Breast cancer

Updated 15 October 2014

Diagnosing breast cancer

Normally the primary (main) tumour has been found before surgery. Sometimes though a patient may have only enlarged lymph nodes which have been felt under the arm.

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Breast cancer is usually diagnosed after either a routine mammogram or doctor’s visit, or after a woman discovers a lump in her breast and makes a doctor’s appointment.

A doctor will do a physical examination during which the breast will be palpated gently to feel for any lumps or abnormalities, or a change in shape or texture. The doctor will also check to see whether there are any signs of lumps in your armpits.

There are three parts to diagnosing breast cancer:

- A physical breast examination

- A mammogram/ultrasound scan

- A needle core biopsy of fine needle aspiration biopsy


Physical examination

A doctor will do a physical examination during which the breast will be palpated gently to feel for any lumps or abnormalities, or a change in shape or texture. The doctor will also check to see whether there are any signs of lumps in your armpits.

The doctor will also ask about the patient’s medical history to try and determine her risk factors for breast cancer.


Mammogram/breast ultrasound scan

The next step is to have a mammogram and/or breast ultrasound scan done by a radiologist. The mammogram will produce an X-ray image of your breasts and the breast ultrasound scan will use high-frequency sound waves to create an image of the inside of your breasts.

Here’s what happens during a mammogram:

You stand or sit in front of a special X-ray machine while the radiological technologist lifts each breast and positions it on a platform that holds X-ray film.

A plastic plate presses the breast against the platform. Pressure for a few seconds means the X-ray dose can be lowered and ensures the X-ray shows as much breast tissue as possible.

This pressure is harmless and usually not painful, but it can be uncomfortable.

Avoid having mammograms when your breasts are tender, such as before your period.

Mammograms can pick up the presence of 85 – 90% of breast tumours. They can pick these up before you can feel them.

The denser the breast tissue, the less effective a mammogram is in picking up the presence of tumours. An ultrasound scan is recommended in such cases. A breast ultrasound scan is also capable of revealing whether a lump in your breast is solid, or whether it is filled with liquid (a cyst).


Biopsies


Lastly, if a mammogram or an ultrasound scan picks up any abnormalities in the tissue of the breasts, a biopsy can be ordered. This sampling of the tissue is done to make sure that a lump is not cancerous.

A fine-needle aspiration biopsy can be performed to determine whether a lump is a benign cyst, or not. An examination under a microscope can provide the answers.

At this stage of the examination, doctors can also order an MRI scan, they can check nipple discharges or order a core needle biopsy or a surgical biopsy. A surgical biopsy entails removing part of the lump for examination.


Read more:
Symptoms of breast cancer
Preventing breast cancer
Treating breast cancer


Sources: Health24.com; nhs.uk; breastcancercampaign.org

 

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Ask the Expert

Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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