How is breast cancer diagnosed?
A lump or other change in your breast, or an abnormal area on a mammogram, may be caused by cancer or by another, less serious problem. Our team of specialists is able to give you an expert, accurate diagnosis using a number of techniques, including:
Breast examination by a physician
To determine the cause of any symptoms you may be experiencing, we will perform a thorough physical exam that includes a personal and family medical history and evaluation of your current overall health. This exam may also include:
- Palpation—Carefully feeling the lump and the tissue around it to determine its size and texture and whether it moves easily. Benign lumps often feel different than cancerous ones.
- Nipple discharge examination—Fluid may be collected from spontaneous nipple discharge and then sent to the lab to look for cancer cells. Most nipple secretions are not cancerous. An injury, infection or benign tumor may also cause discharge.
Your physician may also perform one or more imaging tests, including:
- Diagnostic mammogram with digital mammography (also called full-field digital mammography or FFDM)—An X-ray of the breast 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 evaluate abnormalities detected on a screening mammogram. Digital mammography captures images electronically and stores them on a computer, rather than on X-ray film. The images are viewed on a computer screen. Images can be changed, including the degree of magnification, brightness or contrast, to make them easier to see. They can also be transmitted electronically.
- Ultrasound—Uses high-frequency sound waves that do not emit radiation to view the breast. This test is done to further evaluate lumps felt in the breast or identified on a mammogram.
- Magnetic resonance imaging (MRI)—Uses a combination of powerful magnets, radio frequencies and a computer to create detailed images of your breast.
If previous tests reveal any abnormal findings, a biopsy will be performed to determine if cancer or other abnormal cells are present. Using a special biopsy needle, a small sample of breast tissue cells are removed for further examination. Biopsies may be performed under local or general anesthesia.
Depending on the location and size of a breast lump or abnormality, different biopsy procedures may be used. They include:
- Fine needle aspiration biopsy (FNA)—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 differentiate a cyst from a lump.
- Core needle biopsy—A large 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)—A surgeon removes part or all of a lump or suspicious area through an incision into the 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.
- Sentinel node biopsy—Used to determine if cancer cells have spread to the lymph nodes (usually in the armpit area). This surgical procedure may be performed during the initial diagnostic period to aid in determining the stage of the breast cancer. It involves injecting a dye and/or radioactive substance near the tumor. This injection helps to locate the lymph node closest to the tumor—called the sentinel node because it is the one most likely to have cancer cells present if the cancer has spread. The surgeon removes the lymph node that absorbs the substance and sends it to the pathologist to examine it for the presence of cancer cells.
There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. One of these is the stereotactic biopsy, which finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a 3D image of the breast, allowing for a streamlined and accurate biopsy.
The following techniques use a stereotactic approach:
- Vacuum-assisted breast biopsy system—A tube-like structure is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue.
- Ultrasound-guided biopsy—Ultrasound technology is used to help guide the radiologist to the site of the breast lump or mass.
Your role in diagnosis
Remember, you are your first defense against breast cancer. It’s important that you check with your doctor if you notice anything unusual in, on or around your breasts. You should also be sure to follow your doctor’s recommendations regarding regular screening for breast cancer.