in your skin will be closed with stitches or adhesive strips.
You won't need any special preparations if you are getting local anesthesia (numbing of the biopsy site). If you are getting general anesthesia, you will probably need to fast (not eat or drink) for several hours before surgery. Your surgeon will give you more specific instructions. Also, if you are getting a sedative or general anesthesia, be sure to arrange for someone to drive you home. You may be groggy and confused after you wake up from the procedure.
You may have a little bruising or bleeding at the biopsy site. Sometimes the site gets infected. If that happens, you will be treated with antibiotics. A surgical biopsy may cause some additional pain and discomfort. Your health care provider may recommend or prescribe medicine to help you feel better.
The results will show whether you have a hormone receptor-positive or negative type of cancer. If your hormone receptor status is positive, the test also shows the levels of estrogen and/or progesterone receptors. The higher the levels of receptors, the more effective certain medicines may be in treating your cancer. If your hormone receptor status is negative, these medicines will not be effective.
If you have questions about your results, talk to your health care provider.
HER2 testing is often done at the same time as ER/PR testing. That is because some hormone receptor cancers are also HER2-positive. HER2 is a protein found on the surface of all breast cells. Treatments for HER2-positive breast cancer can be very effective but are not effective for HER2-negative cancers.
Estrogen Receptor, Progesterone Receptor Tests: MedlinePlus Medical Test [accessed on Dec 22, 2023]
Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]
Estrogen Receptor and Progesterone Receptor Test | Testing.com. Dec 3, 2021 [accessed on Dec 22, 2023]
Breast Cancer Hormone Receptor Status [accessed on Dec 22, 2023]
Immunohistochemical Test for Estrogen and Progesterone Receptors - Health Encyclopedia - University of Rochester Medical Center [accessed on Dec 22, 2023]
Additional Materials (5)
Hormone Receptor Positive Breast Cancer
Video by Dr. Susan Love Foundation/YouTube
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Video by Mechanisms in Medicine/YouTube
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Estrogen Receptor Assay
A culture dish containing frozen breast tissue. A technician's hands and test instruments are visible as well. This is used for analysis in estrogen receptor assay test. Results suggest whether removal of ovaries or use of antiestrogen drugs are likely to be effective.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Using FFNP to “Light Up” Tumors
A new imaging test takes advantage of the fact that progesterone receptor levels in estrogen receptor-positive tumors go up in response to estrogen if the estrogen receptor is active. The test involves a PET scan that uses a radioactive tracer called FFNP, which binds specifically to progesterone receptors. When more progesterone receptors are present, the amount of FFNP taken up by tumor cells is greater and the signal from FFNP on a PET scan is stronger.
Image by National Cancer Institute
Circulating Progesterone May Increase Breast Cancer Risk
Research found that postmenopausal women with higher circulating progesterone levels experience a 16% increased risk of breast cancer. Additionally, associated risk from progesterone seemed to be modified by estradiol concentrations. Further research is needed to examine the relationship between progesterone and estradiol in breast cancer etiology and to validate these findings in diverse populations.
Image by National Cancer Institute (NCI)
2:57
Hormone Receptor Positive Breast Cancer
Dr. Susan Love Foundation/YouTube
7:47
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Mechanisms in Medicine/YouTube
Sensitive content
This media may include sensitive content
Estrogen Receptor Assay
National Cancer Institute / Linda Bartlett (Photographer)
Using FFNP to “Light Up” Tumors
National Cancer Institute
Circulating Progesterone May Increase Breast Cancer Risk
National Cancer Institute (NCI)
Breast Density Test
Breast Density Test
Also called: Breast Composition
Mammograms detect breast density, breast cancer, and breast changes that are not cancer (benign breast changes). Dense breasts have a high proportion of ductal and connective tissue, while less-dense breasts have a higher proportion of fatty tissue.
Breast Density Test
Also called: Breast Composition
Mammograms detect breast density, breast cancer, and breast changes that are not cancer (benign breast changes). Dense breasts have a high proportion of ductal and connective tissue, while less-dense breasts have a higher proportion of fatty tissue.
{"label":"Breast Density Reference Range","scale":"lin","step":0.5,"hideunits":true,"items":[{"flag":"normal","label":{"short":"(A)","long":"(A) Fatty","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"Your individual breast density classification on your recent mammogram is almost entirely fatty tissue, which is NOT considered \"dense\". Unless an area containing cancer is not included in the image field of the mammogram, mammography is highly sensitive in this setting. The sensitivity of mammography for detecting breast cancer decreases as the breast density increases.","conditions":[]},{"flag":"normal","label":{"short":"(B)","long":"(B) Scattered fibroglandular","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"Your individual breast density classification on your recent mammogram is scattered fibroglandular tissue, which indicates there are scattered areas of dense glandular tissue and fibrous connective tissue (together known as fibroglandular tissue). This result is NOT considered \"dense\".","conditions":[]},{"flag":"borderline","label":{"short":"(C)","long":"(C) Heterogeneously dense","orientation":"horizontal"},"values":{"min":2,"max":3},"text":"Your individual breast density classification on your recent mammogram is heterogeneously dense tissue, which means your breasts have more of these areas of fibroglandular tissue. This result is considered \"dense\". This may make it hard to see small masses in the breast tissue on a mammogram. It also indicates a slightly increased risk of developing breast cancer (1.2x compared to women with average breast density).","conditions":["Dense breasts"]},{"flag":"borderline","label":{"short":"(D)","long":"(D) Extremely dense","orientation":"horizontal"},"values":{"min":3,"max":4},"text":"Your individual breast density classification on your recent mammogram is extremely dense tissue, which makes it hard to see tumors in the breast tissue on a mammogram. The relative risk of developing breast cancer is two-fold (2x) compared to women with average breast density. ","conditions":["Dense breasts"]}],"value":0.5}[{"normal":1},{"normal":0},{"borderline":0},{"borderline":1}]
Use the slider below to see how your results affect your
health.
Your result is (A) Fatty.
Your individual breast density classification on your recent mammogram is almost entirely fatty tissue, which is NOT considered "dense". Unless an area containing cancer is not included in the image field of the mammogram, mammography is highly sensitive in this setting. The sensitivity of mammography for detecting breast cancer decreases as the breast density increases.
Related conditions
https://www.acr.org/-/media/ACR/Files/RADS/BI-RADS/Mammography-Reporting.pdf [accessed on Feb 17, 2019]
https://www.mycdi.com/_asset/5lgdli/CDI-Quality-Institute-Breast-Density-Information-Document-6-15-16.pdf [accessed on Feb 17, 2019]
https://radiopaedia.org/articles/breast-density [accessed on Feb 17, 2019]
https://breast-cancer.ca/densitbi-rads/ [accessed on Feb 17, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Oncotype DX Test
Oncotype DX Test
Also called: 21-Gene Signature, Oncotype DX Tests for Early-Stage Breast Cancer and DCIS
Oncotype DX is a test that analyzes the activity of 21 genes in the breast cancer tissue of certain women with early-stage breast cancer and DCIS. The test measures how aggressive a woman’s breast cancer is and helps to decide if she should get chemotherapy after surgery.
Oncotype DX Test
Also called: 21-Gene Signature, Oncotype DX Tests for Early-Stage Breast Cancer and DCIS
Oncotype DX is a test that analyzes the activity of 21 genes in the breast cancer tissue of certain women with early-stage breast cancer and DCIS. The test measures how aggressive a woman’s breast cancer is and helps to decide if she should get chemotherapy after surgery.
{"label":"Oncotype DX Breast Recurrence Score reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Low risk","long":"Low risk","orientation":"horizontal"},"values":{"min":0,"max":26},"text":"A recurrence score between 0 and 25 means that the cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.","conditions":[]},{"flag":"abnormal","label":{"short":"High risk","long":"High risk","orientation":"horizontal"},"values":{"min":26,"max":100},"text":"A recurrence score between 26 and 100 means that the cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.","conditions":["Chemotherapy for breast cancer"]}],"value":13,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
26
Your result is Low risk.
A recurrence score between 0 and 25 means that the cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.
