Newly Diagnosed With Breast Cancer
Understanding Your Diagnosis
Type of Breast Cancer:
Stage and Grade:
Genetic Testing:
Genetic Counselor:
Your pathology report
After you have a biopsy or surgery to remove the breast cancer, a doctor called a pathologist will examine the removed tissue and run additional tests. The results of all these tests make up your pathology report. Your pathology report is the key to understanding your diagnosis. By providing a clearer picture of how the breast cancer looks and behaves, the test results in the pathology report will help you and your doctor make appropriate treatment choices for your particular diagnosis.
There are two main types of pathology reports:
- a biopsy pathology report
- an excision pathology report with a synoptic summary
The biopsy pathology report describes what is found in the small sample of tissue removed during the biopsy. If the biopsy pathology report finds breast cancer, in most cases you will have surgery to remove the entire cancer, which doctors call an excision.
The synoptic summary in an excision pathology report describes all the characteristics of the whole cancer.
Questions for your Breast Surgeon and Medical Oncologist:
- Will you give me a copy of my “breast biopsy pathology report?”
- What do my receptors mean?
- Will you give me a copy of my “surgical pathology report?”
- What stage is my breast cancer?
- May I have a copy of my “Operative Report” and “History and Physical?”
Planning your treatment
Treatments you may have in addition to surgery:
Fertility issues
Surgery or chemotherapy first?
Ask Questions: Don’t hesitate to ask your healthcare team about your diagnosis, treatment options, potential side effects, and expected outcomes.
Depending on several factors, including the stage of your cancer, your overall health, if and how much the cancer has spread, and the specific characteristics (biology) of your tumor, your doctor may suggest any of the following treatment options, or a combination of multiple:
- Surgery
- Chemotherapy
- Radiation
- Hormone therapy
Second Opinions: Always remember that it is your patient right to seek a second opinion if you have any doubts about your diagnosis or treatment plan. While a second opinion may confirm your original doctor’s diagnosis, another doctor may also be able to provide more details about the type and stage of the breast cancer, raise additional treatment options you hadn’t considered, or recommend a different course of action.
Types of Breast Cancer - Non-invasive or Invasive
Non-invasive breast cancers (stage 0)
Ductal Carcinoma in Situ (DCIS)
Ductal Carcinoma in Situ (DCIS) means the cells that line the milk ducts of the breast have become cancer, but they have not spread into surrounding breast tissue. DCIS is considered non-invasive or pre-invasive breast cancer. DCIS can’t spread outside the breast, but it is often treated because if left alone, some DCIS cells can continue to undergo abnormal changes that cause it to become invasive breast cancer (which can spread).
In most cases, a woman with DCIS can choose between breast-conserving surgery (BCS) and simple mastectomy. But sometimes, if DCIS is throughout the breast, a mastectomy might be a better option. There are clinical studies being done to see if observation instead of surgery might be an option for some women.
Lobular Carcinoma in Situ (LCIS)
Invasive Breast Cancers
Invasive Ductal Carcinoma (IDC)
Invasive Lobular Carcinoma (ILC)
HR-positive breast cancer
HER2-positive breast cancer
HR-positive breast cancer is the most common form of invasive breast cancer and has the best outcome when diagnosed early. It can be treated in several ways, including with hormone therapies that either suppress estrogen levels in the body or prevent estrogen from attaching to receptors. In both cases, HR-positive breast cancers are cut off from hormones needed to grow.
HER2-positive breast cancer (human epidermal growth factor receptor 2) breast tumors are routinely tested for an overexpression of the HER2 protein, and, if found, they are then classified as HER2-positive breast cancers. An estimated 25 to 30 percent of diagnoses are HER2-positive breast cancer. For a long time, HER2-positive breast cancer, which tends to be aggressive, had a poor prognosis. Today, HER2-positive breast cancer has one of the best outcomes overall and a multitude of treatment options.
Until recently, HER2-targeted therapies could only work for patients who had a certain level of HER2 overexpression (3+ values on HER2 testing). Trastuzumab deruxtecan (T-DXd/Enhertu®)—a new drug in an emerging class of targeted treatments called antibody-drug conjugates—was shown to target cells that were previously classified as HER2-negative but actually have lower levels of HER2 protein (values of 1+ or 2+ on HER2 testing, or FISH-). This led to the new classification of breast cancers as HER2-low and opened an exciting avenue for more research breakthroughs.
Patients who don’t have any HER2 overexpression—those that are called HER2-0 in testing—are classified as HER2-negative; they may be HR-positive or triple-negative (see triple-negative breast cancer below). Patients who have HR-positive and HER2-positive breast cancer are sometimes referred to as having triple-positive breast cancer.
Triple-negative breast cancer (TNBC)
Triple-negative breast cancer (TNBC) is characterized by the fact that it’s “negative” for the three main receptors in breast cancer mentioned above (estrogen, progesterone, and HER2). These markers inform prognosis and treatment strategies for breast cancer, as we have many targeted therapies for these types.
TNBC accounts for approximately 15 percent of breast cancer diagnoses and is more commonly diagnosed than other forms in younger women, Black and Hispanic women, as well as women with inherited BRCA1 gene mutations. These breast cancers tend to be more aggressive than those that are HR-positive, and they also tend to be diagnosed at later stages. TNBC is sometimes referred to as basal-like breast cancer, but not all basal tumors are triple-negative.
Because TNBCs lack the common targets for treatment, they have fewer treatment options than other breast cancers. Research is beginning to identify subsets or subtypes of TNBC—and investigating targeted therapies. TNBC is typically treated with surgery, chemotherapy, and radiation, as well as drugs including PARP inhibitors, immunotherapy agents, and antibody-drug conjugates. BCRF investigators are urgently researching potential treatment targets and probing the underlying biology of TNBC to give these patients more options.
Other Rare Types of Breast Cancer
Inflammatory breast cancer (IBC)
Metaplastic breast cancer
Male Breast Cancer
What is Biomarker Testing?
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 hormones estrogen 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.
What Biomarker Testing Includes
Estrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor type 2 receptor (HER2/neu or HER2)
Triple negative
Triple positive
Mental Health Support
When to Seek Mental Health Support
- having a hard time accepting your diagnosis and the changes it brings
- experiencing physical and emotional side effects, such as fatigue, nausea, and mood swings, which can be caused by breast cancer treatments
- feeling overwhelmed about choosing from possible treatment options or where to receive care
- feeling unsure about how you’re going to keep up with everyday responsibilities and expectations at your job or at home
- feeling angry about the way the breast cancer diagnosis has changed your life and affected your personal relationships with a partner, children, family members, or friends
- feeling stressed about finances, including the cost of medical care, having to take unpaid time off from work, or not having enough money to spend on things you enjoy
- feeling anxious about the cancer returning (recurrence)
- feeling afraid of death, particularly if you have been diagnosed with metastatic breast cancer
- grieving about physical changes to your body, such as losing your hair or breasts, or changes to your sexual health
- worrying about fertility
How Mental Health Support Can Help In Survivorship
- reduce feelings of anxiety, depression, and chronic stress
- maintain a more positive outlook by promoting feelings of happiness, contentment, and optimism
- learn coping skills that you can draw upon if you feel overwhelmed
- strengthen your relationships with family and friends
- improve how well you sleep
Find the support you need
Support line
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