How is Breast Cancer Diagnosed?

Learn about common tests to diagnose breast cancer

You’ve found a lump in your breast. What now? Although scary and, at the onset, an unknown road, it’s important that you schedule an appointment with your doctor as soon as possible so that he/she may be able to perform any of the below tests to determine if the lump is cancerous:

Mammogram:

A mammogram is essentially an x-ray of the breast. Low dose radiation is used to scan your breasts for abnormal densities, one side at a time. To get as good of a picture as possible, a skilled technician will gently flatten your breast between two clear glass plates. While some women do report discomfort with the procedure, mammograms usually do not take long. If your mammogram is a diagnostic mammogram (done only if your doctor is concerned about an area and wants to make sure it’s not cancer), then the technician might have to take additional pictures. It’s natural to be worried about the radiation, but did you know that there is background radiation all around us throughout our daily lives? A typical mammogram that takes two pictures each of each breast will give you a radiation dose of about 0.4mSV, which is relatively low, and no case of cancer caused by the radiation from mammograms has been proven.

How you can prepare

  • Wear comfortable clothing, ideally a separate top and bottom
  • Bring a comfortable bra
  • The procedure is done standing, so let the technician know if standing for the time is difficult, and if you would like to take seated rest breaks
  • You may have to move your arm up and out of the way. Let the technician know if you have shoulder pain or limitations in range of motion.
  • Do not wear lotion, deodorant or powder the day of the mammogram
  • You are taking excellent care of yourself! Plan a nice reward for after.
  • Tell your doctor when you expect your next period and ask when to best schedule your mammogram. Some women have breast tenderness around the time of their periods and may want to schedule their mammograms after!

 

Ultrasound:

An ultrasound is a non-invasive test that can check your breasts for suspicious lumps. During a breast ultrasound, the technician will squeeze ‘goop’ on your breast and then move a probe across your breast. The ultrasound signal can show areas of calcifications in the breast, which may or may not indicate malignancy, depending on what they look like on the screen. A solid breast mass tends to be benign if it

  • Doesn’t have any sharp edges
  • Has only few (maybe 2 or 3) subdivisions
  • Has a homogenous texture
  • Is egg shaped
  • Is surrounded by a thin capsule

Breast lesions might be malignant if they

  • Have edges and spikes
  • Have multiple subdivisions
  • Cast a shadow that can be made visible on the ultrasound image
  • Has areas of different textures.
  • Have small areas of calcifications

 

When these criteria of classifying a lesion are kept in mind, breast ultrasound is 95% successful in correctly identifying benign lesions as benign.

During the ultrasound, the technician will capture some images of the breast (the ultrasound image, not the outside of your breast), and show it to the Radiologist. If there is an area of concern, the Radiologist might perform a biopsy right there and then.

 

Biopsy:

 

A biopsy is a procedure during which a small amount of tissue from the area of concern is removed for further examination under the microscope. This entails applying a numbing spray to your breast and injecting some pain medication- much like the dentist does when you go in for a root canal. You will be awake during the procedure, and it takes about 20 minutes. The doctor (often a Radiologist when done under ultrasound guidance) may make a small incision in your breast and will then use one of the following ways to retrieve a tissue sample from your breast:

  • A thin needle with an attached syringe (aptly this is called fine needle aspiration) will take a small sample of the lesion, this may take 5-10 minutes
  • A hollow needle that has a smaller needle inside of it and can collect the core of the area of concern (this is named -wait for it- core needle biopsy). This can take around 20-30 minutes.

 

An open biopsy is a more involved procedure often done in an OR setting which includes an incision to remove some part of the lesion. This is called incisional biopsy when some part of the area of concern is removed, and excisional biopsy when all of the tissue of concern is removed. You may want to set several hours aside as this is a bigger procedure. Be sure to rest afterwards; we recommend planning for someone to drive you home after as you might receive sedating medications.

 

Good to know: Fine needle aspirations and core biopsies usually do not leave a scar.



This is how you can prepare:

  • Wear comfortable, loose-fitting clothing, like a two- piece. Wear a comfortable bra that won’t bother your incision.
  • Don’t put on lotion, deodorant or powder.
  • Don’t wear earrings or necklaces
  • A breast biopsy is an outpatient procedure, and you will be able to go home afterwards. Even though no heavy sedation is involved, consider having someone drive you there and back!
  • Before you leave, ask your physician which over the counter pain reliever will be okay to use- your medical team may want you to stay away from those that inhibit blood coagulation, such as ibuprofen, aspirin and naproxen.
  • Plan on taking it easy after the procedure. Avoid strenuous activities, especially those that involve lifting with the side of the biopsy. After all, our breasts rest on top of our pecs, so when we engage our chest muscles, we can feel it in our boob!

 

It may take some time until you get all the results back. The mammogram may not be read for a couple of days. The tissue obtained through biopsy will be sent to a specialized lab, where a Pathologist examines it under the microscope. For this, the tissue needs to undergo specific preparations and stainings, which take time. Stay tuned for our future blog post about how to deal with uncertainty while waiting for your results. You got this!

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