Related conditions
{"label":"Oncotype DX Breast DCIS score reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Low risk","long":"Low risk","orientation":"horizontal"},"values":{"min":0,"max":39},"text":"A recurrence score lower than 39 means that the DCIS has a low risk of recurrence. The benefit of radiation therapy is likely to be small and will not outweigh the risks of side effects.","conditions":[]},{"flag":"borderline","label":{"short":"Intermediate risk","long":"Intermediate risk","orientation":"horizontal"},"values":{"min":39,"max":54},"text":"A recurrence score between 39 and 54 means that the DCIS has an intermediate risk of recurrence. It\u2019s unclear whether the benefits of radiation therapy outweigh the risks of side effects.","conditions":[]},{"flag":"abnormal","label":{"short":"High risk","long":"High risk","orientation":"horizontal"},"values":{"min":54,"max":100},"text":"A recurrence score greater than 54 means that the DCIS has a high risk of recurrence, and the benefits of radiation therapy are likely to be greater than the risks of side effects.","conditions":["Radiation therapy"]}],"units":[{"printSymbol":"{score}","code":"{score}","name":"score"}],"value":20,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"normal":0},{"borderline":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
{score}
39
54
Your result is Low risk.
A recurrence score lower than 39 means that the DCIS has a low risk of recurrence. The benefit of radiation therapy is likely to be small and will not outweigh the risks of side effects.
Related conditions
Oncotype DX is a gene expression profile that identifies the presence of 21 genes in a breast tumor sample (biopsy). This is done to help differentiate tumors which are likely to metastasize (spread to other tissues and organs) from tumors which are less aggressive and more likely to be cured with local treatment only.
Your doctor may want to use the Oncotype DX test to help predict how high is your risk of breast cancer recurrence and to determine whether you need adjuvant chemotherapy or not.
Not everyone needs to get this test, which is mainly indicated in the following cases:
If you have recently been diagnosed with early-stage (stage I or II) invasive breast cancer, especially if it has not yet spread to your lymph nodes.
If you have a high clinical risk of breast cancer recurrence, and your tumor is estrogen receptor-positive or progesterone receptor-positive (meaning that the cancer cells respond to treatment with hormones).
If you have recently been diagnosed with a type of breast cancer called ductal carcinoma in situ (DCIS), because it can help your doctor determine whether you need radiation therapy or not.
After using anesthesia, a biopsy procedure (taking a small piece of the affected tissue) can be performed to collect a sample of the breast tumor. In other cases, the whole tumor may be surgically removed. Then, the collected piece will be sent to a pathologist for its evaluation.
You may be asked to refrain from eating, but usually, no further preparations are needed. Follow any instructions provided by your healthcare practitioner.
Biopsies are considered to be low-risk procedures; however, as with most procedures, a biopsy also carries the risk of pain on the site, bleeding, and infection. You may also have a bad reaction to the anesthesia.
The Oncotype DX test assigns a recurrence score between 0 and 100, which correlates to the likelihood that your cancer returns within 10 years of diagnosis:
Recurrence score of 17 or lower: this means that your cancer has a low risk of recurrence. Hence, you may not need chemotherapy and can be spared from the side effects it produces.
Recurrence score between 18 and 30: this means that your cancer has an intermediate risk of recurrence. Chemotherapy might benefit some women in this range.
Recurrence score equal or higher than 31: this means that your risk of cancer recurrence is high. Therefore, you are likely to benefit from treatment with adjuvant chemotherapy.
If you have been diagnosed with ductal carcinoma in situ (DCIS), the results are different and are called a DCIS score:
Recurrence score of 38 or lower: this means that the DCIS has a low risk of recurrence. Hence, you may not need radiation therapy and can be spared from the side effects it produces.
Recurrence score between 39 and 54: this means that the DCIS has an intermediate risk of recurrence. Radiation therapy might benefit some women in this range.
Recurrence score higher than 54: this means that your risk of DCIS recurrence is high. Therefore, you are likely to benefit from treatment with adjuvant radiation therapy.
Oncotype DX Tests for Early-Stage Breast Cancer and DCIS [accessed on Dec 18, 2023]
BreastCancer.org: Oncotype DX Test [accessed on Sep 21, 2018]
Breast Cancer: Diagnosis | Cancer.Net [accessed on Sep 21, 2018]
Tumor Markers - National Cancer Institute [accessed on Sep 21, 2018]
Breast Cancer Gene Expression Tests [accessed on Sep 21, 2018]
Medscape: Medscape Access [accessed on Sep 21, 2018]
Oncotype DX Test for Breast Cancer [accessed on Sep 21, 2018]
Oncotype DX: Genomic Test to Inform Breast Cancer Treatment [accessed on Sep 21, 2018]
The impact of Oncotype DX testing on breast cancer management and chemotherapy prescribing patterns in a tertiary referral centre [accessed on Sep 21, 2018]
Additional Materials (7)
The Oncotype DX Test: Understanding Your Breast Cancer Tumor
Video by Breast Cancer Answers®/YouTube
DCIS (Stage 0) Breast Cancer and the Oncotype DX DCIS Score
Video by Oncotype IQ/YouTube
DCIS (Stage 0) Breast Cancer and the Oncotype DX DCIS Score
Video by Exact Sciences/Vimeo
What is DCIS Breast Cancer?
Video by Breast Cancer Answers®/YouTube
How Serious is DCIS Breast Cancer?
Video by Breast Cancer Answers®/YouTube
High-Grade DCIS, What Is It? -Dr. Jay Harness
Video by Breast Cancer Answers®/YouTube
Post Lumpectomy DCIS Probability, Can DCIS Return After A Lumpectomy?
Video by Breast Cancer Answers®/YouTube
1:52
The Oncotype DX Test: Understanding Your Breast Cancer Tumor
Breast Cancer Answers®/YouTube
2:53
DCIS (Stage 0) Breast Cancer and the Oncotype DX DCIS Score
Oncotype IQ/YouTube
3:03
DCIS (Stage 0) Breast Cancer and the Oncotype DX DCIS Score
Exact Sciences/Vimeo
3:29
What is DCIS Breast Cancer?
Breast Cancer Answers®/YouTube
3:49
How Serious is DCIS Breast Cancer?
Breast Cancer Answers®/YouTube
5:40
High-Grade DCIS, What Is It? -Dr. Jay Harness
Breast Cancer Answers®/YouTube
3:40
Post Lumpectomy DCIS Probability, Can DCIS Return After A Lumpectomy?
Breast Cancer Answers®/YouTube
Sentinel Lymph Node Biopsy
Sentinel Lymph Node Biopsy
Also called: SLNB, Biopsy of the Sentinel Lymph Node, Lymph Node Biopsy, Sentinel Node Biopsy, Sentinel Lymph Node Mapping and Biopsy
A sentinel lymph node biopsy is a test that checks lymph nodes for cancer cells. Some cancers, such as breast cancer and melanoma, can spread through the lymphatic system. The sentinel lymph node is the first node where a cancer usually spreads. The test can show whether your cancer is likely to spread.
Sentinel Lymph Node Biopsy
Also called: SLNB, Biopsy of the Sentinel Lymph Node, Lymph Node Biopsy, Sentinel Node Biopsy, Sentinel Lymph Node Mapping and Biopsy
A sentinel lymph node biopsy is a test that checks lymph nodes for cancer cells. Some cancers, such as breast cancer and melanoma, can spread through the lymphatic system. The sentinel lymph node is the first node where a cancer usually spreads. The test can show whether your cancer is likely to spread.
{"label":"Sentinel lymph node biopsy reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"negative","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"If your results are negative, it means no cancer cells were found, and it's unlikely that the cancer has spread. You will not need to have any more lymph nodes removed.","conditions":["Breast cancer","Melanoma","Penile cancer","Endometrial cancer"]},{"flag":"positive","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"If your results are positive, it means cancer was found and may have spread to nearby lymph nodes and\/or other organs. Your provider may recommend removing and testing more lymph nodes to check for cancer cells.","conditions":["Breast cancer","Melanoma","Penile cancer","Endometrial cancer"]}],"value":0.5,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
Your result is Negative.
