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Diagnosis
If you have a symptom or screening test result that suggests cancer, your
doctor must find out whether it is due to cancer or to some other cause. Your
doctor may ask about your personal and family medical history. You may have a
physical exam. Your doctor also may order a mammogram or other
imaging procedure. These tests make pictures of tissues inside the breast. After the
tests, your doctor may decide no other exams are needed. Your doctor may
suggest that you have a follow-up exam later on. Or you may need to have a
biopsy to look for cancer cells.
Your health care provider feels each breast for lumps and looks for other
problems. If you have a lump, your doctor will feel its size, shape, and
texture. Your doctor will also check to see if it moves easily. Benign lumps
often feel different from cancerous ones. Lumps that are soft, smooth, round,
and movable are likely to be benign. A hard, oddly shaped lump that feels
firmly attached within the breast is more likely to be cancer.
Diagnostic mammograms
are x-ray pictures of the breast. They take clearer, more
detailed images of areas that look abnormal on a screening mammogram. Doctors
use them to learn more about unusual breast changes, such as a lump, pain,
thickening, nipple discharge, or change in breast size or shape. Diagnostic
mammograms may focus on a specific area of the breast. They may involve special
techniques and more views than screening mammograms.
An
ultrasound
device sends out sound waves that people cannot hear. The waves
bounce off tissues. A computer uses the echoes to create a picture. Your doctor
can view these pictures on a monitor. The pictures may show whether a lump is
solid or filled with fluid. A
cyst
is a fluid-filled sac. Cysts are not cancer.
But a solid mass may be cancer. After the test, your doctor can store the
pictures on video or print them out. This exam may be used along with a
mammogram.
Magnetic resonance imaging
(MRI) uses a powerful magnet linked to a computer.
MRI makes detailed pictures of breast tissue. Your doctor can view these
pictures on a monitor or print them on film. MRI may be used along with a
mammogram.
Your doctor may refer you to a
surgeon
or breast disease specialist for a
biopsy. Fluid or tissue is removed from your breast to help find out if there
is cancer.
Some suspicious areas can be seen on a mammogram but cannot be felt during a
clinical breast exam. Doctors can use imaging procedures to help see the area
and remove tissue. Such procedures include
ultrasound-guided,
needle-localized,
or
stereotactic biopsy.
Doctors can remove tissue from the breast in different ways:
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Fine-needle aspiration:
Your doctor uses a thin needle to remove fluid from a
breast lump. If the fluid appears to contain cells, a
pathologist
at a lab
checks them for cancer with a microscope. If the fluid is clear, it may not
need to be checked by a lab.
-
Core biopsy:
Your doctor uses a thick needle to remove breast tissue. A
pathologist checks for cancer cells. This procedure is also called a needle
biopsy.
-
Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks
the tissue for cancer cells.
-
An
incisional
biopsy takes a sample of a lump or abnormal area.
-
An
excisional
biopsy takes the entire lump or area.
If cancer cells are found, the pathologist can tell what kind of cancer it is.
The most common type of breast cancer is ductal
carcinoma. Abnormal cells are
found in the lining of the ducts. Lobular carcinoma is another type. Abnormal
cells are found in the lobules.
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You may want to ask your doctor the following questions before having a biopsy:
- What kind of biopsy will I have? Why?
- How long will it take? Will I be awake? Will it hurt? Will I have
anesthesia? What kind?
- Are there any risks? What are the chances of infection or bleeding after the biopsy?
- How soon will I know the results?
- If I do have cancer, who will talk with me about the next steps? When?
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