Breast cancer diagnosis is very important for every woman. If you have been referred to hospital with a breast lump or a change in the appearance of your breasts, then you will usually have three assessments (called a triple assessment):
- A physical examination of your breasts (and armpits) by a doctor or specialist nurse.
- Imaging of your breast by mammography and/or ultrasound.
- Testing a small sample of cells (a biopsy) taken from your breast or armpit using a needle.
The Breast Cancer Diagnosis: Triple Assessment
The use of these three tests means an accurate diagnosis can be made promptly. For women with an unusual lump that can be biopsied. There is good evidence that triple assessment gives a more accurate diagnosis than just using one or two tests. However, some patients will only need a physical examination and imaging. A biopsy is only carried out if there is an abnormal area found through physical examination or imaging.
When the three tests give the same result, it is nearly always possible to give a definitive diagnosis. Whether positive or negative, appropriate treatment can be discussed as soon as possible.
All three tests were usually carried out at the same visit to the breast unit.
This is an examination of your breasts, armpits (axillae), the area around your collarbone and your neck. Test carried out by a hospital doctor or specialist nurse. They examine breasts to find any abnormalities, including lumps or other signs or symptoms of breast cancer. And also other areas are examined to check for enlarged lymph nodes, which can be a sign of breast cancer. Lymph nodes are glands found in your leg and other areas that are part of your immune system.
This involves imaging the inside of your breasts using either a mammogram or an ultrasound examination. Some people may have both.
Note: Mammogram – An x-ray that uses very low doses of radiation.
The best method of imaging for you will depend on your age andphysical characteristics:
If you are 40 or over, they should give you two-view mammography. Although it’s carried out at two angles for each breast. Not only that additional views also be required. You may also have an ultrasound examination if your doctors think this will provide useful extra information. For example, some patients with breast implants, MRI investigation, may be helpful. This imaging is not routine for diagnostic assessment. An MRI is a scan using radio waves and a magnetic field to create images of the body.
Note: MRI – magnetic resonance imaging
If you are under 40 (or pregnant or breastfeeding), you are likely to have an ultrasound examination rather than a mammogram. This is because breast tissue in younger women and those who are pregnant or breastfeeding is often denser, making the mammogram more difficult to interpret. Any abnormalities are therefore usually picked up better by ultrasound than a mammogram. However, you may need both types of imaging and younger, pregnant or breastfeeding women can have a mammogram.
Sometimes, if your hospital doctor or specialist nurse thinks you have a benign condition (such as a cyst or fibroadenoma) based on their examination. You may be given an ultrasound examination before or instead of mammography. Ultrasound is also used to check for signs of breast cancer in the lymph nodes.
One of two techniques can be used to take a sample of cells (a biopsy) from the lump or area of abnormality in your breast and/or armpit: a core biopsy or FNA.
Note: FNA – Fine Needle Aspiration
A pathologist will examine the sample in the laboratory to determine whether it contains cancer cells. A FNA or core biopsy can be used, however, core biopsy is now more common. Either technique can be performed in an outpatient clinic, and you can go home afterward (unless you have further appointments to attend). You should have a biopsy on the same day as your other tests. Both procedures use a needle, and the results are usually available within a few days.
For a core biopsy, more than one sample is usually taken. A local anaesthetic is always given beforehand. The biopsy itself should not be painful. The anaesthetic injection may cause discomfort for a short period. Also, bruising can occur at the biopsy site. But the wound is too small and no need for stitches, and it should heal quickly.
For FNA, a thin needle used to take the sample of cells from the breast lump or abnormal area in your breast or armpit. FNA can be painful for some women. The test tends to be more painful if the needle has to be inserted relatively deep into your breast or when the needle needs to be moved around within the breast. They may offer you a local anaesthetic before FNA to reduce any pain. However, because having a local anaesthewtic can itself cause discomfort, many women choose not to have this injection.
Breast Cancer Diagnosis – Getting the results.
You will usually have an appointment within three to five working days of your tests to receive the results. No one should have to wait longer than a week for their results.
As soon as your results are available, a member of your breast care team should give them to you (but not until you are ready to hear them). When you receive your results, your doctor will explain whether you have breast cancer. And also explain the next steps for you. If any tests need to repeat or further tests are needed, this should be explained to you. Many breast care teams provide a written record for women of their results that they can refer to later.
If there is anything that you don’t understand about the terms used, ask your hospital doctor or breast care nurse to explain these to you. Most women’s results show that they don’t have breast cancer. If your results show that you do not have breast cancer, but you have any remaining concerns, problems or you notice any new changes to your breasts unusual for you, visit your GP.
If you receive a diagnosis of breast cancer, you will need and be offered some treatment.
Read our article about IORT
. One of the Radiation Therapy for Breast Cancer.