There are many different types of breast cancer. The doctor who determines what type of breast cancer you have is called a "pathologist." The type of cancer you have is called your "diagnosis." It is very important that the pathologist gives you an accurate diagnosis. It is also important that you understand your diagnosis. Your treatment will be different depending on your diagnosis.
Here's how doctors make a breast cancer diagnosis. A doctor takes a sample of your breast tissue. (This is called a "biopsy.") Then, the pathologist looks at the tissue sample. (The tissue samples that pathologists look at are also called "breast tissue slides.") The pathologist describes your cancer in a report. The report tells your "specific disease characteristics." Your disease characteristics tell what type of breast cancer you have. The disease characteristics help your doctors decide what treatment to recommend.
Learning about your diagnosis helps you make informed care choices. The challenging part is that your diagnosis can be hard to understand. The good news is that all of your doctors should have the important information about your disease, but it may have to be gathered from a number of places. These may include:
What You Can Do:
Ask if there is more than one name for it. For example, "breast cancer," "invasive ductal carcinoma," and "infiltrating ductal carcinoma" can all mean the same thing.
Is this the first time you have ever had breast cancer? If so, here are some important questions to ask your doctor:
The answers to these questions will help you understand some of your disease characteristics. Be sure to ask what each disease characteristic means for you. You need this information to make informed treatment choices.
Have you been diagnosed with breast cancer a second time? If so, you may want to ask your doctor these questions:
Once again, the answers to these questions will help you figure out your treatment choices. The more information you have about your specific diagnosis, the more informed your treatment choice will be.
They are important because doctors decide which treatments to recommend based on your diagnosis. Each woman with breast cancer has a different set of disease characteristics. These characteristics help doctors predict which women will most likely benefit from each treatment. And there are some drugs that only help women with one specific characteristic. Several different disease characteristics will be listed on your pathology report. The following four characteristics are the ones used most often by doctors to recommend treatment.
You can learn more about these and other disease characteristics by reading Dr. Susan Love's Breast Book or visiting her web site.
Lymph Node Status—Lymph nodes are small oval glands that help your body fight infection. They also help filter the fluid that circulates throughout the body, trapping bacteria, cancer cells, and other harmful substances. If a woman's breast cancer has spread to any of the lymph nodes near her breast or under her arm, her breast cancer is considered node-positive. If a woman's breast cancer has not spread to the lymph nodes, her breast cancer is considered node-negative.
Women with node-negative breast cancer have a better chance of survival than women with node-positive breast cancer. So doctors often offer more aggressive treatments to women with node-positive breast cancer. For example, some doctors recommend stronger types of chemotherapy drugs to women with node-positive breast cancer than to women with node-negative breast cancer.
Sometimes treatment recommendations are based on the number of lymph nodes that have been invaded by the cancer. For example, doctors will more likely recommend radiationtherapy after mastectomy for women with a greater number of positive lymph nodes.
Herceptin® (trastuzumab) is a drug that can block HER2/neu, and is FDA-approved to treat HER2/neu positive node-negative or node-positive breast cancer. It is an effective treatment in many women with HER2/neu-positive breast cancer, but the drug has little effect on women with HER2/neu-negative breast cancer. Heralded as the first biologic for breast cancer and a major advance in targeted cancer therapies when first introduced, the drug has been included in breast cancer treatment in the U.S. since receiving approval for use by the FDA in 1998.
Remember—Sometimes the more specific your diagnosis is, the more specific your treatment can be. It is important to use drugs that have been shown to help your type of breast cancer. And it is important not to use drugs that have not been shown to help your type of breast cancer, unless you are taking part in a clinical trial about the drug. That's because all cancer drugs have side effects, so you may be hurting your body more than helping it. It's important to learn about the risks and benefits of each treatment before making any decision about your care.
Your pathology report has important information about your cancer. Ask your doctor if a breast pathologist wrote your pathology report. If not, you might want to ask if a breast pathologist is available to look at your breast tissue or if your breast tissue slides can be reviewed at a hospital where there is a breast pathologist.
Your pathology report helps your oncologist and others understand what type of cancer you have. It also helps them predict what the cancer tumor will do. And it helps your doctors and you understand what treatments may help you. Ask your doctor to explain your specific disease characteristics to you.
Dr. Susan Love's Breast Bookhas a helpful section called "How to Interpret a Biopsy Report." She also has this information on her web site.
There are two kinds of second opinionsthat can help you. You should get both kinds of second opinions.
Get a pathology second opinion before getting a treatment second opinion. A pathology second opinion can help you be sure that your diagnosis and disease characteristics are correct. This is very important, because doctors base their treatment advice on your pathology report. If your pathology report is wrong, you might get the wrong care. Every so often, it's difficult for pathologists to give a clear-cut diagnosis. So you may get conflicting pathology reports. In this case, it's especially important to learn as much as you can about your specific diagnosis.
To get a pathology second opinion you must have your breast tissue slides sent to a second breast pathologist. You can arrange to have this done on your own. You do not need your doctor's OK to have a pathology second opinion. But you may have to pay for it yourself. This is what you need to do:
Right now, researchers are looking for specific ways to identify different subtypes of breast cancer. They are also trying to find more targeted ways to treat specific types of breast cancer. This is a promising area of research. It holds the future of breast cancer treatment.
Your breast tumor gives important information about your disease. This information may be important to your future care. It might help you later as new treatments and drugs come out. Your tissue also contains information that can help breast cancer researchers. This is why we think it is important that you ask that your breast tissue be stored properly and that you have access to it in the future. Ask your doctors these questions:
10. The information presented in this box is adapted from the National Cancer Institute's (NCI) Physician Data Query (PDQ) database.
11. The Breast International Group (BIG) 1-98 Collaborative Group. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 2005 Dec 29; 353(26): 2747-57.
ATAC Trialists' Group. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 2005 Jan 1-7; 365(9453): 60-62.
12. Pauletti G, Dandekar S, Rong H, et al. Assessment of methods for tissue-based detection of the HER-2/neu alteration in human breast cancer: a direct comparison of fluorescence in situ hybridization and immunohistochemistry. J Clin Oncol 2000 Nov 1; 18(21): 3651-64.
Yaziji H, Goldstein LC, Barry TS, et al. HER-2 testing in breast cancer using parallel tissue-based methods. JAMA 2004 Apr 28; 291(16): 1972-7.
Chorn N. Accurate identification of HER2-positive patients is essential for superior outcomes with trastuzumab therapy. Oncol Nurs Forum 2006 Mar; 33(2): 265-272.
13. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005 Oct 20; 353(16): 1659-72.
Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005 Oct 20; 353(16): 1673-84.
Joensuu H, Kellokumpu-Lehtinen PL, Bono P, et al. Adjuvant docetaxel or vinorelbine with or without trastuzumab for breast cancer. N Engl J Med 2006 Feb 23; 354(8): 809-20.
14. See NBCC for analyses of the two articles on Herceptin use among women with early breast cancer by Romond, et al., and Joensuu, et al. See also a fact sheet on the early-stopping of clinical trials