How Breast Cancer is Diagnosed

No one is excited to get a mammogram or go through other breast cancer screening tests. However, keeping on top of breast health and regular screening can be life-saving. The sooner breast cancer is diagnosed, the better the outcome is more likely to be.

First Steps

Keeping on top of regular breast self-checks, yearly mammograms, and annual physicals can help increase the chances of finding breast cancer in the early stages. That is to say, mammograms and self-checks will not increase the chances of a diagnosis but of early detection of the disease should it occur. These are three possible first steps in a potential breast cancer diagnosis.

Self Breast Check

A self breast-check, also known as breast self-exams, is a method used to keep yourself informed and aware of your own breasts and breast tissue. They should be done monthly, if possible, and especially if you meet a high number of risk factors, and they do not take long. But if performed regularly, they can keep you very familiar with the feel and appearance of the breasts, meaning any change is sure to stand out.

The process is relatively simple:

  • Start by looking at your breasts, both looking down and checking them in a mirror. Check for any changes in color, size, or shape. Signs of cancer or other infection are swelling, redness, dimpling, puckering, or discoloration. Especially check the nipple for inversion, pain, or unexpected or bloody discharge.
  • Raise your arms and reexamine. Having your arms up may shift the positions of the breasts to reveal something you may have missed otherwise.
  • Use the pads of a few fingers to carefully feel over the entire breast. Use consistent, small, circular motions to move across, up, and down the whole breast, covering the collarbone to the top of the rib cage and cleavage to the armpit
  • . Use enough pressure to feel deep tissue but not enough to hurt yourself.
  • Lay down and repeat the process.

Keeping up with regular breast self-exams will make it easier to notice any changes. If you find anything of concern, speak with your physician to discuss options and further screening.

Clinical Breast Exam

A clinical breast exam is part of the standard physical. It is a breast exam performed by your doctor, in which they will physically examine and feel each breast to feel for any changes or lumps in the tissue. The clinical breast exam becomes particularly relevant if you are at high risk of breast cancer or have noticed changes in your breasts during a breast self-examination. Raise any concerns with your physician so they can help you and discuss any necessary next steps.

It is not as simple as finding a lump and having doctors diagnose breast cancer. Should something be found during these exams, your doctor will likely send you to get a mammogram or ultrasound.

Breast Imaging Tests

Mammograms

Another way to keep on top of your breast cancer risk and status is to receive regular mammograms. A screening mammogram, or mammography, is an X-ray of the breast using a low dose of radiation. Two plates will compress the breast at different angles to get multiple digital images, which a radiologist can examine for signs of breast disease or any other possible abnormality.

However, those who have particularly dense breast tissue or scar tissue in the breast are likely to have false positives in a mammogram. Breast cancer, dense tissue, and even cysts (fluid-filled sacs) appear white on x-rays, with limited ways to distinguish between them. For this reason, a potential positive from a diagnostic mammogram is not considered conclusively positive. Additional tests or a biopsy should be taken to confirm accuracy.

Ultrasound

A breast ultrasound uses sound waves to form a picture of the breast tissue. This is a good alternative to a mammogram if you’re pregnant and shouldn’t be exposed to x-rays. While ultrasounds are not generally used for cancer screening, they work well at differentiating a fluid-filled cyst from more solid masses. It can also give locations of tumors to help doctors, should they need to perform a biopsy or further investigation. Some surgical oncologists will use ultrasound during lumpectomies to establish the boundaries of the breast cancer before they begin removal.

MRI Scan

MRIs, or Magnetic Resonance Imaging tests, use magnetic fields to produce images of the breast’s interior. A contrast dye is injected before the screening, revealing where any blockages are. MRIs are not often used to diagnose breast cancer but instead used after an initial diagnosis to see how far cancer has spread. However, it can be used in combination with a mammogram to screen if:

  • there is a strong family history of breast cancer or ovarian cancer
  • the breasts are particularly dense (primarily ducts, fibrous tissue, and glands, with little fatty tissue), so any signs of breast cancer would be difficult to spot on a mammogram alone
  • the BRCA1 or BRCA2 gene mutation or other genetic mutations are present
  • radiation treatments have been applied to the chest before age 30

These traits can potentially lead to a high risk of breast cancer or, in the case of the dense tissue, an increased risk of missing early-stage breast cancer.

Metastatic Breast Cancer Detection

Specific imaging tests can detect metastasis once breast cancer has already been diagnosed. Biopsies can be performed by interventional radiologists, doctors whose primary focus is minimally invasive and targeted therapy.

Biopsy Sample

There are multiple kinds of biopsies, each serving their own purposes, though generally speaking, a biopsy is used to confirm or rule out a breast cancer diagnosis. Put simply, a biopsy takes a small amount of cells or tissue from an area of concern to examine under a microscope to establish whether these cells are cancerous or not. A pathologist–a doctor specialized in interpreting lab data and evaluating and diagnosing based on cells and tissues–will create a pathology report to explain what was found and discuss potential treatment options.

Fine Needle Aspiration Biopsy

The tissue or cell sample is removed using a thin needle.

Core Needle Biopsy

Like the fine needle aspiration method, the core needle biopsy uses a needle to remove the needed sample. However, the needle gets a core of tissue, so it collects a larger sample. This is generally the preferred technique for getting breast cancer diagnosed once an abnormality has been found in the breast, whether through physical examination or imaging tests. A pathologist will examine the sample to establish whether they are invasive cancer cells and identify any cancer biomarkers. Local anesthesia is commonly used to minimize discomfort during the procedure.

Image-Guided Biopsy

Image-guided biopsies are a form of core needle biopsy that map the area and guide the needle to the correct area of calcifications or mass through the use of imaging devices, such as ultrasound, mammography, or MRI. Usually, a marker is left behind–a small metal clip, usually titanium–to mark where the sample was taken.

Surgical Biopsy

Surgical biopsies are usually performed after a diagnosis has already been given, so they are rarely used as diagnostic tests. Most potential breast cancer patients will be given a form of needle biopsy to avoid unnecessary surgery. However, surgical biopsy does yield the largest amount of tissue.

Sentinel Lymph Node Biopsy

Breast cancer will sometimes spread into the local lymphatic system. The lymph nodes the breast cancer cells reach first are referred to as the sentinel lymph nodes and are usually the axillary lymph nodes (found under the arms). The sentinel lymph node biopsy removes 1-3 lymph nodes to avoid needing to remove more lymph nodes later.

Staging Breast Cancer

Once a breast cancer diagnosis has been established, your doctor will establish its severity in one of the breast cancer stages. The stage helps determine your prognosis and the best treatment options to take moving forward.

Some procedures that may be used to establish the breast cancer’s stage are:

  • Mammogram
  • Breast MRI
  • Blood tests
  • Bone scan
  • PET scan
  • CT scan

The stages ran from 0–meaning noninvasive and relatively contained–to IV–also called metastatic, meaning it has spread to other parts of the body.

Treatment Options

A patient’s treatment plan will be determined based on their breast cancer stage, health, and other factors. Dr. Gorman at the Texas Breast Center always ensures that each patient receives a personalized and targeted approach to breast cancer treatment to best meet their needs.