But, if during regular thorough self-examinations at home any suspicious changes are detected in either breast, a doctor should be called right away. The doctor might then order a mammogram or ultrasound to confirm or discount concern. If imaging points to the likelihood of breast cancer, the doctor will order a biopsy. All tests built data toward negative or positive breast cancer diagnosis.
A complete personal and family history will be taken to determine risk factors. If a family history of breast cancer is apparent, genetic testing for BRCA mutations will likely be advises.
The breasts will be thoroughly examined for lumps or suspicious texture, size, relationship to skin and chest muscles and nipple condition. The armpit and just above the collarbone will also be felt for indication of enlarged lymph nodes and spread of disease. A complete physical check will help judge general health.
If the doctor suspects that breast cancer is present, more procedures will be performed that include imaging tests, biopsies or both.
A mammogram takes an x-ray of the breast to look for breast changes or signs of masses. Most times, they are suggested for women every two years as part of normal gynecological screenings but also as preventative or early intervention screenings for women at higher risk for breast cancer. Screening mammograms usually take 2 x-rays of each breast. Diagnostic mammograms take a closer look with more pictures.
look of a change seen on a screening mammogram. More pictures are taken of the area that may be cancer.
An utrasound is usually the second imaging test use after a usually after a mammogram to get a closer look and discern the difference between fluid-filled cysts and solid masses. The procedure employs sonography using sound waves to outline parts of the breast that cannot be felt, but can be seen in the mammogram.
Magnetic Resonance Imaging (MRI) is another effective and a more sensitive technique to detect cancer in dense tissues. MRI has a very high negative predictive value, which helps distinguish benign tumors and malignant tumors and decrease the possibility of false negative diagnosis. It can also detect in situ lobular and ductal carcinomas, distinguishing them properly from malignant and invasive tumors. The disadvantage with MRI scans is that they lack the specificity of mammograms, which might result in false positives. The test is very expensive and intravenous injections of gadolinium, which enables better contrast images, could be harmful for patients with a history of renal diseases.
MRI is advisable for patients if
- Physical examination reveals excessive scarring and swelling of breast tissues with dimpling of breasts and irregularities in nipple structures.
- Patients with a family history of breast cancer.
- Patients who have earlier undergone breast implants.
- Metastatic tumors present in the axilla.
- Patients with a positive result for BRCA 1 and 2 mutations (highly susceptible).
- Patients with a history of breast surgeries or lumpectomies.
A biopsy is ordered when the imaging tests and the physical exam indicate that cancer is potentially present. The biopsy is the only way to confirm cancer for sure. The procedure requires taking fluid, tissue or both from the suspected area of the breast and testing it in a laboratory.
Three main techniques are applied for biopsies.
A fine needle aspiration removes fluids from a suspected cyst in the breast. Core needle biopsy is used when a large amount of suspicious tissue needs to be removed. It is done using a larger needle with a to scrape out all the suspicious tissue. A marker might be used in this regard to point out the exact location of biopsy, so that in the future, if surgery is required, the marker makes it easy to locate the target regions. This is done when the patient is under the influence of local anesthesia. Both FNA and CNB are aided by ultrasound imaging to locate the affected areas.
Surgical biopsy involves surgical removal of the affected tissue with some amount of the normal tissue known as the “margin.” The process, performed in the hospital under anesthesia, is referred to as lumpectomy, wide local excision, wide local surgical biopsy or an open biopsy.
If cancer is found, two additional typical confirmatory laboratory tests are performed.
The estrogen and progesterone receptor test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue.
The human epidermal growth factor type 2 receptor (HER2/neu) test, measures the amount of HER2/neu protein in the breast tissue cells. The protein, when present in higher amounts, indicates a more aggressive form of cancer.
Read about the stages of Breast Cancer.
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