Breast Cancer

Causes & Risk Factors

Breast cancer risk is influenced by a combination of factors, many of which are not modifiable:

•  Sex and age — being female and increasing age are the most significant risk factors.

•  Family history and inherited genetic variants — a family history of breast or ovarian cancer, or a known BRCA1/BRCA2 variant, substantially increases risk.

•  Reproductive history — early age at first menstrual period, late menopause, and having no children or a late first pregnancy are associated with modestly increased risk.

•  Hormone exposure — prolonged use of certain hormone replacement therapies has been associated with increased risk.

•  Lifestyle factors — obesity (particularly after menopause), alcohol consumption, and physical inactivity are recognized modifiable risk factors.

•  Personal history of breast conditions — a prior breast biopsy showing certain atypical findings, or previous breast cancer, increases risk of a new occurrence.

Symptoms & When to Test

Many early breast cancers are detected through screening before symptoms develop, but certain findings warrant prompt evaluation.

•  A new lump or thickening in the breast or underarm area

•  Change in breast size, shape, or appearance

•  Skin changes, including dimpling, redness, or texture resembling an orange peel

•  Nipple changes, including inversion, discharge (particularly if bloody), or scaling

•  Persistent breast pain in one specific area (though breast pain is more often not due to cancer)

•  A new lump in the underarm (axillary) area

When Should You Consider Testing?

Any new breast lump, persistent skin or nipple change, or new axillary lump should be evaluated by a doctor promptly. Routine screening mammography, as recommended by your doctor based on your age and risk profile, is separate from symptom-driven evaluation and should continue as advised.

Why Tests Are Combined

Histopathology confirms the diagnosis and tumor type, but treatment decisions depend heavily on biomarker status — ER and PR indicate whether the tumor is hormone-receptor driven (relevant to hormone therapy), HER2 indicates eligibility for HER2-targeted therapy, and Ki-67 provides information about how rapidly the tumor cells are dividing.

HER2 status in particular is assessed using a two-step approach in some cases: initial IHC, followed by an in-situ hybridization method when the IHC result is equivocal, since accurate HER2 classification directly determines eligibility for HER2-targeted treatment.

Together, these biomarkers define the tumor's molecular subtype (for example, hormone-receptor-positive, HER2-positive, or triple-negative), which is one of the most important factors guiding treatment selection in breast cancer.

Tests Available at NPL

Most tumor molecular tests, histopathology, IHC, and genetic tests do not require fasting. However, some blood-based investigations ordered alongside cancer testing may have specific preparation requirements. Please follow the instructions provided by your doctor or NPL.

Home Sample Collection

Breast cancer diagnosis requires a tissue biopsy (core needle or surgical), which must be performed by a specialist radiologist or surgeon at a hospital or clinic — this is not a home sample collection service.

Once your biopsy sample is obtained, NPL arranges secure transport of the tissue to our accredited laboratory for histopathology and biomarker (ER, PR, HER2, Ki-67) testing.

Reports are delivered securely to your treating oncologist or surgeon, and to you, within the timeframe specified for the tests ordered.

When to See a Doctor

•  Any new breast or underarm lump

•  Change in breast size, shape, or skin appearance

•  New nipple discharge, inversion, or scaling

•  Persistent, localized breast pain that does not resolve

•  A screening mammogram finding requiring follow-up biopsy