If your results are negative, it means no cancer cells were found, and it's unlikely that the cancer has spread. You will not need to have any more lymph nodes removed.
Related conditions
Breast cancer
Melanoma
Penile cancer
Endometrial cancer
A sentinel lymph node biopsy is a test that checks lymph nodes for cancer cells. Lymph nodes are part of the lymphatic system, a network of organs and vessels that help the body fight infections and other diseases. Lymph nodes are located throughout the body, including the underarms, neck, chest, abdomen, and groin.
Certain cancers, such as breast cancer and melanoma (the most dangerous form of skin cancer), can spread through the lymphatic system. Cancers spread when cells break off from the original tumor and are carried to other parts of the body. The sentinel lymph node is the first node where these types of cancers are most likely to spread. The node is usually located near the site of the original tumor. Sometimes there is more than one sentinel lymph node.
A sentinel lymph node biopsy can show how likely it is that your cancer is spreading (metastasizing).
Other names: lymph node biopsy, sentinel node biopsy, sentinel lymph node mapping and biopsy
A sentinel lymph node biopsy is used to find out whether an early-stage cancer has spread through the lymphatic system. It's most often used for people who have breast cancer or melanoma.
You may need this test if you've been diagnosed with breast cancer, melanoma, or certain other types of cancer. It can show whether your cancer is spreading.
A sentinel lymph node biopsy may be done in a hospital or an outpatient surgical center. The procedure usually includes a special type of imaging test called lymphoscintigraphy. Lymphoscintigraphy takes pictures of the lymphatic system and is used to locate the sentinel lymph node. The procedure includes the following steps:
A health care provider will apply medicine to numb the skin over the procedure area.
You will be injected with a small amount of a radioactive substance called a tracer near the tumor. The tracer will travel and collect in the sentinel lymph node, or nodes. You may also be injected with a blue dye that stains the lymph node, making it easier to see.
You will be given general anesthesia. General anesthesia is a medicine that makes you unconscious. It makes sure you won't feel any pain during the surgery. A specially trained doctor called an anesthesiologist will give you this medicine.
Once you're unconscious, a camera will take images of the area. The camera finds and records the location of the tracer, which will have settled in the sentinel node.
The node will be removed and sent to a lab, where it will be checked for cancer cells. This part of the test is known as a biopsy.
The original tumor is also usually removed during the procedure.
You will probably need to fast (not eat or drink) for several hours before the test. You may also need to stop taking blood thinners, such as aspirin, for a certain time before your test. Your provider will let you know when you need to stop taking your medicine and anything else you need to do to prepare for the test.
In addition, be sure to arrange for someone to drive you home. You may be groggy and confused after you wake up from the procedure.
You may have a little bleeding, pain, or bruising at the biopsy site. There is also a small risk of infection, which can be treated with antibiotics. Allergic reactions to the tracer are rare and usually mild.
There is very little exposure to radiation in a sentinel lymph node biopsy. While radiation exposure from the tracer in a sentinel lymph node biopsy is safe for most adults, it can be harmful to an unborn baby. So be sure to tell your provider if you are pregnant or think you may be pregnant.
The results will be given as positive or negative.
If your results are positive, it means cancer was found and may have spread to nearby lymph nodes and/or other organs. Your provider may recommend removing and testing more lymph nodes to check for cancer cells.
If your results are negative, it means no cancer cells were found, and it's unlikely that the cancer has spread. You will not need to have any more lymph nodes removed.
If you have questions about your results, talk to your health care provider.
While sentinel lymph node biopsies are mostly used for people with breast cancer or melanoma, it is currently being studied for use with other types of cancer, including:
Colon cancer
Stomach cancer
Thyroid cancer
Non-small cell lung cancer
Sentinel Lymph Node Biopsy: MedlinePlus Medical Test [accessed on Feb 03, 2024]
Sentinel Lymph Node Biopsy - NCI. National Cancer Institute. Jun 25, 2019 [accessed on Feb 03, 2024]
Melanoma: Tests After Diagnosis - Health Encyclopedia - University of Rochester Medical Center [accessed on Feb 03, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Sentinel Lymph Node Biopsy of the Breast
Sentinel lymph node biopsy of the breast. The first of three panels shows a radioactive substance and/or blue dye injected near the tumor; the middle panel shows that the injected material is followed visually and/or with a probe that detects radioactivity to find the sentinel nodes (the first lymph nodes to take up the material); the third panel shows the removal of the tumor and the sentinel nodes to check for cancer cells.
Sentinel lymph node biopsy of the breast. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).
Sentinel Lymph Node & Axillary Lymph Node Procedures for Breast Cancer - Mayo Clinic
Video by Mayo Clinic/YouTube
Surgery for Melanoma Patients: Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection
Video by American Cancer Society/YouTube
Sentinel Node Biopsy: Breast Cancer Lymph Node Surgery
Video by Breast Cancer School for Patients/YouTube
Sentinel Lymph Node Mapping for Gynecologic Cancers
Video by Memorial Sloan Kettering/YouTube
Introduction to the Lymphatic System
Video by Osmosis/YouTube
Lymphatic System, Part 2
Video by Tammy Moore/YouTube
The Lymphatic System, Part 1
Video by Tammy Moore/YouTube
The lymphatic system's role in immunity | Lymphatic system physiology | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
lymphatic system
Diagram of the lymphatic system.
Image by Cancer Research UK / Wikimedia Commons
Lymphatic System
Lymphatic System
Image by NIH
Lymph Node of Head and Neck
3D visualization reconstructed from scanned human data of male revealing lymphatic structures (lacrimal glands, tonsils, salivary glands, thymus, subclavian veins axillary nodes, stomach, cisterna chyli). The lymphatic system works in concert with the immune system. It can be described as an extensive network of vessels that shuttle molecular waste-filled fluid (lymph) through purifiying centers called lymph nodes.
Image by TheVisualMD
Lymphatic, circulatory and nervous systems
The systems of the human body consist of: circulatory, digestive, endocrine, immune/lymphatic, integumentary, muscular, reproductive, skeletal, urinary. This image depicts the circulatory, endocrine, immune/lymphatic, nervous
Image by TheVisualMD
Babies Sitting Showing Respiratory Lymphatic Circulatory and Skeletal Systems
One of the most obvious ways that we notice the overall immune health of a baby is through the presence or absence of respiratory infections. Respiratory illness is the leading cause of hospitalization among young children. Lymph nodes and vessels are a direct component of the immune system. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, and thoracic regions. Lymph tissue aids the immune system by collecting and breaking down toxins and other waste products of the body. Lymph vessels transport lymph, a clear fluid derived from intercellular spaces around the body, eventually back into the blood. An infant's circulatory system will face an olympian job over the course of the individual's lifetime; the heart will beat 2.5 billion times and pump millions of gallons of blood through the body's vast network of arteries and veins. An infant's heart doubles in size the first year of life. Nutrition plays a key role in the development and maintenance of a healthy circulatory system by providing building blocks such as iron needed for red blood cell production.
Image by TheVisualMD
Lymphatic System
Lymphatic Trunks and Ducts System
Image by OpenStax College
Babies Sitting Showing Respiratory Lymphatic Circulatory and Skeletal Systems
One of the most obvious ways that we notice the overall immune health of a baby is through the presence or absence of respiratory infections. Respiratory illness is the leading cause of hospitalization among young children. Lymph nodes and vessels are a direct component of the immune system. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, and thoracic regions. Lymph tissue aids the immune system by collecting and breaking down toxins and other waste products of the body. Lymph vessels transport lymph, a clear fluid derived from intercellular spaces around the body, eventually back into the blood. An infant's circulatory system will face an olympian job over the course of the individual's lifetime; the heart will beat 2.5 billion times and pump millions of gallons of blood through the body's vast network of arteries and veins. An infant's heart doubles in size the first year of life. Nutrition plays a key role in the development and maintenance of a healthy circulatory system by providing building blocks such as iron, needed for red blood cell production.
