How Is Breast Cancer Diagnosed?

The key to detecting cancer in your breast is obtaining a breast cancer screening test (often a mammogram) from your doctor or health care provider. Screening will help detect the presence of lumps (usually with no cancer) before cancer forms.

Although going for tests may make you uneasy about the potential results or discomfort (generally mild) from the procedures, early detection is important in limiting the disease or setting you on the road to a cure.

It is important to remember that a lump or other changes in your breast, or an abnormal area on a mammogram, may be caused by cancer or may be caused by other, less serious problems. Remember, too, that breast cancer can be curable, especially if it is caught early.

Making the Diagnosis

The first step your health care provider will take if there is a suspicion of breast cancer will be to perform a complete physical examination and medical history. He or she will want to evaluate your overall health, as well as ask you questions about risk factors you may have for breast cancer and benign breast conditions. This will include questions about whether any of your first-degree relatives (mother, sister) had breast conditions, breast cancer, or other cancers.

Your health care provider will also carefully examine the lump and the tissue around it, including its size, its texture, and whether it moves easily. Benign lumps often feel different from cancerous ones. Your health care provider will also look for any changes in the nipples.

Any fluid coming out of your nipple may be collected and then sent to the lab to look for cancer cells. But most nipple discharges are not cancer. An injury, infection, or benign tumor may cause a discharge.

If you are at high risk for breast cancer, a procedure called ductal lavage may be used. This procedure collects cells from inside the milk duct system. This is where most breast cancers begin.

If your health care provider or your gynecologist refers you to a surgeon, it does not necessarily mean that she or he thinks you have cancer. Your doctor may have sent you to a surgeon because he or she does not have the same level of expertise and experience in diagnosis changes in the breast as a surgeon.

You will likely be asked to have a diagnostic mammogram. A mammogram is an x-ray of your breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.

A diagnostic mammogram is also used to check abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in checking out breast changes, regardless of your age.

 

Mammogram

A mammogram performed by a skilled technologist who knows how to position your breast should not be painful. If something abnormal is detected in the mammogram or during a physical exam, the next step is usually to take additional x-ray views or an ultrasound.

Ultrasound uses high-frequency sound waves, not heard by humans. The sound waves enter your breast and bounce back. The pattern of their echoes produces a picture called a sonogram, which is displayed on a screen. This exam is often used along with mammography.

 

Ultrasound Image

Magnetic resonance imaging (MRI) is increasingly being used as a breast screening and diagnostic tool. In March 2007, the American Cancer Society (ACS) recommended that women at high risk of breast cancer undergo MRI scans every year in addition to regular mammograms beginning at age 30. Women at high risk are those who have tested positive for the BRCA1 or BRCA2 gene mutation, or who have a mother, sister, or daughter who tested positive. Women are also considered high risk if they have had at least two close relatives with breast cancer or if they had chest radiation for Hodgkin's disease. MRI is not a screening test for the average woman.

Scintigraphy is a specialized radiology procedure used to scan and assess abnormalities in your breasts when other examinations do not give a clear answer. This breast scan is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the procedure. The radioactive substance—called a radionuclide (radiopharmaceutical or radioactive tracer)—is taken up by certain tissues in your body.

Based on these examinations, your doctor may decide that no more tests are needed and no treatment is necessary. In such cases, your doctor may want to check you regularly to watch for any changes.

Biopsy

Often your doctor must remove fluid or tissue from your breast. It is sent to the lab to look for cancer cells. The procedure is called a biopsy.

A biopsy is done to remove tissue or cells from your body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to see if cancer cells or other abnormal cells are present.

Biopsies may be performed under local anesthetic (which numbs the area where the biopsy is taken) or general anesthetic (which makes you go to sleep). There are several types of breast biopsy procedures. The type of biopsy you have will depend on the location and size of the breast lump or abnormality. Be sure to ask which type you are going to have so that you won't be surprised. A biopsy can usually be done in your health care provider's office under local anesthetic.

Types of breast biopsy procedures include, but are not limited to, the following:

• Fine-needle aspiration biopsy - a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine-needle aspiration biopsy may be performed to help tell a cyst from a solid lump. A needle biopsy may be done on an outpatient basis or in a doctor's office.

 

Fine-Needle Aspiration Biopsy

• Core needle biopsy - a larger needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.
• Surgical biopsy (also called an open biopsy) - your surgeon removes part or all of a lump or suspicious area through an incision in your breast. There are two types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed. During an excisional biopsy, the entire lump is removed. 

 

Surgical Biopsy

In some cases, if your breast lump is very small and deep and hard to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump using x-rays for guidance. Your surgeon follows this wire to help locate the lump.

If your biopsy report comes back negative, it means that you do not have cancer. But even if it does, you need to be sure to continue seeing your health care professional for clinical breast examinations, continue doing monthly self-breast examinations, and have regular mammograms.

If your biopsy report comes back positive, your health care provider will order more tests to find out the size and extent of the cancer in the breast and to see if the cancer has spread to other parts of your body. This is called "staging," and it is important to know in planning your treatment.