Breast Cancer: Diagnosis
Return To Main Guide:
|How Is Breast Cancer Diagnosed?
In the past some breast lumps were found by routine medical examinations, but the majority were discovered by women themselves, either by chance or through self-examination. Today increasingly most cases of breast cancer are first discovered by a mammogram test. Women who are under 35 or pregnant may be offered an ultrasound scan as an alternative. A scan can help when doctors suspect a lump is a cyst or with a suspicious finding in the breasts that does not show up well in a mammogram. In a few instances doctors turn to digital imaging techniques such as a digital mammography. When a suspicious lump occurs a biopsy will usually need to be performed. The cells will be examined under a microscope for signs of cancer. If the biopsy is positive the doctor will need to determine the stage of cancer growth which will determine the best course of treatment (for example lumpectomy procedure or mastectomy). If it is suspected that cancer has spread beyond the breast a CT scan (computerized tomography, CAT) or MRI (magnetic resonance imaging) may be ordered.
When To Carry Out Tests
The American Cancer Society Recommends
Mammograms: Women aged 40 and older to have a mammogram every year and continue to do so while in good health.
Clinical Breast Examination (CBE): Women in their 20s and 30s should have a clinical breast exam (CBE) every 3 years by a health expert (doctor or nurse). After the age of 40 this should be once a year. It is a good idea to have a CBE shortly before a mammogram so that you use the exam to learn what your breasts look and feel like.
Breast Self-Examination (BSE): This is an option for women starting in their 20s and should be carried out every month. Do report any breast changes to a doctor or nurse immediately. A BSE is particularly important for women at risk of breast cancer recurrence.
The idea behind breast self-examination (BSE) is that a woman becomes so familiar with her breasts that she is able to spot changes very early. BSE is a sort of continual surveillance which would otherwise not be possible unless the woman is a doctor herself. For example if a doctor examines a woman's breasts annually, lets say in August, but a cancerous lump only feels big enough to recognize in September, the woman loses 11 crucial months. Ideally a BSE should be carried out on a monthly basis, even by those who go for routine mammograms. If not, an occasional exam is still better than none. See: How to do a breast self examination, with diagrams.
Performing a breast self-examination takes about 15 minutes. Women who are still menstruating should self-examine a week after a period has passed when their breasts are less likely to feel sensitive. Postmenopause women can self-examine any time. Women who have undergone hysterectomies, but who still have functioning ovaries should choose a time when they are not feeling bloated or tender, indicating a time of hormonal activity.
Every so often it is worth asking a gynecologist, family doctor or nurse to carry out a professional clinical breast examination. This would include taking a breast history of past problems and potential risk factors, any current concerns, a visual inspection under good light and careful palpation of all the breast tissue including beneath the nipples, armpits and collarbone.
If a breast change is detected, what then? Try not to panic, although this of course easier said than done. 9 times out of 10, the lump will turn out to be a fluid filled cyst. However it is important to ask a clinician to evaluate it. If it is a cyst, the doctor can insert a needle into the lump to withdraw (aspirate) fluid, prompting the cyst to collapse. If the cyst is causing some breast pain, this may resolve the issue. If the lump turns out to be solid the doctor will try to take sample tissue by breast biopsy for a pathologist to analyze. Quite often, if a lump feels solid from the start, a doctor will carry out a core biopsy. This is a procedure which does not require cutting the skin, but uses a wider cutting needle to obtain small cylinders of tissue. The needle may be attached to a special 'biopsy gun' which shoots the needle in and out. Another procedure called a mammotome uses an ultrasound scan to locate the suspicious area before the doctor makes a tiny incision and inserts a probe with a high speed rotating cutter attached to a vacuum pump. This allows the doctor to remove an adequate amount of tissue without leaving a large scar. Both biopsy techniques are usually carried out with a local anesthetic. Results may take up to 48 hours.
Open Biopsy (Surgery)
Sometimes surgery is necessary as a diagnostic technique to remove part of a lump for examination. This is known as a surgical biopsy or open biopsy. It is most commonly carried out in a hospital’s outpatient department under local anesthesia. The surgeon may use a procedure called stereotactic wire localization where a thin wire is inserted into the needle to help locate the lump under suspicion and to anchor the needle in place so a sample of cells can be extracted. An open biopsy is usually only done where the lump is difficult to reach or where the results of a core biopsy are not conclusive.
A mammogram is a special kind of breast X-ray which can detect cancerous tumors and breast abnormalities. It used both for screening in women who have no symptoms as well as in those who have developed a lump or pain in the breast. A mammography can detect tumors that are still too small to detect by a BSE. However, as most mammographies are only carried out every 2 years, it is best to use one in conjunction with regular breast exams. During a mammogram procedure one breast at a time will be compressed between two plates. A radiologist will take an image from above and to the side of the breast. To avoid unnecessary radiation exposure to other parts of the body the woman will be asked to wear a lead apron. Some women experience mild discomfort with the procedure. Women who are still menstruating are recommended to wait for testing until a week after their period has gone, when the breasts are at their least sensitive. Women having a mammogram should avoid using deodorant, powders or lotions on the day of their test as this can block the images. Results should arrive within 3 to 4 weeks.
Also known as: full-field digital mammogram (FFDM). A digital mammography is similar to a regular mammogram in that X-rays are taken of the breasts. The difference is the way in which the information is recorded. Standard mammogram's are stored on photographic film whereas digital ones are stored on a computer. The computer images allow a doctor to examine the images more carefully, to adjust size, brightness and contrast areas. Digital images can also be sent to other doctors more easily for consultation. However as digital mammograms are more expensive they have not yet been rolled out extensively.
Screening and self-examination can be a hassle, and going through a biopsy even more so. On the other hand failing not to detect a very curable cancer at an early stage because either the patient or doctor refuses to carry out the appropriate tests is tragic. A not too uncommon scenario is a where a woman is considered too 'young' to have breast cancer and the doctor tells her that a lump must be benign. She is told to go home and come back in another year. No matter how young the woman, any persistent breast lump must be properly checked. Waiting a month until the next menstrual cycle has passed is a reasonable thing to do and may save a biopsy. If a doctor still feels no further tests are necessary the woman should ask for an explanation, and if she is not happy with it, get a second opinion or change doctors. Ensuring an early diagnosis will improve a woman's breast cancer survival rates.
Breast Cancer Diagnosis: What Next?
Breast cancer can be slow to grow, or it can be aggressive. If a positive diagnosis has been given, the next step is for the pathologist is to assign a grade to the cancer - see breast cancer stages. This will be based on the biopsy and will help predict a woman's prognosis (outcome). You may want check out books on breast cancer and start to inform yourself about your condition.
|Related Articles on Breast Cancer
For more diagnostic issues, see the following:
Back to Homepage: Womens Health Advice