Image by TheVisualMD
In Defense of You: Your Immune System
Image by TheVisualMD
Lymph Node and Lymph interstitial fluid
Lymph Node and Vasculature: The image shows a human lymph node and its vasculature (blood vessels). Lymph nodes are encapsulated bundles of lymph tissue found throughout the body, especially in the neck, armpit, groin, lung, and aortic areas. These aggregations of lymph tissue aid the immunological system by collecting and breaking down toxins and other waste products of the body.
Image by TheVisualMD
Lymph Node with Vasculature
Computer generated illustration of a human lymph node and its vasculature. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, lung and aortic areas. These aggregations of lymph tissue aid the immunological system by collecting and breaking down toxins and other waste products of the body.
Image by TheVisualMD
Immune System and Autoimmune Diseases
Normally, an individual's immune system learns to identify and ignore all of the distinctive little structures found on that individual's own cells. Sometimes, however, it will make a mistake and identify its own body as foreign. If that happens, the immune system produces antibodies that attempt to destroy the body's own cells in the same way it would try to destroy a foreign invader.
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Lymph Node Biopsy
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Lymph Node Biopsy
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Sentinel Lymph Node Biopsy
This is a picture of the first radio-guided sentinel lymph node biopsy using real-time imaging by means of a portable gamma camera (Sentinella) in a patient with colon cancer
The lobes and ducts of the breast, and nearby lymph nodes (above) are areas that cancer can attack. The temporary inconvenience of a mammogram can save you from troublesome and costly treatment and surgery by catching breast cancer early, when it is easiest to treat.
Image by NIH
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Breast Cancer Surgery
Breast surgeon Dr. Nora Jaskowiak of The University of Chicago Medical Center explains how far mastectomies and other breast surgeries have come and the impact on the patient's life.
Image by TheVisualMD
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Mastectomy (Simple)
Title Mastectomy (Simple) Description Treatment for breast cancer - removal of breast and a sample of underarm lymph nodes.
Image by National Cancer Institute / Linda Bartlett (Photographer)
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Mastectomy
Total (simple) Mastectomy Description Total (simple) mastectomy; drawing shows removal of the breast and lymph nodes. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed.
Image by National Cancer Institute
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Radical Mastectomy
Mastectomy (Radical) Description Halsted radical mastectomy. Removal of the entire breast and chest muscles, as well as lymph nodes in underarm area for the treatment of breast cancer.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Front view of the breast
Diagram showing the front view of the breast.
Image by Centers for Disease Control and Prevention (CDC)
Side view of the breast
Diagram showing the side view of the breast.
Image by Centers for Disease Control and Prevention (CDC)
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Breast and adjacent lymph nodes
Illustration of Breast and Adjacent Lymph Nodes Description: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Image by National Cancer Institute, Don Bliss (Illustrator)
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Breast and Adjacent Lymph Nodes
The female breast (nipple, areola, ducts, lobes, lobules, and fatty tissue) and adjacent lymph nodes and lymph vessels (no labels appear in the illustration).
Image by National Cancer Institute (NCI) / Don Bliss (Illustrator)
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Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
Most breast cancers begin in the lobules or ducts of the breast, which produce breast milk and carry it to the nipples after pregnancy. Invasive cancers spread outside of the lobules and ducts and penetrate into the surrounding breast tissue. From there, cancer cells may travel to lymph nodes in the armpit area. In stage IV breast cancer, cancer cells have spread into other parts of the body, such as the lungs or bones. HER2-positive breast cancer is aggressive and is likely to spread quickly. It is also resistant to hormone therapy. However, treatment with the drugs trastuzumab and/or lapatinib may help women who test positive for HER2.
Image by TheVisualMD
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Metastatic Breast Cancer in Pleural Fluid
Image by Ed Uthman/Flickr
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Diagram showing the network of lymph nodes in and around the breast.
Diagram showing the network of lymph nodes in and around the breast.
Image by Cancer Research UK / Wikimedia Commons
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Breast lobes and ducts
Diagram showing the lobes and ducts of a breast.
Image by Cancer Research UK / Wikimedia Commons
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Breast
Breast and Adjacent Lymph Nodes Description The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Image by National Cancer Institute
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Breast Anatomy
Breast Anatomy; observe lobes, lobules, ducts, areola, nipple, fat, lymph nodes and lymphatic vessels.
Image by National Cancer Institute / Don Bliss (Illustrator)
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External and Internal Anatomy of Breast
The breast is made up of a variety of tissues and structures, including fat, blood vessels, lymph vessels, ligaments, and nerves. The mammary gland is embedded in the breast's fatty tissue and contains 15-20 lobes, each of which is subdivided into smaller lobules. The breast milk that is produced drains from the lobes into the nipple via the lactiferous ducts.
Image by TheVisualMD
Lymph Nodes
Lymph Nodes
Lymph Nodes
Lymph Nodes
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Breast Lymph Nodes
Lymph vessels form a network in each breast, draining into lymph nodes in the underarm and along the breast bone. Cancer cells may break away from the main tumor and spread to other parts of the body through the lymphatic system.
Interactive by TheVisualMD
Sentinel Lymph Node Biopsy of the Breast
Sentinel lymph node biopsy of the breast. The first of three panels shows a radioactive substance and/or blue dye injected near the tumor; the middle panel shows that the injected material is followed visually and/or with a probe that detects radioactivity to find the sentinel nodes (the first lymph nodes to take up the material); the third panel shows the removal of the tumor and the sentinel nodes to check for cancer cells.
Sentinel lymph node biopsy of the breast. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).
Also called: TP53 Mutation Analysis; TP53 Gene Sequencing, TP53 Full Gene Analysis; TP53 Somatic Mutation
A TP53 genetic test looks for a mutation in the gene TP53 (tumor protein 53). TP53 is a type of gene called a tumor suppressor. If you have the mutation (acquired or inherited), you are at higher risk for getting cancer. The test can help choose treatment for people who have cancer.
TP53 Genetic Test
Also called: TP53 Mutation Analysis; TP53 Gene Sequencing, TP53 Full Gene Analysis; TP53 Somatic Mutation
A TP53 genetic test looks for a mutation in the gene TP53 (tumor protein 53). TP53 is a type of gene called a tumor suppressor. If you have the mutation (acquired or inherited), you are at higher risk for getting cancer. The test can help choose treatment for people who have cancer.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
Your result is negative for known pathogenic mutations in the TP53 gene.
Related conditions
A TP53 genetic test usually uses a sample of your blood to look for changes in the tumor protein 53 gene, or TP53 for short. Changes in your genes are also called gene variants or mutations. Changes in the TP53 gene are linked to many different types of cancer.
Genes are parts of DNA in your cells that you inherit from your parents. You inherit two copies of each gene, one from each parent. Genes carry information that controls what you look like and how your body works.
TP53 is a type of gene called a "tumor suppressor." Tumor suppressor genes provide instructions for making proteins that control how fast your cells grow and divide to make new cells. TP53 proteins also help stop the growth of abnormal cells.
If you have certain changes in a TP53 gene, the gene or the protein it makes may not work well or may stop working completely. As a result, your cells may grow out of control, which can lead to tumors and cancer. Changes in your TP53 gene can be acquired or inherited.
Acquired changes in your genes develop at some time after you're born. Most changes in TP53 genes are acquired changes. More than half of all adult cancers involve a change in this gene.
Acquired changes in your TP53 gene:
Can happen if your cells make a mistake when they divide to make new cells
Can happen if you're exposed to substances that cause cancer
Show up only in certain types of cells
Usually aren't in sperm or egg cells, so you can't pass them down to children
Inherited changes in your genes are changes that you're born with. They show up in all the cells in your body, including your egg or sperm cells. That means they can be passed down to your children. Inherited changes in the TP53 gene cause a rare genetic condition called Li-Fraumeni syndrome (LFS). It increases your risk of developing certain types of cancer. Cancers that are linked to Li-Fraumeni syndrome commonly happen in the breast, bone, or muscles.
A TP53 genetic test is used to look for changes in your TP53 genes. It's not a routine test. It is often used to:
Help choose treatment for people who have cancer
Check for inherited changes in the TP53 gene in people who have a personal or family history of cancers that may be linked to Li-Fraumeni syndrome
You may need a TP53 test if you:
Have been diagnosed with cancer. The test can check whether an acquired change in your TP53 gene is causing your cancer. This information can help your provider select the right treatment and predict how your cancer may behave over time.
