Every person with breast cancer is different, and every tumor is different. The more we can learn about your specific tumor, the better we can customize your treatment plan to you.
At Fred Hutch Cancer Center, we do extensive testing to diagnose and stage your disease precisely and accurately. Identifying features of your disease is important. It helps your physicians choose the treatments that will work best.
Risk Factors for Breast Cancer
Many things can affect the chances that you might develop breast cancer. If you have questions or concerns about your risk level or how to lower your risk, talk with your primary care physician or ask for a referral to the Breast Health Clinic at Fred Hutch.
The following factors are linked with higher breast cancer risk:
- Being female
- Getting older
- Having a body mass index (BMI) over 30 after menopause
- Having had proliferative breast lesions such as atypia (“proliferative” means there is more cell growth than normal, and “atypia” means the cells look abnormal)
- Having dense breast tissue
- Taking hormone therapy for menopause symptoms for more than 4–5 years
- Having your first menstrual period before age 13 or having later menopause (in the U.S., the average age for menopause is 52)
- Having never given birth
- Having your first full-term pregnancy at an older age
- Having already had breast cancer
- Having a family history of breast cancer
- Having a family history of certain genetic mutations (changes)
- Drinking more than four alcoholic drinks per week
- Smoking
- Being exposed to therapeutic ionizing radiation, such as having radiation therapy to your chest or breast
These factors may lower your breast cancer risk:
- Breastfeeding
- Being physically active
- Losing weight after menopause
- Eating a low-fat diet after menopause
- Medicine (chemoprevention) or surgery (such as a risk-reducing mastectomy), which may be options for some higher-risk people
Getting a Diagnosis
Getting a breast cancer diagnosis usually starts in one of two ways. One is that your screening mammogram shows something that isn’t normal. The other is that you notice signs or symptoms and decide to see a physician. Then, you will often have an exam, imaging tests and a biopsy.
Diagnosis Process at Fred Hutch
Many of our breast cancer patients are first diagnosed right here at Fred Hutch. Our breast health experts look at your signs and symptoms, and they do screenings, imaging tests and biopsies. Fred Hutch breast imaging specialists study your imaging tests and give the results.
Our pathologists test your tissue samples to get details about your specific cancer. Together, these details create a complex picture that will help guide decisions about your treatment. For example, some medicines may work well against some types of breast cancers but not others.
If You Were Diagnosed Elsewhere
We have many patients with breast cancer who come to Fred Hutch after they have been diagnosed somewhere else. Before your first visit with Fred Hutch physicians, we will go over the results of your scans and tests so far. Our breast imaging specialists look at your mammograms and any other scans. Our pathologists look at the pathology slides and the report from your biopsy. We may also run more tests on your tissue samples. We do this in order to be sure about your diagnosis and to plan treatment that matches your needs.
Imaging Tests and Biopsies
We offer a full range of imaging tests and biopsy methods to get the details we need to know your diagnosis, stage your disease and plan your care.
Imaging Tests for Breast Cancer
Fred Hutch is recognized as a Breast Imaging Center of Excellence by the American College of Radiology.
Our technologists and radiologists specialize in breast imaging only. They will do your imaging tests and give the results. To help find and diagnose breast cancer, we use mammography, ultrasound and breast MRI (magnetic resonance imaging).
Your team uses the same types of imaging to figure out the stage of your disease. For staging, you may also need more imaging, like a chest X-ray, CT (computed tomography) scan, PET (positron emission tomography) scan or bone scan.
Biopsies for Breast Cancer
To know for sure if you have breast cancer, you will need a biopsy. Biopsies show if there are cancer cells in a small tissue sample or in a tumor that was taken out by surgeons.
In most cases, Fred Hutch breast health specialists get a sample of tissue using a small needle (core biopsy) under precise image guidance. This can mean using ultrasound, mammography (stereotactic biopsy) and MRI imaging. If core biopsies do not give your care team clear results, you might need a surgical biopsy.
After diagnosis, most people will need surgery to take out their breast tumor. We may do more tests on the tumor as well as nearby lymph nodes to see if cancer has spread there (sentinel lymph node biopsy).
