Breast Cancer Detection & Diagnosis
Even though breast cancer affects far too many women, the good news is that it can be detected early. And that starts by performing breast self-exams and visiting your doctor for regular screenings. Because many women experience no breast cancer symptoms at all, regular screenings are especially important. The earlier breast cancer is detected, the easier it is to treat successfully.
During an office visit, you will have a physical exam that will include questions about your personal and family medical history. For most women over 40, your doctor will more than likely also recommend a mammogram.
Clinical Breast Exam
During an in-office breast exam, both of your breasts are checked by your doctor— usually a gynecologist. This may include raising your arms over your head, letting them hang by your sides, or pressing your hands against your hips.
In addition to looking for differences in size or shape between your breasts, your doctor will check your breasts' skin for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Your primary care physician or gynecologist will check your entire breast, underarm, and collarbone area by using the pads of their fingers to feel for lumps. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. The lymph nodes near the breast are also checked to see if they are enlarged.
If a lump is present, its size, shape, and texture will be examined. Your doctor will also check to see if the lump moves easily. Benign (noncancerous) lumps often feel different from malignant (cancerous) ones. Lumps that are soft, smooth, round, and movable are likely to be benign. On the other hand, a malignant lump is a hard, oddly shaped lump that feels firmly attached within the breast. Regardless, further tests are needed to make an accurate diagnosis.
A mammogram— an x-ray picture of tissues inside the breast— can often show a breast lump before it can be felt. They can also show a cluster of calcium specks, called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further testing is needed to find out whether abnormal cells are present.
Women should get regular screening mammograms to detect breast cancer early— even before they have symptoms. According to the American Cancer Society:
- Women between the ages 40 to 44 have the choice to start yearly mammography
- Women aged 45 to 54 are recommended to receive a mammogram every year
- Women age 55 and older can switch to having a mammogram every two years or continue yearly screening if they choose
- Women under the age of 40 who have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them
Some doctors will also recommend a baseline mammogram at age 35 so they can compare future mammograms to one when you were younger.
If the mammogram shows an abnormal area within the breast, your doctor may order clearer, more detailed images of that area. Doctors use diagnostic mammograms to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast, offering more detailed views than traditional screening mammograms.
Other Breast Cancer Diagnostic Imaging
Other imaging tests may be ordered if an abnormal area is found during a clinical breast exam or with a mammogram. These can include:
- Ultrasound: An ultrasound uses sound waves to create a picture of the breast tissue. The sound waves echo differently when bouncing off abnormal tissue and healthy tissue. An ultrasound can distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.
- MRI: An MRI uses magnetic fields to produce detailed images of the body. They are used to check for additional disease or to determine how much the cancer has grown or spread.
If an abnormal area is found during an exam or on a mammogram, you will likely need a biopsy. A biopsy is the removal of tissue to look for cancer cells. It is the only way to tell for sure if cancer is present.
Your doctor may refer you to a surgeon or breast cancer specialist for a biopsy. The surgeon or doctor will remove fluid or tissue from your breast in one of several ways:
- Fine-needle aspiration biopsy: The use of a thin needle to remove cells or fluid from a breast lump.
- Core biopsy: The use of a wide needle to remove a sample of breast tissue.
- Skin biopsy: The removal of a small sample of skin if there are skin changes on your breast.
- Surgical biopsy: The removal of a sample of tissue.
- An incisional biopsy takes a part of the lump or abnormal area.
- An excisional biopsy takes the entire lump or abnormal area.
- Image-guided biopsy: A needle is guided to the site of the abnormal growth with the help of an imaging technique, such as mammography, ultrasound, or MRI. An image-guided biopsy can be done using a fine needle or core needle (see above), depending on the amount of tissue being removed. Imaging tests may also be used to help conduct a biopsy on a lump that can be felt, to help find the best location.
- Sentinel lymph node biopsy: To determine if there is cancer in the lymph nodes near the breast, a surgeon injects a radioactive substance and/or a blue dye near the tumor to locate the position of the sentinel lymph node. Once the sentinel lymph node is found, the surgeon makes a small incision in the overlying skin and removes the node. The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy or during a follow-up surgical procedure. This procedure is usually done at the same time the primary tumor is removed. However, the procedure can also be done either before or after the removal of the cancer.
A pathologist will check the tissue or fluid removed from your breast for cancer cells. From this, the pathologist can tell what type of breast cancer it is. The most common type of breast cancer that is diagnosed is ductal carcinoma.