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  • How is breast cancer diagnosed?

    Contents

    Diagnosis

    If you have symptoms of breast cancer, your GP will take a full medical history, which will include your family history. They will also perform a physical examination, checking both your breasts as well as the lymph nodes under your arms and above your collarbone. To find out if your breast change has been caused by cancer, your GP may arrange some tests, such as a mammogram and biopsy. They may also refer you to a specialist for these and other tests.

    General tests 

    Mammogram

    A mammogram is a low-dose x-ray of the breast tissue. This x-ray can check any lumps or other changes found by the physical examination. It can also find changes that are too small to be felt during a physical examination.

    During the mammogram, one breast at a time is pressed between two x-ray plates, which spread the breast tissue out so that clear pictures can be taken. This can be uncomfortable, but it takes only about 20 seconds. Both breasts will be checked.

    Tomosynthesis - Also known as three-dimensional mammography or digital breast tomosynthesis (DBT), tomosynthesis takes x-rays of the breast from different angles and uses a computer to combine them into a three-dimensional image. This form of breast imaging is sometimes used to find small breast cancers, particularly in women with dense breast tissue.

    Ultrasound 

    An ultrasound is a painless scan that uses soundwaves to create a picture of your breast. It will be done if a mammogram picks up breast changes, or if you or your GP can feel a lump that doesn’t show up on the mammogram.

    The person performing the ultrasound will spread a gel on your breast, and then move a small device called a transducer over the area. This sends out soundwaves that echo when they meet something dense, like an organ or a tumour. A computer creates a picture from these echoes. The scan is painless and takes about 15–20 minutes.

    MRI

    A magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to create pictures of the breast tissue on a computer.

    Breast MRI is not a standard test for breast cancer and can involve extra costs. It is mainly used to screen people who are at high risk of breast cancer or to diagnose breast cancer in women with very dense breast tissue or implants. It may also be used to help plan breast surgery.

    Before an MRI, you will have an injection of a contrast dye to make any cancerous breast tissue easier to see. You will lie face down on a table with cushioned openings for your breasts and rest your arms above your head. The table slides into the machine, which is large and shaped like a cylinder. The scan is painless and takes 30–60 minutes.

    Biopsy

    During a biopsy, a small sample of cells or tissue is removed from your breast. A specialist doctor called a pathologist examines the sample and checks it for cancer cells under a microscope.

    There are a few ways of taking a biopsy, and you may need more than one. The biopsy may be done in a specialist’s rooms, at a radiology practice, in hospital or at a breast clinic.

    Core biopsy

    A needle is used to remove a piece of tissue (a core) from the lump or abnormal area. It is usually done under local anaesthetic, so your breast will be numb, although you may feel some pain or discomfort when the anaesthetic is given. During the core biopsy, a mammogram, ultrasound or MRI scan is used to guide the needle into place. You may have some bruising to your breast afterwards.

    Vacuum-assisted stereotactic core biopsy

    In this type of core biopsy, a number of small tissue samples are removed through one small cut (incision) in the skin using a needle and a suction-type instrument. This biopsy is done under a local anaesthetic, but you may feel some discomfort. A mammogram, ultrasound or MRI may be used to guide the needle into place.

    Fine needle aspiration (FNA)

    A thin needle is used to take cells from an abnormal lymph node (core biopsy is preferred for breast lumps). Sometimes an ultrasound is used to help guide the needle into place. A local anaesthetic may be used to numb the area where the needle will be inserted.

    Surgical biopsy

    If the abnormal area is too small to be biopsied using other methods, or the biopsy result is not clear enough to rule out cancer, a surgical biopsy is done. Before the biopsy, a guide wire may be put into the breast to help the surgeon find the abnormal tissue. You will be given a local anaesthetic, and the doctor may use a mammogram, ultrasound or MRI to guide the wire into place. The biopsy is then done under a general anaesthetic. The lump and a small area of nearby breast tissue are removed, along with the wire. This is usually done as day surgery, but some people stay in hospital overnight.

    Further tests

    If the tests described show that you have breast cancer, one or more tests may be done to check whether the cancer has spread to other parts of your body. Bone scans and CT scans are not routine tests for breast cancer and are only done if the cancer has a high risk of spreading.

    Blood tests

    Blood samples may be taken to check your general health and to look at your bone and liver function for signs of cancer.

    Chest x-ray

    Your doctor may take an x-ray of your chest to check your lungs for signs of cancer.

    Bone scan

    A bone scan may be done to see if the breast cancer has spread to your bones. A small amount of radioactive material is injected into a vein, usually in your arm. This material is attracted to areas of bone where there is cancer. After a few hours, the bones are viewed with a scanning machine, which sends pictures to a computer. This scan is painless and the radioactive material is not harmful. You should drink plenty of fluids on the day of the test and the day after.

    CT scan

    A CT (computerised tomography) scan uses x-rays and a computer to create detailed, cross-sectional pictures of the inside of the body. Before the scan, you will either drink a liquid dye or be given an injection of dye into a vein in your arm. This dye, known as the contrast, makes the pictures clearer. You will lie flat on a table while the CT scanner, which is large and round like a doughnut, takes pictures. This painless test takes 30–40 minutes.

    This website page was last reviewed and updated October 2019

    Information last reviewed: Prof Christobel Saunders, Professor of Surgical Oncology and Head, Division of Surgery, The University of Western Australia, and Consultant Surgeon, Royal Perth, Fiona Stanley and St John of God Subiaco Hospitals, WA; Dr Marie-Frances Burke, Radiation Oncologist, Medical Director, Genesis CancerCare Queensland, QLD; Kylie Campbell, Breast Care Nurse and Clinical Lead, Murraylands, McGrath Foundation, SA; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland, QLD; Annmaree Mitchell, Consumer; Sarah Pratt, Nurse Coordinator, Breast Service, Peter MacCallum Cancer Centre, VIC; Dr Wendy Vincent, Breast Physician, Chris O’Brien Lifehouse and Royal Hospital for Women, Randwick, NSW, and Clinical Director BreastScreen NSW, Royal Prince Alfred Hospital, NSW; A/Prof Nicholas Wilcken, Director of Medical Oncology, Westmead Hospital, and Co-ordinating Editor, Cochrane Breast Cancer Group, NSW.

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