Have a personal and/or family health history that suggests you may have inherited Li-Fraumeni syndrome. Providers may use different sets of guidelines to decide who needs to be tested for Li-Fraumeni syndrome. Talk with your provider or a genetic counselor about testing if you or your family members have had cancers that are closely linked to Li-Fraumeni syndrome. These cancers include:
Osteosarcoma, a form of bone cancer
Soft tissue sarcoma, cancer of the muscle and connective tissues
Breast cancer
Brain tumors
Acute (sudden) leukemia
Adrenal cortical carcinoma, a type of adrenal gland cancer
A TP53 test is often done on a sample of blood. Tissue from a tumor or bone marrow may sometimes be used instead. Bone marrow is a spongy tissue found inside most bones.
For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For tumor tissue testing, tissue is removed during a procedure called a biopsy. A biopsy may be done in different ways depending on where the tumor is located. A provider may use a hollow needle or surgery to take a tissue sample from a tumor.
For a bone marrow test, a provider usually takes a sample from the back of your hip bone. You will be given an injection (shot) of medicine to numb the area. You may also be given medicine to help you relax or sleep.
A bone marrow test has two parts that are usually done one after the other:
For a bone marrow aspiration, the provider pushes a hollow thin needle into the bone. A sample of bone marrow fluid is removed using a syringe attached to the needle.
For a bone marrow biopsy, the provider inserts a larger hollow needle into the bone and twists the needle to take out a small piece of bone marrow tissue.
The procedure takes only a few minutes. You may feel pressure or a brief, sharp pain when the samples are being taken. Afterwards, the area will be bandaged. You'll stay lying down for about 15 minutes to make sure the bleeding stops. You may need to stay longer if you had medicine to relax or sleep.
A blood test usually doesn't require any preparation. If you're having a tissue biopsy or a bone marrow test, ask your provider how you should prepare. If you will be given medicine to relax or sleep, plan to have someone take you home after the test in case you are drowsy.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
After a tissue biopsy or a bone marrow test, you may have some soreness where the sample was taken. This usually goes away in a few days. If you need pain relief, talk with your provider.
If you have cancer and your results show you have an acquired change in your TP53 gene, ask your provider how this information affects your treatment plan and future health.
If your test results show you have an inherited change in one copy of your TP53 gene, you have Li-Fraumeni syndrome. This doesn't mean you have cancer. But your risk of getting cancer is higher than most people. Talk with your provider about the steps you can take to reduce your risk of cancer. Your provider may discuss:
Having frequent cancer screening tests to help find cancer early when it may be easier to treat
Having a yearly physical exam
Making lifestyle changes, such as getting more exercise, eating a healthier diet, and quitting smoking
Chemoprevention, which is taking certain medicines or other substances to reduce the risk of developing cancer or to keep it from coming back
Mastectomy to help prevent breast cancer
The right steps for you will depend on your age, health history, and family health history.
If you think you may have Li-Fraumeni syndrome, it may help to talk with a genetic counselor before getting tested. The counselor can help you understand the risks and benefits of testing for you and your family. This can help you make informed decisions.
If you are diagnosed with Li-Fraumeni syndrome, a counselor can explain your risk for cancer and discuss whether family members should be tested. A genetic counselor can also help you make plans to manage your risk over time.
TP53 Genetic Test: MedlinePlus Lab Test Information [accessed on Dec 19, 2018]
TP53 gene - Genetics Home Reference - NIH [accessed on Dec 19, 2018]
481044: p53 Tumor Suppressor Gene Protein,... | LabCorp [accessed on Dec 19, 2018]
https://www.ambrygen.com/sites/default/files/web/understanding_your_results/cancer/tp53_uyr.pdf [accessed on Dec 19, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (10)
p53 Tumour Suppressor and MDM2
Video by Neural Academy/YouTube
NEOPLASIA 4: p53 gene: The Guardian of the genome. functions, regulation and inactivation
Video by ilovepathology/YouTube
The Role of p53 in Cancer
Video by Maja Divjak/YouTube
Tumor suppressors | Biomolecules | MCAT | Khan Academy
Video by khanacademymedicine/YouTube
P53 animation - tumor supressor gene animation
Video by Biology animation videos/YouTube
Apoptotic Pathways
Video by Genentech/YouTube
P53
Cartoon representation of a complex between DNA and the protein p53 (described in Cho et al. Science 265 pp. 346, 1994 [1])
Image by Thomas Splettstoesser/Wikimedia
031-P53-1olg 1tup 1ycq
p53 tumor supressor. Flexible portions of the molecule that are not included in the structures are shown schematically.
Image by Protein Data Bank. David Goodsell./Wikimedia
Tumour suppressor p53-DNA complex
Image by /Wikimedia
Glioblastoma P53
Immunhistochemische Färbung der Tumorzellen für p53. Ansammlung von (defektem) p53-Protein in den Tumorzellkernen bei einem sekundären Glioblastom mit Mutation des TP53 Gens.
Image by Marvin 101/Wikimedia
3:34
p53 Tumour Suppressor and MDM2
Neural Academy/YouTube
10:22
NEOPLASIA 4: p53 gene: The Guardian of the genome. functions, regulation and inactivation
ilovepathology/YouTube
3:53
The Role of p53 in Cancer
Maja Divjak/YouTube
4:44
Tumor suppressors | Biomolecules | MCAT | Khan Academy
khanacademymedicine/YouTube
2:36
P53 animation - tumor supressor gene animation
Biology animation videos/YouTube
2:05
Apoptotic Pathways
Genentech/YouTube
P53
Thomas Splettstoesser/Wikimedia
031-P53-1olg 1tup 1ycq
Protein Data Bank. David Goodsell./Wikimedia
Tumour suppressor p53-DNA complex
/Wikimedia
Glioblastoma P53
Marvin 101/Wikimedia
Polygenic Risk Score
Polygenic Risk Score
Also called: PRS, Genetic risk score, Genome-wide score, Polygenic score
A polygenic risk score (PRS) is a score that gives you the genetic risk of developing a disease, based on the total number of risk alleles (specific version of a gene) related to the disease. The higher the score, the higher the risk of developing the disease.
Polygenic Risk Score
Also called: PRS, Genetic risk score, Genome-wide score, Polygenic score
A polygenic risk score (PRS) is a score that gives you the genetic risk of developing a disease, based on the total number of risk alleles (specific version of a gene) related to the disease. The higher the score, the higher the risk of developing the disease.
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Use the slider below to see how your results affect your
health.
Your result is Low risk.
A polygenic risk score can only explain the relative risk for a disease. A low risk PRS has little predictive value.
Related conditions
Many people have an illness, or several illnesses, that are affected by changes in either one or many of their genes, frequently coupled with environmental factors.
Researchers are studying these changes to understand the role that genetics plays in diseases across different populations.
A “polygenic risk score” is one way by which people can learn about their risk of developing a disease, based on the total number of changes related to the disease.
What is a genomic variant?
All humans have near-identical DNA sequences across the estimated 6 billion-letter code for their genome.
Slight differences exist between individuals, making each of us unique. These differences, called genomic variants, occur at specific locations within the DNA.
DNA is read like a code. This code is made up of four types of chemical building blocks - adenine, thymine, cytosine and guanine, abbreviated with the letters A, T, C and G. A genomic variant occurs in a location within the DNA where that code differs among people.
For example, in Person One below, the location shows a "C" base. But in the same location in Person Two, it is a "T."
There are roughly 4 to 5 million such genomic variants in an individual’s genome. These variants may be unique to that individual or occur in others as well.
Some variants increase the risk of developing diseases, while others may reduce such risk; others have no effect on disease risk.
The question is: How do these genomic variants influence the risk for specific diseases?
Image shows genomic variants represented by the letter “V.” Some are shared among individuals, while others are specific to one person.
Researchers often divide genetic diseases into two classes: those that are associated with a single gene and those that are influenced by multiple genes and environmental factors. Many diseases fall on a spectrum between these two extremes.