Fred Hutch pathologists will study and test your tissue samples to learn about your specific disease. This matters so your team can choose the treatments that will work best for you.
Schedule a Mammogram
Fred Hutchinson performs screening and diagnostic mammograms. At the clinic you can choose to have an appointment where we give you your imaging results the same day.
You may also choose to have a mammogram at a location near your home. This is done in our mammogram van.
Staging Breast Cancer
Staging means finding out how far cancer has spread in your breast or other parts of your body. Accurate staging helps your physicians decide which therapies to use to treat your disease. There are two main systems for staging breast cancer: TNM staging and overall stage grouping.
How We Determine Your Stage
Your Fred Hutch physicians will base your stage on a physical exam, imaging tests and biopsies. This is sometimes called clinical staging. We will do all the tests you need at Fred Hutch. Your team will help plan your appointments to make a schedule that works best for you.
Most people with breast cancer will have surgery to remove their tumor as well as some lymph nodes under their arm. Tests on the tumor and nodes can give your physicians more details about the type of cancer and the treatments you may need. It is normal to learn more about your stage after this surgery. This is called pathologic staging.
TNM Staging
TNM stands for tumor, nodes and metastasis. Your TNM stage is:
- The letter T with a number from 0 to 4. A higher T number means the tumor is larger, has spread more widely into nearby tissues or both.
- The letter N with a number from 0 to 3. A higher N number means more spread of cancer cells to lymph nodes near the breast, such as in the armpit or under the collarbone.
- The letter M with a 0 or 1. M0 means physicians did not find cancer in lymph nodes away from your breast or in distant organs. M1 means distant spread was found.
Overall Stage Grouping
After your physician finds your TNM stage, they will assign a stage using Roman numerals I (one), II (two), III (three) or IV (four).
- Stage 0: Noninvasive cancers (which are only in the milk ducts or glands).
- Stage I: The tumor is smaller than 1 inch across. It has not spread to lymph nodes under your arm or to other places outside your breast.
- Stage II: The tumor is 1 to 2 inches across, or cancer has spread to lymph nodes under your arm. Stage I or II cancers are considered early-stage cancers.
- Stage III: Cancer is in your breast, surrounding tissues and lymph nodes. Stage III cancers may be considered early-stage or advanced cancers.
- Stage IV: Cancer has spread to distant parts of your body or to lymph nodes outside your armpit. This is called metastatic cancer.
Ductal Carcinoma in Situ (Stage 0 Breast Cancer)
In this noninvasive type of breast cancer, cancer cells are only in the milk ducts. Surgery to remove the cancer is recommended to keep it from turning into invasive cancer. Surgery is also important to rule out the chance that some invasive cancer is already there. Radiation therapy and hormone therapy are also common parts of treatment.
Invasive Breast Cancer
This type can start in the milk ducts or the lobules (glands that make milk), and it can grow into surrounding breast tissue. The most common types of invasive breast cancer are:
- Invasive ductal carcinoma
- Invasive lobular carcinoma
Invasive breast cancer can spread beyond your breast. Breast cancer typically spreads to lymph nodes under the arm and to other nodes in the same region before it spreads to other parts of the body. Breast cancer that spreads to other organs, such as the lung, liver or bones, is called metastatic or stage IV (four) disease.
Along with the types listed above, there are other types of breast cancer. They include rare types like inflammatory breast cancer, metaplastic breast cancer, angiosarcoma and Paget disease of the nipple.
Metastatic Breast Cancer
People living with metastatic breast cancer have more treatment options today than ever before. At Fred Hutch Cancer Center, we provide the latest in evidence-based care, including a wide range of supportive care services, to help you thrive while living with this form of breast cancer.
Many of our physicians also conduct research and offer the option to take part in clinical trials, which can give you access to promising therapies not available any other way. New treatments at Fred Hutch may put your cancer into remission and give you a good quality of life for years.
Hormone Receptor Status
To select the right treatments for you, your care team needs to know if your cancer cells have hormone receptors. These are points where estrogen, progesterone or both can attach and make the cells grow. If your cancer cells have these, your cancer is hormone receptor-positive (HR+). It may respond to endocrine therapies (also called hormonal or anti-estrogen therapies).
