10. Staging of breast cancer
10.1 Stage 1
Recommendations
If you have been diagnosed with stage 1 breast cancer, should you have staging examinations with conventional imaging techniques, such as X-rays, computed tomography scan or ultrasound scan?
No, for women with suspected clinical stage 1 breast cancer without symptoms of metastases, the ECIBC's Guidelines Development Group (GDG) suggests not using staging examinations with conventional imaging techniques.
And with positron emission tomography-computed tomography?
No, the GDG recommends not using staging examinations with positron emission tomography-computed tomography (PET-CT).
Who are these recommendations for?
- You have been diagnosed with breast cancer
- You do not have symptoms that suggest potential metastases
- You may have been told by your healthcare professional that it could be stage 1 breast cancer
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the different clinical stages of breast cancer and whether you have symptoms of metastases.
You may also wish to speak with your healthcare professional about:
- risk of the cancer developing or spreading to other parts of the body
- treatment for stage 1 breast cancer
- anxiety and distress.
Additional considerations
This recommendation suggests not having staging examinations if you have been diagnosed with clinical stage 1 breast cancer, because there are probably greater harms than benefits.
The evidence suggests that using staging examinations at clinical stage 1 may not find more metastases and it may result in a slight increase of a false positive result. This means a woman would have further tests, including a biopsy, which will confirm that she does not have metastases, but may have suffered unnecessary anxiety and distress.
The GDG also noted that the costs of providing staging examinations to women with clinical stage 1 breast cancer are high.
Definitions
The severity of breast cancer is described by five stages, depending on tumour size and location. Stage 0 means pre-cancerous cells are present in the breast (e.g. carcinoma in situ). Stage 1 means there is a small tumour in the breast, but no lymph node involvement (this is called invasive cancer). Stages 2 and 3 mean either that the tumour is larger or that there are some cancer cells in the lymph nodes of the armpit or other nearby tissues, such as the skin. Stage 4 means the cancer has spread to form tumours (metastases) in other, distant parts of the body. Severity increases with stage and consequently treatment options vary between stages.
Metastasis refers to the spread of cancer cells from the place where they first formed to another part of the body.
Biopsy: a sample of tissue to be taken from your breast or elsewhere, to test for cancer.
Positron emission tomography-computed tomography is a medical procedure that uses radioactive substances to measure some biological processes.
10.2 Stage 2
Recommendations
If you have been diagnosed with stage 2 breast cancer, should you have staging examinations?
No, for women with suspected clinical stage 2 breast cancer without symptoms of metastases, the ECIBC's Guidelines Development Group (GDG) suggests not using staging examinations with conventional imaging techniques or with positron emission tomography-computed tomography (PET-CT).
Who are these recommendations for?
- You have been diagnosed with breast cancer
- You do not have symptoms that suggest potential metastases
- You may have been told by your healthcare professional that it could be stage 2 breast cancer
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the different clinical stages of breast cancer and whether you have symptoms of metastases.
You may also wish to speak with your healthcare professional about:
- risk of the cancer developing or spreading to other parts of the body
- treatment for stage 2 breast cancer
- anxiety and distress.
Additional considerations
This recommendation suggests not having staging examinations if you have been diagnosed with clinical stage 2 breast cancer, because there are probably greater harms than benefits.
Conventional staging examinations in women with clinical stage 2A breast cancer may find slightly more metastases. It may also slightly increase the chances of receiving a false positive result, which means a woman would have further tests, including biopsy. These tests will confirm that she does not have metastases, but may have suffered unnecessary anxiety and distress. The chances of a false positive result are higher for clinical stage 2B.
The evidence suggests PET-CT staging examinations result in an increase in detection of metastases in women with clinical stage 2B and a slight increase in detection of metastases in stage 2A. However, PET-CT also results in a large increase in false positive results in women with clinical stage 2A and moderate increase in stage 2B.
The GDG noted that the costs of providing PET-CT staging examinations to women with clinical stage 2 breast cancer are high.
Definitions
The severity of breast cancer is described by five stages, depending on tumour size and location. Stage 0 means pre-cancerous cells are present in the breast (e.g. carcinoma in situ). Stage 1 means there is a small tumour in the breast, but no lymph node involvement (this is called invasive cancer). Stages 2 and 3 mean either that the tumour is larger or that there are some cancer cells in the lymph nodes of the armpit or other nearby tissues, such as the skin. Stage 4 means the cancer has spread to form tumours (metastases) in other, distant parts of the body. Severity increases with stage and consequently treatment options vary between stages.
Metastasis refers to the spread of cancer cells from the place where they first formed to another part of the body.
Biopsy: a sample of tissue to be taken from your breast or elsewhere, to test for cancer.
Positron emission tomography-computed tomography is a medical procedure that uses radioactive substances to measure some biological processes.
10.3 Stage 3
Recommendations
If you have been diagnosed with stage 3 breast cancer, should you have staging examinations?
Yes, for women with suspected clinical stage 3 breast cancer without symptoms of metastases, the ECIBC's Guidelines Development Group (GDG) recommends using staging exams with conventional imaging techniques. However, if positron emission tomography-computed tomography (PET-CT) is available, the GDG suggests using PET-CT alone.
Who are these recommendations for?
- You have been diagnosed with breast cancer
- You do not have symptoms that suggest potential metastases
- You may have been told by your healthcare professional that it could be stage 3 breast cancer
What would following these recommendations mean for you?
It might be important to speak with your healthcare professional about the different clinical stages of breast cancer and whether you have symptoms of metastases.
You may also wish to speak with your healthcare professional about:
- risk of the cancer developing or spreading to other parts of the body
- treatment for stage 3 breast cancer
- anxiety and distress.
Additional considerations
Having staging examinations with conventional imaging techniques is likely to find more metastases. It is also likely to result in a large increase in false positive results, which means a woman would have further tests, including biopsy. These tests will confirm that she does not have metastases, but may have suffered unnecessary anxiety and distress.
However, the GDG judged that, for women with suspected clinical stage 3, the benefits are greater than the harms.
Using PET-CT examinations probably results in more women being correctly staged, which is helpful in deciding on their treatment plans, and it may reduce the risk of receiving a false positive result, but the evidence is very uncertain for this last effect.
The GDG noted that the costs would be higher when staging examinations with PET-CT are provided.
Definitions
The severity of breast cancer is described by five stages, depending on tumour size and location. Stage 0 means pre-cancerous cells are present in the breast (e.g. carcinoma in situ). Stage 1 means there is a small tumour in the breast, but no lymph node involvement (this is called invasive cancer). Stages 2 and 3 mean either that the tumour is larger or that there are some cancer cells in the lymph nodes of the armpit or other nearby tissues, such as the skin. Stage 4 means the cancer has spread to form tumours (metastases) in other, distant parts of the body. Severity increases with stage and consequently treatment options vary between stages.
Metastasis refers to the spread of cancer cells from the place where they first formed to another part of the body.
Biopsy: a sample of tissue to be taken from your breast or elsewhere, to test for cancer.
Positron emission tomography-computed tomography is a medical procedure that uses radioactive substances to measure biological processes.