Single-gene diseases
Many inherited diseases can be traced to variants in a single gene. Cystic fibrosis, a progressive genetic disease that causes long-term lung infections and limits the ability to breathe over time, is caused by variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7.
Each small “v” represents a genomic variant that is present in an individual’s genome but are not associated with cystic fibrosis. Each larger “V” represents a CFTR gene mutation.
Complex diseases
Complex diseases occur as a result of many genomic variants, paired with environmental influences (such a diet, sleep, stress and smoking). They are also called “polygenic” diseases - with “poly” meaning many and “genic” involving genes.
Each red “v” represents variants in an individual’s genome that is associated with coronary artery disease. Each smaller gray “v” is a variant that is also present in the person’s genome but is not implicated in disease.
Coronary artery disease is a complex disease. Researchers have found about 60 genomic variants that are present more frequently in people with coronary artery disease. Most of these variants are dispersed across the genome and do not cluster on one specific chromosome.
Researchers identify genomic variants associated with complex diseases by comparing the genomes of individuals with and without those diseases.
The enormous amount of genomic data now available enables researchers to calculate which variants tend to be found more frequently in groups of people with a given disease. There can be hundreds or even thousands of variants per disease.
Researchers put this information into a computer and use statistics to estimate how the collection of a person’s variants affect their risk for a certain disease.
This yields polygenic risk scores.
All of this can be done without knowing the specific genes involved in the complex disease. While we may someday know all the genes involved, researchers can estimate risk now without this link.
A polygenic risk score can only explain the relative risk for a disease. Why relative? The data used for generating a polygenic risk score comes from large scale genomic studies. These studies find genomic variants by comparing groups with a certain disease to a group without the disease.
A polygenic risk score tells you how a person’s risk compares to others with a different genetic constitution. However, polygenic scores do not provide a baseline or timeframe for the progression of a disease. For example, consider two people with high polygenic risk scores for having coronary heart disease. The first person is 22 years old, while the latter is 98. Although they have the same polygenic risk score, they will have different lifetime risks of the disease. Polygenic risk scores only show correlations, not causations.
Absolute risk is different. Absolute risk shows the likelihood of a disease occurring. Women who carry a BRCA1 mutation have a 60-80% absolute risk of breast cancer. This would be true even without any comparison to any groups of people.
Each polygenic risk score can be put on a bell curve distribution. Most people will find their scores to be in the middle, indicating average risk for developing a disease. Others may find themselves on the tail ends, putting them at either low or high risk. People with scores on the high-risk portion of the spectrum may benefit from discussions about this risk with their physicians and genetic counselors for further health assessments.
The majority of genomic studies to date have examined individuals of European ancestry. Because of this issue, there may not be adequate data about genomic variants from other populations for calculating a polygenic risk score in those populations. This historic lack of diversity in genomic studies is also a concern for other genomics-related research areas and contributes to a widespread concern about increasing health disparities beyond polygenic risk scores.
The percentage of ancestry populations included in large-scale genomic studies is overwhelmingly European.
At this point in time, the accuracy of polygenic risk scores may only be valid and useful for European ancestry populations. More research is needed to derive the data for making polygenic risk scores useful for other populations.
Looking to the future
Polygenic risk scores are not yet routinely used by health professionals because there are no guidelines for practice and researchers are still improving how these scores are generated. However, private healthcare and direct-to-consumer companies have already begun generating polygenic risk scores for their consumers and they may someday serve as an important new tool to guide healthcare decisions.
Polygenic risk scores will always be probabilities, not certainties. Understanding how polygenic risk scores can impact peoples’ lives and health is an active area of research being supported by the National Human Genome Research Institute.
https://www.genome.gov/Health/Genomics-and-Medicine/Polygenic-risk-scores [accessed on Nov 08, 2019]
https://blogs.cdc.gov/genomics/2019/06/03/is-it-time/ [accessed on Nov 08, 2019]
https://www.nature.com/articles/s41467-019-11112-0 [accessed on Nov 08, 2019]
https://news.harvard.edu/gazette/story/2018/08/polygenic-risk-scoring-flags-likelihood-of-developing-common-diseases/ [accessed on Nov 08, 2019]
https://elifesciences.org/articles/43657 [accessed on Nov 08, 2019]
https://www.precisionmedicineadvisors.com/precisionmedicine-blog/2019/2/14/what-health-care-providers-need-to-know-about-polygenic-risk-scores [accessed on Nov 08, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (13)
Sekar Kathiresan: Why Are Polygenic Risk Scores Important?
Video by Broad Institute/YouTube
Polygenic Risk Scores Bring New Potential for Predicting Disease Risk
Video by Illumina/YouTube
Polygenic Risk Score Series | Learn About PRSs from Leading Researchers
Video by Illumina/YouTube
Polygenic Risk Score Series | Discover Key Considerations for Developing PRS
Video by Illumina/YouTube
Polygenic Risk Score Series | Learn More About Using Polygenic Risk Scores
Video by Illumina/YouTube
Polygenic Risk Score Series | Discover How PRSs Will Impact Clinical Care
Video by Illumina/YouTube
Polygenic Risk Score Series | Explore Future Uses for Polygenic Risk Scores
Video by Illumina/YouTube
Genomic variant
There are roughly 4 to 5 million such genomic variants in an individual’s genome. These variants may be unique to that individual or occur in others as well.
Image by National Human Genome Research Institute
Multiple genomic variants shown on different strands of DNA double-helix
Image shows genomic variants represented by the letter “V.” Some are shared among individuals, while others are specific to one person.
Image by National Human Genome Research Institute
Cystic fibrosis, a single gene disease
Each small “v” represents a genomic variant that is present in an individual’s genome but are not associated with cystic fibrosis. Each larger “V” represents a CFTR gene mutation.
Image by National Human Genome Research Institute
Coronary artery disease, a polygenic disease
Each red “v” represents variants in an individual’s genome that is associated with coronary artery disease. Each smaller gray “v” is a variant that is also present in the person’s genome but is not implicated in disease.
Image by National Human Genome Research Institute
Polygenic Risk Score Bell Curve
Each polygenic risk score can be put on a bell curve distribution. Most people will find their scores to be in the middle, indicating average risk for developing a disease. Others may find themselves on the tail ends, putting them at either low or high risk. People with scores on the high-risk portion of the spectrum may benefit from discussions about this risk with their physicians and genetic counselors for further health assessments.
Image by National Human Genome Research Institute
Pie chart showing 78% European, 10% Asian, 2% African, 1 % Hispanic, .5% Other minorities, 8.5% Unreported
The percentage of ancestry populations included in large-scale genomic studies is overwhelmingly European.
Image by National Human Genome Research Institute
1:23
Sekar Kathiresan: Why Are Polygenic Risk Scores Important?
Broad Institute/YouTube
4:36
Polygenic Risk Scores Bring New Potential for Predicting Disease Risk
Illumina/YouTube
1:44
Polygenic Risk Score Series | Learn About PRSs from Leading Researchers
Illumina/YouTube
2:21
Polygenic Risk Score Series | Discover Key Considerations for Developing PRS
Illumina/YouTube
2:07
Polygenic Risk Score Series | Learn More About Using Polygenic Risk Scores
Illumina/YouTube
2:26
Polygenic Risk Score Series | Discover How PRSs Will Impact Clinical Care
Illumina/YouTube
2:45
Polygenic Risk Score Series | Explore Future Uses for Polygenic Risk Scores
Illumina/YouTube
Genomic variant
National Human Genome Research Institute
Multiple genomic variants shown on different strands of DNA double-helix
National Human Genome Research Institute
Cystic fibrosis, a single gene disease
National Human Genome Research Institute
Coronary artery disease, a polygenic disease
National Human Genome Research Institute
Polygenic Risk Score Bell Curve
National Human Genome Research Institute
Pie chart showing 78% European, 10% Asian, 2% African, 1 % Hispanic, .5% Other minorities, 8.5% Unreported
National Human Genome Research Institute
Stages
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Staging Cancer
Image by TheVisualMD
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Staging Cancer
Cancer staging, that is, determining the extent and spread of cancer in the body, is used by doctors to plan treatment and to arrive at a prognosis (estimate of future course and outcome) for the disease.