HER2 Status
Another key feature is if the cancer cells have more HER2 receptors than normal. HER2 stands for human epidermal growth factor type 2. If your cancer cells have more of these receptors than normal, the cancer is HER2-positive (HER2+). It may respond to certain targeted therapies, such as trastuzumab.
Triple-negative breast cancer is breast cancer that has normal HER2 receptors and doesn’t have receptors for estrogen or progesterone.
Other Features of Your Cancer
Based on the type and stage of your breast cancer, your Fred Hutch care team may run more tests on your cancer cells. For example, we may do genetic testing to see how likely early-stage breast cancer is to spread or come back. If tests show that the risk is high, you may benefit from having chemotherapy along with endocrine therapy, rather than endocrine therapy alone.
There are many more examples. If tests show that you have genetic changes in the genes BRCA1 or BRCA2, you might benefit from a group of medicines called PARP inhibitors. At Fred Hutch, we do any testing that can help us choose the treatments that are right for you.
Resources
There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.
Whether you are newly diagnosed, or going through treatment, or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community.
Cancer Research Organizations
Our list of online resources provides accurate health information from reliable and reputable sources, like the National Cancer Institute (NCI), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).
American Cancer Society
ACS: Overview of Lymphedema
Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin that causes swelling (edema). Cancer and its surgery or other treatments may cause lymphedema. It's important to understand why lymphedema can happen and when to get help and support.
American Cancer Society
ACS: Breast Cancer in Men
Here you can find out all about breast cancer in men, including risk factors, symptoms, how it is found and how it is treated.
American Society of Clinical Oncology
American Society of Clinical Oncology (ASCO) Answers: Breast Cancer
ASCO Answers is a collection of oncologist-approved patient education materials developed by ASCO for people with cancer and their caregivers. Here you can find illustrations and information on the different types of breast cancer.
CancerCare
CancerCare Treatment Update: Metastatic Breast Cancer
The CancerCare Connect® Booklet Series offers up-to-date, easy-to-read information on the latest treatments, managing side effects and coping with cancer.
CancerCare
Coping With Triple Negative Breast Cancer from CancerCare
How to cope with triple negative breast cancer.
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Breast Cancer, Ductal Carcinoma In Situ
Breast cancer ductal carcinoma in situ: This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Breast Cancer, Invasive
Breast cancer invasive: This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Breast Cancer, Metastatic
Breast cancer metastatic: This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.
National Cancer Institute
National Cancer Institute (NCI): Surgery Choices for Women with DCIS or Breast Cancer
This information is for patients diagnosed with DCIS or breast cancer and are facing a decision about which surgery to have. Your choice may be between breast-sparing surgery, mastectomy or mastectomy with reconstruction.
Susan G. Komen
Susan G. Komen: Breast Cancer in Men
Here you will find statistics and information about breast cancer in men.
Cancer Support Organizations
Our list includes local and national organizations that are dedicated to improving the quality of life for patients and family members through providing emotional support, education and community.
BreastCancer.org
BreastCancer.org is a nonprofit organization dedicated to providing the most reliable, complete, and up-to-date information about breast cancer. Their mission is to help women and their loved ones make sense of the complex medical and personal information about breast health and breast cancer, so they can make the best decisions for their lives.
Bright Pink
Bright Pink helps to save lives from breast and ovarian cancer by empowering women to know their risk and manage their health proactively.
Facing Our Risk of Cancer Empowered (FORCE)
FORCE provides resources and support to individuals and families affected by hereditary breast, ovarian, and related cancers.
Living Beyond Breast Cancer
Living Beyond Breast Cancer provides education, programs and support to help people whose lives have been impacted by breast cancer.
National Breast Cancer Foundation (NBCF)
NBCF aims to save lives by increasing awareness of breast cancer through education and by providing mammograms for those in need. Their programs provide women help for today and hope for tomorrow.
Susan G. Komen
Susan G. Komen provides education, support and financial assistance to those affected by breast cancer.