The Who, What, Where, When and Sometimes, Why.

Emerging Areas in Diagnosis

The tools below are under study for use in breast cancer diagnosis. They may give information about tumors that can help guide treatment.

Breast magnetic resonance imaging (MRI) uses magnetic fields to create high-quality images of the breast.

There’s growing interest in breast MRI as a tool to find and help stage breast cancer. In some cases, breast MRI images may be more useful than mammograms and breast ultrasound images.

Learn about breast MRI and breast cancer screening.

Breast MRI for diagnosis

Breast MRI may help diagnose breast cancer in some women.

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 [89].

Researchers are studying other ways breast MRI may be helpful in diagnosis. For example, breast MRI is under study as a way to find breast cancer has spread to the axillary lymph nodes [89-91].

Breast MRI for surgical planning

Although controversial, breast MRI is sometimes used to help decide whether a person 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 before surgery to see how widely the cancer appears to have spread in the breast.

Using breast MRI in this way is controversial because it’s not clear if the small masses an MRI finds are more effectively treated with mastectomy or with lumpectomy plus radiation therapy [16,92-93].

Studies have shown women who have breast MRI before surgery are more likely to have mastectomy instead of lumpectomy plus radiation therapy [94-96]. Based on the breast MRI images, women chose mastectomy although it may not have been a better option.

A meta-analysis that combined the results of 4 studies showed using breast MRI before surgery to make treatment decisions did not lower the risk of breast cancer recurrence [92].

This means women chose mastectomy over lumpectomy based on breast MRI results when lumpectomy plus radiation therapy would have been an equally good option. So, having a breast MRI before surgery may lead to more mastectomies with no added treatment benefit.

Some findings also show women who have breast MRI before surgery are more likely to have prophylactic mastectomy of the healthy (contralateral) breast, although there’s no proven benefit of having this surgery [96-97].

Talk with your provider if you have any questions about the benefits and risks of using breast MRI to plan your treatment.

3D mammography (also called breast tomosynthesis) takes multiple, standard 2-dimensional (2D) digital images of the breast. Computer software combines the 2D images into a 3D image. 

3D mammography is under study for use in breast cancer diagnosis and staging [98-101].

Learn about 3D mammography and breast cancer screening

Positron emission tomography (PET) is a test that shows how much sugar is consumed by cells. Cancer cells tend to consume more sugar than normal cells and this can help identify tumors.

With PET, a short-term radioactive sugar is injected into the body. The cancer cells can then be imaged with a special camera.

PET is used to find metastases (cancer that has spread beyond the breast and nearby lymph nodes to other organs, such as the bones, lungs, liver and brain).

PET is under study for breast cancer staging and finding cancer that has spread to the lymph nodes in the underarm area (axillary nodes) [102-104].

However, some findings suggest it can’t give a detailed enough image to make it a good tool for this task [100].

Visit the Society of Nuclear Medicine’s discoverMI.org website for more information on PET.  

Tumor profiling (using gene expression profiling tools) gives information about the genes in cancer cells. You may also hear the terms genomic testing and molecular profiling.

How is tumor profiling done?

Tumor profiling tests take a sample of the tumor (removed during a biopsy or surgery) and looks at a set of genes.

Specific genes (or combinations of genes) may give useful information about prognosis and may help guide treatment decisions.

Tumor profiling and breast cancer staging

Oncotype DX® is part of breast cancer staging for some estrogen receptor-positive, lymph node-negative tumors. It’s the only tumor profiling test used in breast cancer staging.

Tumor profiling and treatment

For some breast cancers, tumor profiling can help predict whether the cancer is likely to metastasize (when cancer spreads to other organs) [43].

Tumor profiling is used to help make treatment decisions in some people with estrogen receptor-positive cancers. People with breast tumors that have gene profiles showing a high risk of metastasis may be more likely to benefit from chemotherapy than those with tumors showing a low risk.

The tumor profiling tests recommended by the American Society of Clinical Oncology (ASCO) are [43-44]:

Breast Cancer Index®

Breast Cancer Index is a tumor profiling test that looks at a set of 11 genes to give prognostic information for some breast cancers.

Breast Cancer Index may be considered when making treatment decisions for some estrogen receptor-positive, HER2-negative, lymph node-negative breast cancers [43].  

There’s growing interest in learning how molecular and genetic differences among breast cancers relate to prognosis (chances for survival) 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 4 main molecular subtypes:

  • Luminal A
  • Luminal B
  • Basal-like/triple negative
  • HER2-enriched

Molecular subtypes are used mostly in research settings and are not included in pathology reports.

Prognosis and treatment decisions are mainly guided by tumor stagetumor gradehormone receptor status and HER2 status.

Learn more about the molecular subtypes of breast cancer

Tests that check for circulating tumor cells or circulating tumor DNA in the blood are sometimes called liquid biopsies.

Circulating tumor cells and circulating tumor DNA tests for people with metastatic breast cancer

Circulating tumor cell levels can help predict survival for people diagnosed with metastatic breast cancer [105-106].

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 [107-109].

Circulating tumor cell and circulating tumor DNA tests should not be used to guide breast cancer treatment because they haven’t been shown to offer benefit [16,110-113].

These topics are under study.

Circulating tumor cells and circulating tumor DNA tests for people with early breast cancer

Circulating tumor cells may help predict recurrence and survival in people with early breast cancer [114-115].

Some studies have found women with early breast cancer who had more circulating tumor cells had a worse prognosis than those who had few or no circulating tumor cells [114-117].

Similarly, some findings have shown women with circulating tumor DNA after treatment for early breast cancer may have a worse prognosis than those with no circulating tumor DNA [117].

Circulating tumor cell and circulating tumor DNA tests should not be used to guide early breast cancer treatment because they haven’t been shown to offer benefit [16].

These topics are under study.

Learn about Komen-funded research on circulating tumor cell tests in Science Buzz.  

 Our commitment to research

At Susan G. Komen®, we are committed to saving lives by meeting the most critical needs in our communities and investing in breakthrough research to prevent and cure breast cancer. Our Research Program our continuing investment in research is an essential driving force for achieving this mission.

Since our inception in 1982, Komen has provided funding to support research grants that have greatly expanded our knowledge of breast cancer and helped us understand that breast cancer is not just a single disease but many diseases, unique to each individual.

To date, Komen has provided more than $1 billion to researchers in 47 states, the District of Columbia and 24 countries to support research that has resulted in a better understanding of breast cancer; earlier detection; personalized, less invasive treatments for what was once a “one-treatment-fits-all” disease; and improvements in both quality of life and survival rates.

Learn more about our continuing investment in research and the exciting research that we are funding, because nothing would make us happier than ending breast cancer forever.

 Updated 12/14/20

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