Image by TheVisualMD
Breast Cancer and Pregnancy - Stages
KEY POINTS
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.
The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.
Tumor (T). The size and location of the tumor.
Lymph Node (N). The size and location of lymph nodes where cancer has spread.
Metastasis (M). The spread of cancer to other parts of the body.
The grading system is used to describe how quickly a breast tumor is likely to grow and spread.
Biomarker testing is used to find out whether breast cancer cells have certain receptors.
The TNM system, the grading system, and biomarker status are combined to find out the breast cancer stage.
Talk to your doctor to find out what your breast cancer stage is and how it is used to plan the best treatment for you.
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out if the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
Some procedures may expose the unborn baby to harmful radiation or dyes. These procedures are done only if absolutely necessary. Certain actions can be taken to expose the unborn baby to as little radiation as possible, such as the use of a lead-lined shield to cover the abdomen.
The following tests and procedures may be used to stage breast cancer during pregnancy:
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in bones with cancer and is detected by a scanner.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the liver, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.
To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.
There are 3 types of breast cancer stage groups:
Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests (if done), and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status (ER, PR, HER2). In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory testresults from breast tissue and lymph nodes removed during surgery.
Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.
The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.
For breast cancer, the TNM system describes the tumor as follows:
Tumor (T). The size and location of the tumor.
Tumor sizes are often measured in millimeters (mm) or centimeters. Common items that can be used to show tumor size in mm include: a sharp pencil point (1 mm), a new crayon point (2 mm), a pencil-top eraser (5 mm), a pea (10 mm), a peanut (20 mm), and a lime (50 mm).
TX: Primary tumor cannot be assessed.
T0: No sign of a primary tumor in the breast.
Tis: Carcinoma in situ. There are 2 types of breast carcinoma in situ:
Tis (DCIS): DCIS is a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer that is able to spread to other tissues. At this time, there is no way to know which lesions can become invasive.
Tis (Paget disease): Paget disease of the nipple is a condition in which abnormal cells are found in the skin cells of the nipple and may spread to the areola. It is not staged according to the TNM system. If Paget disease AND an invasive breast cancer are present, the TNM system is used to stage the invasive breast cancer.
T1: The tumor is 20 millimeters or smaller. There are 4 subtypes of a T1 tumor depending on the size of the tumor:
T1mi: the tumor is 1 millimeter or smaller.
T1a: the tumor is larger than 1 millimeter but not larger than 5 millimeters.
T1b: the tumor is larger than 5 millimeters but not larger than 10 millimeters.
T1c: the tumor is larger than 10 millimeters but not larger than 20 millimeters.
T2: The tumor is larger than 20 millimeters but not larger than 50 millimeters.
T3: The tumor is larger than 50 millimeters.
T4: The tumor is described as one of the following:
T4a: the tumor has grown into the chest wall.
T4b: the tumor has grown into the skin—an ulcer has formed on the surface of the skin on the breast, small tumor nodules have formed in the same breast as the primary tumor, and/or there is swelling of the skin on the breast.
T4c: the tumor has grown into the chest wall and the skin.
T4d: inflammatory breast cancer—one-third or more of the skin on the breast is red and swollen (called peau d’orange).
Lymph Node (N). The size and location of lymph nodes where cancer has spread.
When the lymph nodes are removed by surgery and studied under a microscope by a pathologist, pathologic staging is used to describe the lymph nodes. The pathologic staging of lymph nodes is described below.
NX: The lymph nodes cannot be assessed.
N0: No sign of cancer in the lymph nodes, or tiny clusters of cancer cells not larger than 0.2 millimeters in the lymph nodes.
N1: Cancer is described as one of the following:
N1mi: cancer has spread to the axillary (armpit area) lymph nodes and is larger than 0.2 millimeters but not larger than 2 millimeters.
N1a: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
N1b: cancer has spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy. Cancer is not found in the axillary lymph nodes.
N1c: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer is also found by sentinel lymph node biopsy in the lymph nodes near the breastbone on the same side of the body as the primary tumor.
N2: Cancer is described as one of the following:
N2a: cancer has spread to 4 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
N2b: cancer has spread to lymph nodes near the breastbone and the cancer is found by imaging tests. Cancer is not found in the axillary lymph nodes by sentinel lymph node biopsy or lymph node dissection.
N3: Cancer is described as one of the following:
N3a: cancer has spread to 10 or more axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters, or cancer has spread to lymph nodes below the collarbone.
N3b: cancer has spread to 1 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone and the cancer is found by imaging tests;
or
cancer has spread to 4 to 9 axillary lymph nodes and cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy.
N3c: cancer has spread to lymph nodes above the collarbone on the same side of the body as the primary tumor.
When the lymph nodes are checked using mammography or ultrasound, it is called clinical staging. The clinical staging of lymph nodes is not described here.
Metastasis (M). The spread of cancer to other parts of the body.
M0: There is no sign that cancer has spread to other parts of the body.
M1: Cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. If cancer has spread to distant lymph nodes, the cancer in the lymph nodes is larger than 0.2 millimeters.
The grading system is used to describe how quickly a breast tumor is likely to grow and spread.
The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:
How much of the tumor tissue has normal breast ducts.
The size and shape of the nuclei in the tumor cells.
How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.
For each feature, the pathologist assigns a score of 1 to 3; a score of “1” means the cells and tumor tissue look the most like normal cells and tissue, and a score of “3” means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.
Three grades are possible:
Total score of 3 to 5: G1 (Low grade or well differentiated).
Total score of 6 to 7: G2 (Intermediate grade or moderately differentiated).
Total score of 8 to 9: G3 (High grade or poorly differentiated).
Biomarker testing is used to find out whether breast cancer cells have certain receptors.
Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormonesestrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.
Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.
For breast cancer, biomarker testing includes the following:
Estrogen receptor (ER). If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
Progesterone receptor (PR). If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
Human epidermal growth factor type 2 receptor (HER2/neu or HER2). If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive(HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ breast cancer is more likely to grow and divide faster than HER2- breast cancer.
Sometimes the breast cancer cells will be described as triple negative or triple positive.
Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.
It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.
The TNM system, the grading system, and biomarker status are combined to find out the breast cancer stage.
Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:
If the tumor size is 30 millimeters (T2), has not spread to nearby lymph nodes (N0), has not spread to distant parts of the body (M0), and is:
Grade 1
HER2+
ER-
PR-
The cancer is stage IIA.
If the tumor size is 53 millimeters (T3), has spread to 4 to 9 axillary lymph nodes (N2), has not spread to other parts of the body (M0), and is:
Grade 2
HER2+
ER+
PR-
The tumor is stage IIIA.
If the tumor size is 65 millimeters (T3), has spread to 3 axillary lymph nodes (N1a), has spread to the lungs (M1), and is:
Grade 1
HER2+
ER-
PR-
The cancer is stage IV.
Talk to your doctor to find out what your breast cancer stage is and how it is used to plan the best treatment for you.
After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.
You are likely to have many questions. Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you.
Source: National Cancer Institute (NCI)
Additional Materials (5)
Diagram showing stage 1A breast cancer
Stage 1B breast cancer
Stage 2A breast cancer - Diagram 1 of 2
Stage 2A breast cancer - Diagram 2 of 2
Stage 2B breast cancer - Diagram 1 of 3
Stage 2B breast cancer - Diagram 2 of 3
Stage 2B breast cancer - Diagram 3 of 3
Stage 3A breast cancer- Diagram 1 of 3
Stage 3A breast cancer- Diagram 2 of 3
Stage 3A breast cancer- Diagram 3 of 3
Diagram 1 of 3 showing stage 3C breast cancer
Stage 3C breast cancer - Diagram 2 of 3
Stage 3C breast cancer - Diagram 3 of 3
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Stages of Breast Cancer
Interactive by Cancer Research UK / Wikimedia
Screening for Cancer, cancer screening
Image by TheVisualMD
Tumor Sizing
Cancer staging, that is, determining the extent and spread of cancer in the body, is used by doctors to plan treatment and to arrive at a prognosis (estimate of future course and outcome) for the disease. For most cancers, staging is done using the TNM (Tumor, Node, Metastasis) system, developed by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). A T1 tumor may be the size of a pea (less than 2cm); a T3 tumor could be the size of a lime (up to 5 cm).
