Learn about Breast cancer diagnosis at Consumer Reports Health.

Breast cancer

How do doctors diagnose breast cancer?

If you're worried about a lump or change in your breast, you should see your doctor.

He or she will probably ask you how long you've had your symptoms and ask other questions about your health. He or she may also ask whether any of your female relatives have had breast cancer or ovarian cancer.

Your doctor will examine your breasts and feel under your arms and at the base of your neck for lumps or any

lymph nodes
Lymph nodes (also called glands) are small, bean-shaped lumps that you cannot usually see or easily feel. They are located in various parts of the body, such as the neck, armpit and groin. Lymph nodes filter the lymph fluid and remove unusual things, such as bacteria and cancer cells.

lymph nodes that seem larger than normal. Your doctor will look for:

Lumps in your breast
Painful lumps
Changes in your nipple
Changes in the skin of your breast
Discharge from your nipple.

If your doctor is concerned that there is a chance you could have breast cancer, you will need to have some tests. Tests for breast cancer include getting images of the inside of the breast and taking a sample of tissue to test for cancer.

Taking images of the breast

There are several tests that take pictures of the breast. The most common types are a mammogram, ultrasound and

MRI scan
The magnetic resonance imaging (MRI) machine uses a magnetic field to create detailed pictures of the inside of the body. These pictures allow doctors to look at parts of the body in three-dimensional images.

MRI (magnetic resonance imaging).

A mammogram is an X-ray of the breast. To get a good picture, the person doing the mammogram will first place your breast on a metal plate in the mammogram machine. He or she will then lower a clear plastic plate onto your breast to flatten it slightly.

Having a mammogram can be uncomfortable because your breast is squeezed between the two plates. Some women say it hurts.
But the test takes just a few minutes and any pain should pass quickly.
Mammograms are useful for spotting changes in the breast that might be difficult to feel.
This is a good test for breast cancer but, like all tests, it can give the wrong result. Studies show that, on average, 1 in 5 cancers are missed by mammograms. It's more likely to miss cancer in younger women than in older women. This is because young women's breasts may be firmer with more dense tissue in them, which makes mammograms hard to read.
There's also a small chance that you'll be told you may have breast cancer when you don't.

Source:
National Cancer Institute.
Breast cancer (PDQ): screening. Health professional version.
Available at http://www.nci.nih.gov (accessed on 7 May 2009).

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If your doctor finds a lump during the examination or mammogram, you may have an ultrasound.

This uses sound waves to get a picture of the breast.
It tends to be used for younger women who may not get a clear picture on a mammogram. This is because their breasts may be firmer and have more dense tissue in them.
Ultrasound scans can also be used to see if a lump is solid or if it contains fluid. Lumps that contain fluid are usually cysts and not cancer.

Some women may have an MRI after their mammogram or ultrasound. It might be helpful for women who have very dense breast tissue or who have a lot of scarring from previous breast surgery or silicone breast implants. These things can make mammograms hard to read.

Source:
National Cancer Institute.
Breast cancer (PDQ): screening. Health professional version.
Available at http://www.nci.nih.gov (accessed on 7 May 2009).

Taking a tissue sample

If your doctor finds a lump or something abnormal on your mammogram, you may need to have some breast tissue removed for testing. Here are the most common ways to do this.

Your doctor may use a fine needle and syringe to collect some cells from your breast. This test is called fine needle aspiration.
Or you may have a core needle biopsy. In this test, the doctor uses a bigger needle to collect a small sample of tissue (called a biopsy) from your breast. You'll be given a

local anesthetic
Local anesthetic is a painkiller for one area of your body. You usually get it as a shot. It makes that area numb. An example is the novocaine you get when your dentist fills a cavity.

local anesthetic to numb the area, so you shouldn't feel any pain.
In both tests, the doctor may guide the needle by feeling the lump in your breast. If it's not easy to feel the lump, the doctor might use an ultrasound or a mammogram to guide the needle to the right place.

Source:
National Cancer Institute.
Breast cancer (PDQ): screening. Health professional version.
Available at http://www.nci.nih.gov (accessed on 7 May 2009).

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Sometimes the whole lump is removed. This is called an excision biopsy.
The cells, tissue or lumps are sent to a laboratory where they are examined for signs of cancer.

Getting your results

You will normally get your test results within the week. However long you have to wait, this will be an anxious time. Ask your doctor or breast cancer nurse when you will get your results. If you want someone to talk to, your doctor may be able to put you in touch with a counselor or someone who has been through a similar experience.

When you get your results, you will be told whether you have breast cancer or not. You may feel very anxious about getting your results. If you're told you have breast cancer, you may feel devastated. But it's important to remember that the treatment of breast cancer has improved dramatically in the last 10 years or so. This means that more women of all ages are now surviving breast cancer.

If you have breast cancer, your doctor may want to carry out some more tests to see how far your cancer has spread. You will probably have blood tests and an X-ray.

After these tests, your doctor or nurse may be able to tell you what type of breast cancer you have and how serious it is. To learn more, see Types of breast cancer and Staging and grading breast cancer

Your biopsy may show whether your cancer more sensitive to estrogen than other cancers (it is

estrogen-receptor positive
Estrogen-receptor positive tumors are cancers that are encouraged to grow by the presence of the hormone estrogen.

estrogen-receptor positive). This means that estrogen encourages your cancer grow. It's important to know if your cancer is estrogen-receptor positive because you may be able to take a drug (such as tamoxifen) to block these hormones and stop the cancer from spreading.

But you may have to wait until you have surgery to find these things out. To learn more, see More about surgery for breast cancer.

Sources for the information on this page:

National Cancer Institute.Breast cancer (PDQ): screening. Health professional version.Available at http://www.nci.nih.gov (accessed on 7 May 2009).

This information was last updated on May 11, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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