【Breast Cancer Part 3】Don't Rush Into Surgery! These Are Important Tests To Decide The Best Breast Cancer Treatment Option
- drteoyinkeong
- Oct 9
- 5 min read
Updated: Oct 13
Johor Bahru, Malaysia
阅读中文版本，请点击这里
As an oncologist, I often remind my patients: Don’t rush into surgery the moment you find a lump in your breast. Surgery is just one of the steps in breast cancer treatment, and it's not always the first step.
Some patients even go straight for lump or breast removal without a biopsy. That’s a risky and impulsive move. Without proper tests, it’s like driving without a map, you might take the wrong path!
So, before starting any breast treatment (whether it’s surgery or medication), you should always complete these 3 essential assessments, also known as the Triple Assessment.
Before Any Breast Cancer Treatment
→ Start with Triple Assessment
1️⃣ Clinical Breast Examination: The doctor examines the breast by hand to check the location, size, texture, and whether the lump is attached to the skin or chest wall.
2️⃣ Imaging (Ultrasound / Mammogram): Used to observe the shape, position, and appearance of the lump and assess the risk of cancer.
3️⃣ Biopsy: A small tissue sample is taken from the lump and tested in a lab to confirm whether it’s cancerous and to identify the type of cancer cells.
‼️ Without a biopsy, it’s impossible to know the true nature of the lump.
If possible, consider adding these tests for a more complete assessment.
Purpose: To check whether the cancer has spread and determine its stage.
Purpose: To see if the cancer cells respond to hormone therapy or targeted therapy.
Common breast cancer markers include ER, PR, HER2, and Ki-67.
‼️ These tests help doctors decide if hormone or targeted medication is suitable — not just surgery.
a) Why Is Biopsy So Important Before Starting Breast Cancer Treatment?
A biopsy is the most crucial step to confirm the nature of a breast lump. It helps answer three key questions:
1️⃣ Is the lump cancerous?→ This determines whether surgery alone is enough or if other treatments (like chemotherapy or hormone therapy) are also needed.
2️⃣ What type of breast cancer is it?→ Different types require different treatment strategies, ensuring the most effective and suitable care.
3️⃣ What is the cancer grade?→ This shows how aggressive the cancer cells are and helps doctors decide how urgent and intense the treatment should be.
💡 Extra insight: Do you know what “cancer grade” means? It’s what pathologists see under the microscope — how abnormal the cancer cells appear. The more abnormal they look, the more aggressive the cancer tends to be.
Cancer Grade | What Does It Mean? | What Should Be Done Next? |
Grade 1  | Cancer cells that seem to look like normal cells, tend to grow slower and have a lower risk of recurrence. | But they're still malignant! A low grade doesn't mean you can delay treatment. |
Grade 2  | Somewhere between low and high grade, with moderate growth activity. | Needs to be assessed together with other test results to decide if more aggressive treatment is necessary. |
Grade 3  | Cancer cells are very different from normal cells. They divide rapidly, grow fast, are highly malignant, and more aggressive | Treatment should start as early as possible, often with a more aggressive approach. |
b) Why Are Staging Scans So Important Before Starting Breast Cancer Treatment?
A biopsy tells us how aggressive the cancer cells are, while a staging scan answers another critical question — Has the breast cancer spread? If yes, to what extend?
i) Possible Clinical Signs of Cancer Spread
If the breast or skin shows the following changes, it may suggest that the cancer has reached a more advanced stage:
⚠️ Note: These symptoms are just reference based on clinical experience, not a substitute for medical tests. Whether the cancer has spread (and to what stage), must be confirmed through imaging studies.
ii) For Accurate Cancer Staging, These Imaging Scans Are Crucial
🟢 CT Scan / PET Scan
➜ The most accurate & precise option. Scans the entire body at once and detect even small areas of cancer spread.
🟠 If resources are limited (ie. CT or PET scans are not available)
➜ The following combination can be used instead:
Chest X-ray – checks the lungs
+ Abdominal ultrasound – checks the liver
+ Bone scan – checks the bones
➜ Together, these tests cover the most common sites where breast cancer tends to spread.
💡 Extra Insight: What’s the Difference Between Cancer Grade and Cancer Stage?
Cancer Grade and Cancer Stage are not the same! Many people confuse the two, but they actually answer very different questions:
c) Why Are Immunohistochemistry Tests So Important Before Starting Breast Cancer Treatment?
In recent years, immunotherapy has gained significant attention in cancer treatment.
‼️ But it’s important to remember: Not every “new” or “advanced” treatment is the best treatment or the right one for you. The key question is — will your cancer cells actually respond to it?
That’s where Immunohistochemistry (IHC) testing comes in. It’s a crucial test that helps determine:
Which treatments or drugs will be most effective for your breast cancer
How fast your cancer cells are growing
Whether your cancer cells have specific traits that guide the next treatment step
The 3 Most Common IHC Markers in Breast Cancer
1. ER / PR (Estrogen & Progesterone Receptors)
→ Helps determine if hormone therapy is suitable.
Older reports only stated “positive” or “negative” — meaning the drugs would either work or not. Newer reports provide more details, including:
The percentage of cancer cells showing positivity
The strength of the response (strong, moderate, or weak)
👉 These details help doctors decide how effective hormone therapy will be — and whether it can be used alone or together with chemotherapy or other treatments.
2. HER2 (sometimes also written as ERBB2)
→ Helps determine if targeted therapy is suitable.
Results interpretation:
0–1+: Weak or no reaction → Targeted therapy unlikely to help
2+: Moderate reaction → Needs further testing for confirmation
3+: Strong reaction → High chance of responding well to targeted drugs
⚠️ Important note: Although most breast cancers show some HER2 positivity, only about 15–20% of patients have strong 3+ results that truly qualify for HER2-targeted therapy. So “positive” doesn’t always mean “suitable" or "effective".
3. Ki-67
→ Indicates how fast the cancer cells are multiplying.
Ki-67 appears only in actively dividing cells, not in resting ones.
Results interpretation:
Below 10% → Slow growth, low malignancy, lower recurrence risk
10–30% → Moderately active; other indicators are needed to assess risk
Above 30% → Highly active and aggressive. Usually requires more intensive treatment such as chemotherapy, targeted therapy, or immunotherapy.
Summary
Without these essential tests, both doctors and patients do not have a clear understanding on how to fight your breast cancer. The consequences may include:
Choosing the wrong treatment, leading to poor results
Going off track and missing the best treatment window
Suffering from unnecessary side effects and pain without real benefit
That’s why, after a breast cancer diagnosis, the first step is not surgery. It’s to complete these three critical tests first:
Biopsy + Staging Scan + Immunohistochemistry (IHC).
Cancer / Oncology Care Brought To You By
👨⚕️Dr Teo Yin Keong
Clinical Oncologist, Johor, Malaysia
马来西亚柔佛新山肿瘤专科医生张引强
©️ TEOncology
