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Diagnosis
This section contains information on diagnosing breast problems and breast cancer.
For more detailed information please follow the links at the bottom of the page to the Breast Cancer Care site.
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Making a diagnosis
This section is for anyone who has found a lump or other change in their breasts, or has been asked to return to the screening clinic where they had a mammogram (breast x-ray).
If you are in this situation, you may be feeling very worried and anxious, but it is important to remember that most breast problems are not a sign of cancer.
Although we refer to 'women' throughout the text, most of the information also applies to men who have noticed a lump or other change in their breast tissue.
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Finding a lump
A woman's breasts go through many perfectly normal changes throughout her lifetime. They are affected by hormonal changes during the menstrual cycle, pregnancy, breast-feeding, the menopause (change of life) and weight loss or weight gain. However, there are changes that you should always go and see your GP about. See the what to look for section for further advice. |
Seeing your GP
When you see your GP s/he may do one of three things:
- reassure you that there is nothing to worry about, as most breast problems turn out to be benign (non-cancerous)
- monitor you for a few months. (If this is suggested, but you feel particularly worried, you can ask to be referred to a breast clinic)
- refer you to a breast clinic for further investigations
If your GP thinks you should be seen urgently you can expect an appointment within two weeks of the referral. Otherwise you may have to wait up to eight weeks. You may want to refer to the Macmillan minimum standards of care for breast cancer.
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Diagnosing breast cancer - tests
When you are referred to the breast clinic you will be seen by staff experienced in diagnosing and treating breast conditions of all kinds. A doctor or specialist nurse practitioner will see you first and you may also be able to talk to a breast care nurse. They should be able to answer any questions you have. You can ask to see the specialist who leads the team (this will usually be the breast surgeon) at your first consultation or any time later.
You may need to have some or all of the following tests. Some of these tests may not be done routinely in every clinic, or done in the same order.
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Mammogram
A mammogram is a breast x-ray. The breast is compressed between two special x-ray plates, which some women may find uncomfortable or even painful, but it only lasts a few seconds.
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Ultrasound scan
An ultrasound scan uses high-frequency sound waves to produce an image of the breast. The scan is painless and only takes a few minutes. Ultrasound scans can be particularly useful for identifying cysts.
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Fine needle aspiration (FNA)
Fine needle aspiration (FNA) is a type of biopsy that involves removing cells or fluid using a fine needle and syringe. This is then looked at under a microscope and you will get the results in about a week (or the same day if you are seen in a one-stop clinic).
FNA is a simple procedure when a lump can be felt easily. However, some changes picked up on a mammogram can't be felt and are difficult to locate. In such cases FNA is done using ultrasound or x-ray. The specialist uses the pictures produced to guide the needle accurately to the abnormal area.
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Needle core biopsy
Some doctors may follow up the FNA with a needle core biopsy. This procedure uses a larger needle so that more tissue can be taken from the suspicious area, which means that more detailed tests can be done on the sample.
You will be given a local anaesthetic first, and you may find that your breast aches and is bruised later. You won't need stitches and you will be fit to go home afterwards.
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Surgical biopsy
Occasionally, even a needle core biopsy doesn't give enough information about the nature of a lump or suspicious area in the breast. You will then need what is called an excision biopsy, which is a small operation to remove the lump or area of concern.
This may be done under a local or general anaesthetic. You may be in hospital just for the day, or overnight, and you will have a small wound with a stitch or stitches in it.
If there is no lump that you or the surgeon can feel, then a procedure called a localisation biopsy may be needed. The radiologist (specialist in diagnosing disease through x-rays and scans) uses a mammogram or ultrasound scan as a guide to insert a fine wire into the breast to pinpoint the suspicious area. The wire is carefully secured and left there until surgery, which will usually be on the same day.
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Frozen section biopsy
With a frozen section biopsy the surgeon removes the lump under a general anaesthetic. While you are still asleep it is frozen in liquid nitrogen and sent to the pathologist (a specialist who will examine the lump under a microscope) for an immediate report.
If the lump is a cancer the surgeon can then remove the affected area completely, which may mean a mastectomy (removal of the breast) and removal of some of the lymph glands under the arm.
This type of biopsy is rarely used because most women prefer to have their diagnosis confirmed before any major surgery is done. It may be recommended where the FNA and needle core biopsy have been unable to confirm a cancer diagnosis but the surgeon strongly suspects that the lump is a cancer. If it is suggested, you will have time to think about your treatment options before agreeing to surgery.
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Magnetic resonance imaging (MRI)
In some centres an MRI scan may be available. This scan, which doesn't use radiation, gives a three-dimensional image of the breast and may be more sensitive than a mammogram at detecting certain abnormalities of soft tissue. Trials are currently taking place to compare the effectiveness of mammograms with MRI scans.
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For more information on Breast Cancer visit the Breast Cancer Care site
All information supplied by Breast Cancer Care
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