How breast cancer in women is diagnosed
You will usually start by seeing your GP, who will examine you and refer you to a breast clinic to see a specialist. You should receive an appointment for the breast clinic within two weeks
Some women are referred through the NHS Breast Screening Programme because there are changes on their mammogram. Breast screening is a way of picking up breast cancer at an early stage when it’s too small to be felt or seen.
Many hospitals have a special ‘one stop’ breast clinic. This means you might be able to have tests and sometimes get results on the same day. But often you need to wait up to a week for the results or need to come back for further tests.
At the clinic, you’ll see a specialist breast doctor. You may also see a specialist breast nurse or advanced nurse practitioner.
They usually ask you if you’ve had any other breast problems or if anyone in your family has had breast cancer.
The doctor will examine your breast, and the lymph nodes in your armpits and around your neck. After this, they’ll explain which tests you need.
A mammogram is a low-dose x-ray of the breast. You’ll need to take off your top and bra for the mammogram.
The radiographer will position you so that your breast is against the x-ray machine and is gently but firmly compressed with a flat, clear, plastic plate. You’ll have two mammograms of each breast taken from different angles.
The breast tissue needs to be squashed to keep the breast still and to get a clear picture. Most women find this uncomfortable, and for some women it’s painful for a short time.
Mammograms are usually only used in women over the age of 35. In younger women, the breast tissue is more dense (has less fat), which makes it difficult to detect any changes on the mammogram.
An ultrasound uses sound waves to build up a picture of the breast. It can show if a lump is solid (made of cells) or is a fluid-filled cyst.
You’ll be asked to take off your top and bra, and lie down on a couch with your arm above your head. The person doing the scan puts a gel on to your breast and moves a small hand-held device around the area. A picture of the inside of the breast shows up on a screen. An ultrasound only takes a few minutes and is painless.
Ultrasound of the lymph nodes
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You’ll also have an ultrasound of the lymph nodes in the armpit. If any of the nodes feel swollen or look abnormal on the ultrasound, the doctor will do a fine needle aspiration on the node or nodes.
This is when the doctor removes a small piece of tissue or cells from the lump or abnormal area. A pathologist (doctor who specialises in analysing cells) examines the tissue or cells under a microscope to look for cancer cells.
There are different ways of taking a biopsy. Your doctor or nurse will explain the type you will have.
For a few days after the biopsy, your breast may feel sore and bruised. Taking painkillers will help with this and any bruising will go away in a couple of weeks.
Needle (core) biopsy
This is the most common type of biopsy. It’s a quick test where the doctor uses a needle to take small pieces of tissue from the lump or abnormal area. Before taking the biopsy, they inject some local anaesthetic into the area to numb it. You may feel a little pain or a sensation of pressure for a short time during the biopsy.
Fine needle aspiration (FNA)
This is a quick, simple test. The doctor puts a very fine needle into the area and withdraws a sample of cells into a syringe.
Vacuum-assisted biopsy (VAB)
This is a way of taking needle biopsies using a vacuum-assisted method.
The doctor gives you an injection of local anaesthetic into the skin to numb the area. They then make a small cut and insert a needle through it into the breast. A mammogram or ultrasound picture helps them guide the needle to the correct area. The doctor uses the vacuum to gently withdraw a piece of breast tissue into a small collecting chamber. They can take several biopsies without needing to remove the needle and put it in again.
Occasionally, the doctor makes a cut in the skin of the breast and removes the lump or abnormal area. This is done under a general or local anaesthetic, depending on the size of the lump. Usually, you have stitches that dissolve and don’t need to be removed.
Sometimes, an x-ray or ultrasound is used to guide a fine wire into the breast to mark exactly where the surgeon should take the biopsy. This is usually when an abnormal area shows on a mammogram or a lump is too small for the doctor to feel.
The surgeon removes the wire when the excision biopsy is done.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse can also provide support. You can also talk things over with us. You can also search for support organisations on our website.