Image by TheVisualMD
Cancer staging
Staging Cancer : Staging is the process of finding out the amount of cancer in the body and if it has spread. Most tumorous cancers are staged using the TNM system. In the TNM system, T = extent of the primary tumor, N = extent of spread to lymph nodes, M = presence of metastasis. After the TNM description has been decided, the cancer can be designated as Stage 0-IV. Stage 0 =carcinoma in situ. In Stage I, Stage II, and Stage III, higher numbers indicate more extensive disease, ie, greater tumor size, and/or spread of the cancer to nearby lymph nodes, and/or organs adjacent to the primary tumor. In Stage IV, the cancer has spread to another organ.
Image by TheVisualMD
Staging Cancer
Cancer staging, that is, determining the extent and spread of cancer in the body, is used by doctors to plan treatment and to arrive at a prognosis (estimate of future course and outcome) for the disease.
Image by TheVisualMD
Stages of Breast Cancer
Cancer Research UK / Wikimedia
Screening for Cancer, cancer screening
TheVisualMD
Tumor Sizing
TheVisualMD
Cancer staging
TheVisualMD
Staging Cancer
TheVisualMD
Treatment Options
Fetal Developments and Breast Cancer Cells
Image by TheVisualMD
Fetal Developments and Breast Cancer Cells
Fetal Developments and Breast Cancer Cells.jpg
Image by TheVisualMD
Treatment Options for Pregnant Women
KEY POINTS
Treatment options for pregnant women depend on the stage of the disease and the age of the unborn baby.
Three types of standard treatment are used:
Surgery
Radiation therapy
Chemotherapy
Ending the pregnancy does not seem to improve the mother’s chance of survival.
Treatment for breast cancer may cause side effects.
Treatment options for pregnant women depend on the stage of the disease and the age of the unborn baby.
Three types of standard treatment are used:
Surgery
Most pregnant women with breast cancer have surgery to remove the breast. Some of the lymph nodes under the arm may be removed so they can be checked under a microscope by a pathologist for signs of cancer.
Types of surgery to remove the cancer include:
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. This type of surgery is most common in pregnant women.
Modified radical mastectomy. The dotted line shows where the entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed.
Breast-conserving surgery: Surgery to remove the cancer and some normal tissue around it, but not the breast itself. Part of the chest wall lining may also be removed if the cancer is near it. This type of surgery may also be called lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-sparing surgery.
Breast-conserving surgery. The tumor and some normal tissue around it are removed, but not the breast itself. Some lymph nodes under the arm may be removed. Part of the chest wall lining may also be removed if the cancer is near it.
After the doctor removes all of the cancer that can be seen at the time of surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. For pregnant women with early-stage breast cancer, radiation therapy and hormone therapy are given after the baby is born. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
External radiation therapy may be given to pregnant women with early stage (stage I or II) breast cancer after the baby is born. Women with late stage (stage III or IV) breast cancer may be given external radiation therapy after the first 3 months of pregnancy or, if possible, radiation therapy is delayed until after the baby is born.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavitysuch as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
The way the chemotherapy is given depends on the type and stage of the cancer being treated. Systemic chemotherapy is used to treat breast cancer during pregnancy.
Chemotherapy is usually not given during the first 3 months of pregnancy. Chemotherapy given after this time does not usually harm the unborn baby but may cause early labor or low birth weight.
Ending the pregnancy does not seem to improve the mother’s chance of survival.
Because ending the pregnancy is not likely to improve the mother’s chance of survival, it is not usually a treatment option.
Treatment for breast cancer may cause side effects.
For information about side effects caused by treatment for cancer, see our Side Effects page.
Source: National Cancer Institute (NCI)
Additional Materials (1)
Treating Pregnant Women with Breast Cancer - MedStar Health Cancer Network
Video by MedStar Health/YouTube
3:21
Treating Pregnant Women with Breast Cancer - MedStar Health Cancer Network
MedStar Health/YouTube
Early Stage and Late Stage
Incisions with robotic mastectomy and reconstruction are compared with those of the traditional (open) technique.
Image by Northwell
Incisions with robotic mastectomy and reconstruction are compared with those of the traditional (open) technique.
Robotic Comparison - Incisions with robotic mastectomy and reconstruction are compared with those of the traditional (open) technique.
Image by Northwell
Treatment Options For Breast Cancer During Pregnancy - Early Stage and Late Stage
Early Stage Breast Cancer
Pregnant women with early-stage breast cancer (stage I and stage II) are usually treated in the same way as patients who are not pregnant, with some changes to protect the unborn baby. Treatment may include the following:
Modified radical mastectomy, if the breast cancer was diagnosed early in pregnancy.
Breast-conserving surgery, if the breast cancer is diagnosed later in pregnancy. Radiation therapy may be given after the baby is born.
Modified radical mastectomy or breast-conserving surgery during pregnancy. After the first 3 months of pregnancy, certain types of chemotherapy may be given before or after surgery.
Hormone therapy and trastuzumab should not be given during pregnancy.
Late-Stage Breast Cancer
There is no standard treatment for patients with late-stage breast cancer (stage III or stage IV) during pregnancy. Treatment may include the following:
Radiation therapy.
Chemotherapy.
Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.
Source: National Cancer Institute (NCI)
Additional Materials (2)
Cancer Treatment During Pregnancy
Video by MDedge: news and insights for busy physicians/YouTube
Pregnant Nurse Battles Breast Cancer - Nebraska Medicine
Video by Nebraska Medicine Nebraska Medical Center/YouTube
4:18
Cancer Treatment During Pregnancy
MDedge: news and insights for busy physicians/YouTube
4:00
Pregnant Nurse Battles Breast Cancer - Nebraska Medicine
Nebraska Medicine Nebraska Medical Center/YouTube
Special Issues
Mammary Glands Before Pregnancy
Mammary Gland During Lactation
Mammary Gland After Nursing
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Mammary Glands Changes in Pregnancy and Lactation
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Mammary Glands Before Pregnancy
Mammary Gland During Lactation
Mammary Gland After Nursing
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2
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Mammary Glands Changes in Pregnancy and Lactation
Comparison visualization of the alveoli of the mammary glands before pregnancy (image 1), during lactation (image 2) and after nursing (image 3). After reproduction has occurred, the essential role of the mammary glands is to provide nourishing milk to a newborn. Internally, the mammary gland consists of up to 25 lobes which radiate around and open to the nipple. The lobes are separated from each other by fat and connective tissue. Within the lobes are smaller lobules which are made up of alveoli that produce milk during lactation. The alveolar glands pass the milk through lactiferous ducts which open to the nipple.
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Special Issues About Breast Cancer During Pregnancy
KEY POINTS
Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.
Breast cancer does not appear to harm the unborn baby.
Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.
Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.
If surgery is planned, breast-feeding should be stopped to reduce blood flow in the breasts and make them smaller. Many chemotherapy drugs, especially cyclophosphamide and methotrexate, may occur in high levels in breast milk and may harm the nursing baby. Women receiving chemotherapy should not breast-feed.
Stopping lactation does not improve the mother's prognosis.
Breast cancer does not appear to harm the unborn baby.
Breast cancer cells do not seem to pass from the mother to the unborn baby.
Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.
For women who have had breast cancer, pregnancy does not seem to affect their survival. However, some doctors recommend that a woman wait 2 years after treatment for breast cancer before trying to have a baby, so that any early return of the cancer would be detected. This may affect a woman’s decision to become pregnant. The unborn baby does not seem to be affected if the mother has had breast cancer.
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Breast Cancer During Pregnancy
Breast cancer occurs about once in every 3,000 pregnancies. It occurs most often in women aged 32 to 38 years. The cancer rarely affects the fetus itself but our actions to identify and control the cancer might, so it requires specialized care. Learn about solutions that can preserve the health of both you and your baby.