NCCN Guidelines for Patients® | Stage 0 Breast Cancer - page 14

NCCN Guidelines for Patients
Stage 0 Breast Cancer, Version 1.2014
Pathology review
If your mammogram is abnormal, it is very important
for your doctor to make a correct diagnosis. This
means finding out if you have diseased breast tissue,
and if so, what type of breast disease you have.
Diagnosis often requires a biopsy of breast tissue. A
pathologist then needs to look at the biopsy samples
with a microscope. A pathologist is a doctor who’s
an expert in laboratory tests of tissues and cells.
The pathologist will confirm if you have LCIS, DCIS,
invasive breast cancer, or another condition. If you
have another stage of breast cancer (I–IV), NCCN
offers books for those stages.
There is more than one type of biopsy used to test
for breast cancer. FNA (
spiration) and
core needle biopsies use a needle to remove tissue
samples. After the skin is numbed, the needle is
inserted through the skin and into the breast. Core
biopsies can also be done with a probe that is
inserted into the breast with a needle. After the needle
is removed, a vacuum is used to remove tissue
through the probe. When mammography is used to
guide the needle, it is called a stereotactic-guided
biopsy. Ultrasound-guided biopsy uses ultrasound to
guide the needle.
Excisional biopsy
Besides needle biopsies, there are other types of
biopsies that use minor surgery to remove breast
tissue. An incisional biopsy is a surgery that removes
a sample of tissue, whereas an excisional biopsy is
surgery that removes the whole tumor. If a needle,
probe, or incisional biopsy was used for your biopsy,
it is recommended that you have an excisional biopsy
to rule out DCIS or invasive cancer. If no advanced
disease is present, no further treatment is required.
Before an excisional biopsy, you may be asked to
stop eating so that your stomach is nearly empty
for the procedure. You may also need to stop taking
some medicines. Local or general anesthesia may be
During an excisional biopsy, the whole tumor with
some normal-looking tissue around its edge is
removed using a surgical knife. The normal-looking
tissue at the edge of the removed tissue is called the
surgical margin.
See Figure 4.
If your surgeon can’t feel a lump, a small wire will
first be inserted into the area using mammography.
Then your surgeon will remove the tissue at the end
of the wire. This is called a wire localization biopsy.
An excisional biopsy will leave a small scar and may
cause some pain and swelling for a few days. Ask
your treatment team for a complete list of rare and
common side effects.
Risk Reduction
Besides LCIS, there are many other risk factors for
breast cancer. One very important risk factor is if any
of your blood relatives have had breast or ovarian
cancer, especially at a young age. Using your medical
and family history, your doctor will tell you, in general,
how likely you are to get breast cancer.
If your risk may be high, you should be referred to a
genetic counselor. A genetic counselor is an expert in
gene changes related to cancer. The counselor can
better determine your risk for breast cancer.
The counselor may suggest testing for mutations in
genes that are related to breast cancer and passed
down in families. Such mutations can occur in
genes. Normal BRCA genes help to
prevent tumor growth. Women with
gene mutations are more likely to have breast
and ovarian cancer than other women.
Diagnosis | Risk Reduction
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