Techniques under study for use in diagnosing breast cancer include:
These tools may provide information about tumors that can help guide treatment.
There is a growing interest in breast magnetic resonance imaging (MRI) as a tool to find and diagnose breast cancer.
Breast MRI uses magnetic fields to create high quality images that in some cases may be better than mammograms and breast ultrasound images.
Learn more about breast MRI and breast cancer screening.
Breast MRI may help diagnose breast cancer in certain cases.
For women with hard-to-find (occult) breast cancers who have cancer in the lymph nodes in the underarm area (axillary nodes) or metastases at diagnosis, MRI may help find the original tumor in the breast . And, in some cases, MRI may help find breast cancer recurrence .
Other uses for breast MRI under study include distinguishing cancerous breast lumps from benign (non-cancer) ones and checking whether cancer has spread to the axillary lymph nodes [64-65].
An increasingly common, but controversial use of breast MRI is as a tool to help decide whether a woman should have mastectomy or lumpectomy.
Breast MRI can find small tumors in the breast that may be missed by a mammogram. Some health care providers use breast MRI to see how widely the cancer appears to be spread throughout the breast.
Studies have shown that women who have breast MRI before surgery are more likely to choose mastectomy over lumpectomy plus radiation therapy [66-67]. Based on the breast MRI images, they decide mastectomy is the better option.
A major concern about using breast MRI in this way is that it's not clear if the small masses that an MRI finds are better treated with mastectomy or with lumpectomy plus radiation therapy [68-69].
A meta-analysis that combined the results of four studies showed that using breast MRI before surgery to make treatment decisions did not lower the risk of breast cancer recurrence . This means women chose mastectomy over lumpectomy based on breast MRI results when lumpectomy plus radiation therapy would have been an equally good option.
This topic is still under study.
Talk with your provider if you have any questions about the benefits and risks of using breast MRI for planning treatment.
Special imaging machines can take multiple, standard two-dimensional (2D) digital mammograms. Computer software combines the 2D X-ray images into a three-dimensional (3D) image (called breast tomosynthesis). Radiologists must have special training to read these 3D images.
Breast tomosynthesis is under study for use in breast cancer diagnosis and staging [70-71]. One study found digital mammography plus breast tomosynthesis was better at diagnosing breast cancer than digital mammography alone .
Learn about the use of breast tomosynthesis in breast cancer screening.
Positron emission tomography (PET) is a test that shows how much sugar is consumed by cells. With PET, a radioactive sugar is injected into the body. Cancer cells tend to consume more sugar than normal cells and can then be detected by a special camera that images the cells.
PET is used to find metastases (cancer that has spread beyond the breast to other organs, such as the bones, lungs, liver and brain).
PET is under study for breast cancer diagnosis and finding cancer that has spread to the lymph nodes in the armpit (axillary nodes). However, findings suggest it cannot give a detailed enough image to make it a good tool for this task .
Visit the Society of Nuclear Medicine's discoverMI.org website for more information on PET.
Every cell in your body has genes that contain the blueprints (genetic code) for your body. Similarly, every cell in a breast tumor has genes. These genes contain the blueprints for the tumor.
Tumor profiling tests (using gene expression profiling tools) give information about the genes in cancer cells. These tests allow researchers to study thousands of these genes at one time.
Specific genes (or combinations of genes) may give useful information about prognosis and may help guide treatment decisions [74-75].
The gene profiles of some tumors may help predict whether the cancer is more likely to recur (when cancer comes back) and metastasize (when cancer spreads to other organs) . Breast tumors with gene profiles showing a high risk of recurrence may be more likely to benefit from chemotherapy than tumors with gene profiles showing a low risk.
Oncotype Dx® is the only tumor profiling tool widely used in the U.S. It tests a sample of the tumor (removed during a biopsy or surgery) and looks at a set of 21 genes.
Oncotype Dx can be used to help make chemotherapy treatment decisions in some people with estrogen receptor-positive cancers who are going to have hormone therapy .
At this time, other tools are mostly limited to the research setting. Researchers are working to address the technical limits of these tools.
Learn more about Oncotype Dx.
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MammaPrint® is a tumor profiling test that looks at a set of 70 genes to give prognostic information for lymph node-negative breast cancers.
MammaPrint is available in the U.S., but is not widely used. It is more commonly used in Europe at this time.
PAM50 (Prediction Analysis of Microarray 50) is a tumor profiling test that looks at a set of 50 genes to determine the molecular subtype of breast cancer (learn more).
This set of genes may give more information than other tests to help identity which of breast cancers have the highest risk of recurrence and may get the most benefit from chemotherapy [77-79].
There is a growing interest in learning how molecular and genetic differences among breast cancers relate to prognosis and treatment. Understanding these differences may help predict how a person's cancer will respond to a certain treatment.
Most studies divide breast cancer into four major molecular subtypes:
At this time, molecular subtypes are used mostly in research settings and are not included in pathology reports (learn more). Prognosis and treatment decisions are mainly guided by tumor stage, tumor grade, hormone receptor status and HER2 status.
Learn more about the molecular subtypes of breast cancer.
Many studies have shown circulating tumor cell levels can help predict survival time for people diagnosed with metastatic breast cancer [80-83]. The more circulating tumor cells in the blood, the more advanced metastatic breast cancer is likely to be. Having more of these cells may also predict a lack of response to treatment.
Similarly, circulating tumor DNA is under study for use in monitoring metastatic breast cancer and predicting treatment response in metastatic cancers .
At this time, circulating tumor cell and circulating tumor DNA testing are not routinely done in clinical practice. It is still not known how much more information these tests provide over standard tests and tumor markers in guiding metastatic breast cancer treatment. However, this topic is under active study.
Circulating tumor cells may also help predict prognosis in women with early breast cancer, but study findings are mixed [85-89].
Learn about the latest research on circulating tumor cells that Komen is funding in a recent Science Buzz.
Breast Imaging Methods
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