How breast cancer is diagnosed
You will usually start by seeing your GP, who will examine you. They will then refer you to a breast clinic to see a breast specialist. You should receive an appointment for the breast clinic within two weeks.
Women are referred based on guidelines produced by the National Institute for Health and Clinical Excellence (NICE). Some women are referred through the NHS Breast Screening Programme because there are changes on their mammogram.
Many hospitals have a special ‘one stop’ breast clinic, which usually means you can have tests and get the results on the same day. Sometimes, however, you may need to come back for further tests and wait up to a week for the results.
At the clinic you’ll be seen by a breast specialist (a surgeon). You’ll usually be asked if you’ve had previous breast problems or if there’s a history of breast cancer in your family.
The specialist will examine your breasts and the lymph nodes in your armpits. They will then explain which tests you need.
Tests for breast cancer
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Women usually have a mammogram and an ultrasound scan, followed by a fine needle aspiration and/or a needle (core) biopsy. These procedures are explained in detail below.
Fine needle aspiration (FNA),
Ultrasound and FNA of the lymph nodes,
Biopsy such as a needle (core) biopsy, vacuum-assisted biopsy, excision biopsy or wire localisation
A mammogram is a low-dose x-ray of the breast. You’ll be asked to take off your top and bra and be given a gown to wear before the mammogram. The radiographer (who takes the x-ray) will position you so your breast is against the x-ray machine. Your breast is then flattened and compressed with a flat, clear, plastic plate, which keeps the breast still to get a clear picture. This can be uncomfortable and a little painful, but doesn’t last long. You’ll have two mammograms of each breast taken from different angles.
Mammograms are usually only done in women over 40. Breast tissue is denser in younger women, which makes it harder to get a good picture and see any changes. Some breast units now use digital mammography. The image is taken electronically and then stored on a computer in digital form.
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. An ultrasound is more useful than a mammogram in women under 40.
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 onto your breast and moves a small hand-held device around it. A picture of the inside of the breast shows up on a screen. An ultrasound only takes a few minutes and is painless.
Fine needle aspiration
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This is a quick and simple procedure carried out in the x-ray department. The doctor uses x-ray or ultrasound guidance to make sure the cells are taken from the right area. Using a fine needle, your doctor withdraws some cells from the lump into a syringe. The sample is then sent to the laboratory to check for cancer cells.
It can be a bit uncomfortable when the needle goes in, but it’s usually over quickly. Your results may be ready on the same day. You may feel a bit bruised and sore for a few days afterwards – taking some mild painkillers should ease this.
Ultrasound and FNA 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 an FNA on the node or nodes.
This is when a small piece of tissue is removed from the lump or abnormal area and examined under a microscope.
A pathologist (a doctor who specialises in analysing cells) looks for cancerous cells in the tissue. There are different types of biopsy (see below) – your surgeon or breast care nurse will explain which type you’ll have. After a biopsy your breast can be bruised and feel sore for a few days. You can take painkillers until it eases and any bruising should go away within a couple of weeks.
Needle (core) biopsy
The doctor uses a needle to take a small piece of tissue from the lump or abnormal area. First, they will 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. Several biopsies can be taken at the same time.
Vacuum-assisted biopsy (VAB)
A special vacuum-assisted technique is sometimes used to take a biopsy. It can be done when it’s difficult to take a biopsy of the abnormal area or when a previous biopsy result isn’t clear.
The doctor numbs the area with local anaesthetic and makes a small cut in the skin. A probe is placed through the cut into the breast and guided to the correct area using a mammogram or ultrasound. When it’s in the correct position, a vacuum gently draws, cuts and collects a piece of breast tissue into a small chamber. Several biopsies can be taken from different areas without removing the probe.
Occasionally, the whole lump is removed under a general or local anaesthetic, depending on its size. If the lump is too small to be felt but has shown up on a mammogram or ultrasound, the radiologist may need to identify the area for the surgeon before the biopsy. This is done using wire localisation.
Sometimes a very small wire is guided into the area using x-ray or ultrasound. It marks the exact area that needs to be biopsied by the surgeon. Afterwards, it’s removed and the cut is covered with a small dressing (no stitches are needed).
Waiting for test results
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It may take from a few days to a couple of weeks for the results of your tests to be ready. These will show the grade and stage of the cancer. This information will be used by a team of doctors and nurses, known as the multidisciplinary team or MDT, to decide on the most appropriate treatment.
This waiting period can be an anxious time for you. You may find it helpful to talk about how you’re feeling with a partner, your family or close friends. Your breast care nurse, or another support organisation. You can also talk things over with one of our cancer support specialists on our Macmillan Support Line for free on 0808 808 00 00.
Waiting for your test results
It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. Obviously, this waiting period is an anxious time, and it may help you to talk things over with a close friend, a relative, the hospital specialist nurse or a support organisation. You can also contact one of our cancer support specialists.