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If Breast Cancer Is Suspected

If there is any reason to think you might have breast cancer, you may need other tests. After asking you some questions and doing a complete physical exam (including a clinical breast exam), your doctor may suggest further tests such as the ones below.

Imaging Tests

Mammography: Although mammograms are mostly used for screening, they can also be used if there is reason to think you might have breast cancer. These are called diagnostic mammograms. This kind of mammogram might show that everything is OK and you can return to having yearly mammograms. Or it might show that a biopsy should be done. Even if the mammogram doesn’t show a tumor, if you or your doctor can feel a lump you may need a biopsy. The exception would be if ultrasound (see below) shows that the lump is a cyst.

A mammogram cannot show for sure whether cancer is present or not. If your mammogram points to a possible problem, a sample of breast tissue is removed and looked at under a microscope. This is called a biopsy (see below).

Breast ultrasound: An ultrasound uses sound waves to outline a part of the body. The sound wave echoes are picked up by a computer to create an image (picture) that is displayed on the computer screen.

Ultrasound has become a good method to use along with mammograms. It is widely available and costs less than other tests. Usually, it is used to look at a certain area of concern found by the mammogram. It also helps to tell the difference between cysts and solid masses without using a needle to draw out fluid.

A ductogram (also called a galactogram) is a special kind of x-ray that is sometimes helpful in finding the cause of a nipple discharge. A fine plastic tube is placed into the opening of the duct at the nipple. A substance is injected to outline the shape of the duct on an x-ray picture. It will show if there is a mass inside the duct. If there is a discharge, the fluid can be tested for cancer cells.

There are several other tests that can help tell the doctor more about your own situation. If you will have any of these, feel free to ask your doctor to explain them to you. You can also contact the ACS for more information.

Biopsy

A biopsy is done when other tests show that you might have breast cancer. The only way to know for sure is for you to have a biopsy. During this test, cells from the breast are removed so they can be studied in the lab. There are several kinds of biopsies. The doctor will select the one best for you.

Fine needle aspiration biopsy (FNAB): A very thin needle is used in this test to try to draw fluid out of the lump. Your doctor might use ultrasound to guide the needle. The area may be numbed or not. Sometimes the process of giving the anesthetic could cause more discomfort than the biopsy itself.

If the fluid drawn out is clear, the lump is most likely a benign cyst. Bloody or cloudy fluid can mean either a cyst or, rarely, cancer. If the lump is solid, small pieces of tissue are removed. These will be looked at under a microscope to see if they are cancer.

If the biopsy does not provide a clear answer, or your doctor is still not sure, a second biopsy or a different type of biopsy may be needed.

Stereotactic core needle biopsy: The needle used for this test is larger than the one for fine needle biopsy. It is used to remove several cylinders of tissue. The biopsy is done with local anesthesia (the area is numbed) on an outpatient basis.

Surgical biopsy: Sometimes surgery is needed to remove all or part of a lump so it can be looked at under a microscope. The entire lump as well as some normal tissue around it may be removed. Most often this is done in the hospital on an outpatient basis. Local anesthesia is used and sedation may also be given to make the patient less aware of the process.

Ask your doctor which kind of biopsy you will have and what you can expect during and after the test.

Biopsy lab tests: The tissue removed during a biopsy is looked at in the lab to see whether it is benign or cancerous. If it is not cancer, then no further treatment is needed. If it is cancer, the biopsy can help to tell the type of cancer you have and show whether it is invasive or not.

The biopsy sample is also given a grade from 1 to 3. Cancers that look more like normal breast tissue tend to grow and spread more slowly. In general, a lower grade number means a slower-growing cancer, while a higher number means a faster-growing cancer. So the grade helps predict the outcome (prognosis) for the woman.

The biopsy sample can also be tested to see whether it has receptors for certain hormones such as estrogen and progesterone. If it does, it is often referred to as ER-positive or PR-positive. Such cancers tend to have a better outlook than cancers without these receptors because they are much more likely to respond to hormone treatment.

Other lab tests may also be done to help figure out how quickly the cancer is growing and what treatments might work best.

Tests to Find Breast Cancer Spread

Chest x-ray: This test may be done to see whether the cancer has spread to the lungs.

Bone scan: This test can help show whether the cancer has spread to the bones. The patient is given a very low dose of radiation. The bone attracts the radiation which will show up on the scan as a "hot spot." These hot spots could be cancer, but other problems such as arthritis can also be the cause. Therefore, x-rays of hot spots may be needed.

CT scan (computed tomography): A CT scan is a special type of x-ray. Many pictures are taken from different angles. These images are combined by a computer to produce a detailed picture of the internal organs. This test can help tell if the cancer has spread to the liver or other organs. It can also be used to guide a biopsy needle into a suspicious area.

MRI (magnetic resonance imaging): An MRI scan uses radio waves and strong magnets instead of x-rays. This test can be helpful in looking at the brain and spinal cord.

PET scan (positron emission tomography): This test uses a form of sugar that contains a radioactive atom. Cancer cells absorb high amounts of this sugar. A special camera can then spot these cells. PET is useful when the doctor thinks the cancer has spread but doesn’t know where. It may also be useful in checking lymph nodes for cancer before they are removed.

There are other tests that might be done to help the doctor decide on the best treatment for you. Feel free to ask the doctor to explain any other tests you are having.

If cancer is found there is time for you to learn about the disease. A biopsy is done first, followed by further testing and then a decision about treatment is made. You have time to talk to your doctor and family before choosing a course of action. There is no need to rush into treatment. You may also want to get a second opinion before you decide on the treatment that is best for you.


American Cancer Society website: http://www.cancer.org



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