How does my doctor know I have breast cancer?

This information was provided by the Women's Cancer Network. www.wcn.org

If you’re having symptoms of breast cancer or have something suspicious that has shown up on a previous test, your doctor will want to follow up. Your doctor is likely to ask you questions concerning these things:

  • Your medical history
  • Your family history of cancer
  • Any exposure to other risk factors, such as high doses of radiation

Feeling your breast can help your doctor figure out the size and texture of any abnormalities. Benign lumps often feel different from cancerous ones. First you will remove your clothes from the waist up. Then your doctor will look to see if your breasts have changed in any way, such as in shape or size. As you sit and lie down in different positions, the doctor will feel for any lumps. If your doctor feels a lump, you may need other tests, such as a mammogram or ultrasound.

Mammography- A mammogram is an X-ray of your breast. It can give the doctor important information about a breast lump. Some facilities use digital mammography, which also uses X-rays, but collects data on the computer, instead of on film. If something looks unusual, more mammograms or other tests may be needed.

Mammograms are quick and easy. You undress from the waist up, covering your upper body with a wrap provided by your doctor. Then you stand in front of an X-ray machine. Tell the staff if you have trouble standing. They can help make you more comfortable. A technician, usually a woman, will help position your breast on the X-ray plates. The plates flatten the breast so that the X-ray machine can get a clear picture of the breast tissue. The pressure of the plates may pinch a little, and the positioning of your body can be uncomfortable, but it usually lasts for only a minute or two. The whole process lasts about 20 minutes.

You’ll be more comfortable if you schedule your mammogram about a week after your period. During menstruation and the time leading up to it, your breasts may be tender, which can make the test more uncomfortable. To make sure that you get the most reliable results, follow these tips:

  • Don’t wear deodorant or body powder on the day of your mammogram. It can show up as dark spots on the X-rays and interfere with the radiologist’s ability to check the condition of your breasts.
  • Stand perfectly still during the mammogram. If you move, the results might be blurry, and then you’ll need to come back for a second mammogram.
  • If you’ve had previous mammograms or biopsies at another facility, bring a list of the dates and locations where these were done. If possible, bring the actual mammograms themselves. It’s a good idea to get these from your old facility if you decide to switch to a new one.
  • Choose your mammography facility with care. Your facility should have a prominently posted FDA certificate stating that it meets the required standards of safety and quality. If it isn’t, you have every right to ask to see it. If they don’t have this certificate, go somewhere else. Try to have your mammograms at the same facility each year. The longer a facility does your screening, the more familiar they are with your records, and the more likely they are to catch any changes.

You should have the results within 30 days. If there’s a problem, you’ll hear from the doctor within five working days. If you don’t hear anything, don’t assume that no news is good news. Follow up.

Ultrasonography- Ultrasonography uses sound waves to find out whether a lump is solid or filled with fluid. This exam may be used along with mammography. During an ultrasound examination, your doctor spreads a thin coating of lubricating jelly over the area to be imaged. A hand-held device called a transducer directs the sound waves through your skin toward specific tissues. As the sound waves are reflected back from the breast tissues, the patterns formed by the waves create a two-dimensional image of the breast on a computer. The test doesn’t take long and is painless.

These exams may help your doctor decide whether or not you need any more tests or treatment. If any of these test results suggest that cancer may be present, your doctor may need to remove a small amount of breast tissue, usually with a needle. This is called a biopsy. A doctor will suggest doing a biopsy when something suspicious is found in one or more of the tests above.

If you’ve been seeing your primary care doctor for screening up until this point, your doctor may refer you to a surgeon or another doctor who has experience with breast diseases and biopsies to perform the procedure.

How Your Doctor Uses Biopsies to Make Your Diagnosis of Breast Cancer

During a biopsy, a doctor removes cells from your breast and then sends them to a lab to be examined under a microscope. There is more than one kind of biopsy. The type that your doctor suggests depends on what has been learned thus far about the lump and whether or not it can be located by touch alone. Here are brief descriptions of each type of biopsy:

  • Fine needle aspiration biopsy (FNAB). This uses a very thin needle to collect fluid or cells directly from the lump. If the lump can’t be felt easily, ultrasound or computer-guided imaging may be used to help find it. If the needle locates clear fluid, the lump is most likely a cyst. If it finds a solid mass, it’s a tumor that may or may not be cancer. If the lump is solid, the surgeon will remove tissue and send it to a lab for examination. FNAB may be combined with a mammogram and physical exam. Together, these tests are 98 percent accurate in figuring out if a lump is cancerous or not.
  • Ultrasound-guided core needle biopsy. Your doctor may do this biopsy if there is doubt about the results of the FNAB. Core needle biopsy can remove one or more small cylinders of tissue from the lump for further analysis. The radiologist uses ultrasound to guide the needle. And the needle is slightly larger than the one used in FNAB.
  • Stereotactic core needle biopsy. For this procedure, you lie face down with your breast suspended through a hole on the table. The radiologist takes digital images from different angles to help find the mass. Then, the radiologist uses a small biopsy probe to remove tissue samples. The needle is slightly larger than the one used for FNAB.
  • Wire needle localization surgical biopsy. The radiologist inserts a small needle containing a wire into the area that looks suspicious. With the help of mammography or ultrasound, the doctor confirms that the needle is in exactly the right place. Then, the wire is left in place to guide the breast surgeon to the precise location for the biopsy.
  • Surgical biopsy. In some cases, surgery is required to remove part or all of the lump. There are two ways to do this. An incisional biopsy, which removes a portion of the mass. Or an excisional biopsy, which removes the entire mass.

Once the biopsy is done, the tissue is sent to a lab. There, a doctor who examines tissue samples, called a pathologist, looks at the tissue under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is.

If your breast cells were not cancerous but were not completely normal either, you may have a condition that increases your chance of getting cancer. In this case, you would need to have clinical breast exams more often.  If the breast change is cancer, your doctor will talk with you about treatment choices.

Because some of the treatment choices depend on characteristics of the cancer, additional tests may be run on your biopsy specimen to more fully analyze your cancer. This will help your doctor know what treatment to recommend.