How is breast cancer diagnosed?
Getting started—visit your doctor.
If you think you have symptoms of breast
cancer, see a doctor right away. Your doctor will ask questions about your symptoms,
your health history, and risk factors
for breast conditions such as cancer.
To determine whether or not a person has breast cancer, a healthcare professional
examines the breasts for lumps, looking for suspicious abnormalities in texture,
size, and relationship to the skin and muscles of the chest. Changes in the nipples
and skin are also noted. Additionally, the lymph nodes in the armpits and above
the collarbone are examined, and an overall physical exam is probably given.
If there are any signs of cancer, the doctor will suggest more tests. Tests fall
into three main groups: imaging tests, nipple discharge exams, and biopsies.
Imaging tests.
How can imaging tests evaluate breast cancer?
“Imaging” means making a picture of the inside of the body. This can be accomplished
with X-rays (mammogram), magnetic fields (MRI), sound waves (ultrasound), or radioactive
materials (PET scan). Imaging tests can help detect breast cancer
and tell a doctor how far it has spread, and if any
treatment given so far is working.
Diagnostic mammograms.
Mammograms are mostly used for screening, but they can also be used to examine breast
problems found during screening. These problems may include a mass in the breast,
nipple discharge, or other abnormalities. When a mammogram is used to find out more
about a breast problem, it’s called a “diagnostic mammogram.”
Here is what a diagnostic mammogram can show:
- That an abnormality in the breast is not a problem. Women who experience this result
are often asked to have annual mammograms
- That an abnormality is most likely benign. Women with benign abnormalities are often
asked to come back for a mammogram in 4 to 6 months
- That an abnormality is suspicious. In this case, a biopsy is needed
Digital mammograms and computer-aided breast cancer diagnosis.
Technology continues to help doctors diagnose cancer earlier and more accurately.
A digital mammogram—also known as a full-field digital mammogram, or FFDM—is a mammogram
that is recorded on a computer. Doctors can look at these mammograms on a computer
screen to see certain areas more clearly.
What’s more, a technique called computer-aided detection and diagnosis (CAD) helps
radiologists detect suspicious changes on standard and digital mammograms.
Magnetic resonance imaging (MRI).
An MRI is a scan using radio waves and strong magnets in place of X-rays. The body
absorbs the energy from the radio waves, and this can reveal certain diseases when
a computer translates the pattern of absorbed waves back into a detailed picture
of the body’s tissues.
MRIs are common, but not all MRI machines are made to look specifically at the breast.
MRIs can also be expensive. And MRIs can be somewhat uncomfortable: A liquid is
often injected into a vein before an MRI to help raise the contrast of the image
the scan produces and to give doctors a more detailed understanding of what’s going
on in the body. Further, an MRI can take up to an hour—during which time the person
being scanned needs to lie in a narrow tube without moving.
MRIs are important, however. They can help doctors determine the actual size of
a tumor in someone who has been diagnosed with breast cancer. They can also sometimes
detect other cancers in the breast.
Breast ultrasound.
Also called sonography, ultrasound is a method of imaging that uses sound waves
to create a picture of a part of the body. Ultrasound is painless, and it doesn’t
expose you to radiation. This, along with the fact that it is very common and less
expensive than MRI, has made ultrasound a valuable tool to use with mammography.
But ultrasound isn’t recommended to replace mammography. Typically, ultrasound is
used to get a better picture of a specific area seen on a mammogram. This can sometimes
help doctors distinguish between a tumor and a cyst, or non-cancerous,
fluid-filled sac that might form in the breast.
Positron emission tomography (PET) scan.
This type of scan creates an image of chemical changes that take place in the breast
tissue. First, a patient is injected with a small amount of radioactive material
and sugar. Cancer cells absorb sugar faster than other cells, so this helps get
the radioactive material into the cancer. The patient stays still as the scanner
detects the radiation and forms an image.
PET scans are considered more accurate in detecting larger, more aggressive cancers
than they are in locating tumors that are smaller than 8 millimeters across.
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Nipple discharge exams.
Sometimes, a person will be tested for breast cancer because she is having nipple
discharge.
Using a microscope, a doctor can examine this fluid for cancerous cells. Fortunately,
most nipple discharges are not cancerous. If the fluid appears milky or clear green,
cancer is very unlikely. However, if the discharge is red or reddish-brown—possibly
containing blood—it may be caused by cancer, although injury, infection, and benign
tumor are all more likely causes.
Even if no cancer cells are found in someone’s nipple discharge, cancer may still
be present, and a biopsy may be performed.
Specific nipple discharge tests.
Sometimes a test called a ductogram or galactogram is used to help determine the
cause of nipple discharge. Another experimental test called a ductal
lavage uses gentle suction to help give a more accurate picture of a woman's risk
of developing breast cancer. And a simpler test called nipple aspiration
looks for abnormal cells developing in the ducts, also without needles.
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Biopsies.
A biopsy is the only way to really know if a cancer is present.
To confirm that a breast contains a tumor, a doctor will perform a
biopsy, removing a sample of the suspicious tissue to be examined in detail
by a specialist called a
pathologist. The pathologist makes the diagnosis as to whether or not cancer
is present. When a mammogram or other exam finds an abnormality in the breast, a
biopsy is often performed.
Biopsies can be useful in determining if someone has a tumor in the breast, what
type of cancer it is, and whether or not it is invasive (metastatic).
There are a variety of biopsy techniques available. Because each person facing a
possible cancer diagnosis is in a different situation, the choice of which type
of biopsy to use is up to you and your doctor. Discuss the pros and cons of each
type of biopsy with your healthcare team. Here are some of the major types of biopsy:
- Fine needle aspiration biopsy (FNA): FNA biopsies allow doctors
to use very thin, hollow needles to withdraw small amounts of tissue from the breast.
In fact, the FNA biopsy needle is thinner than the needle used for blood tests
- Core needle biopsy (large needle biopsy): Using a larger needle
than an FNA biopsy, the core needle biopsy is performed using a local anesthesia,
meaning the person being biopsied is awake, but the breast is numbed. The core needle
biopsy removes larger pieces of tissue than an FNA biopsy. This may often—though
not always—provide a clearer diagnosis
- Vacuum-assisted biopsies: Vacuum-assisted biopsies can be performed
with a hollow probe. The probe can be guided using X-rays, an ultrasound, or an
MRI. Tissue to be studied under a microscope is suctioned in through the probe.
No stitches are needed, and there is little scarring
- Surgical or open biopsy: When surgery is needed to remove a lump
for examination, this is called a surgical biopsy
- Lymph node dissection and sentinel lymph node biopsy: These techniques
are used to search for cancer in the lymph nodes
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After a breast cancer diagnosis.
Regardless of your diagnosis, you may want a second opinion.
As you decide what treatment
to pursue, you can consult with other healthcare professionals, learn more about
the disease, and, of course, seek advice from friends and family.
You should be confident in your doctor’s diagnosis and treatment plan. Always feel
free to get a second opinion about your condition, and what treatment plan is right
for you.
Get the facts about breast
cancer treatment
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