How breast cancer in men is diagnosed

If they are not sure what the problem is, or think that cancer may be present, you’ll be referred to a specialist for advice or treatment. If they suspect you could have a cancer you should be seen at the hospital within two weeks. 

At the hospital Back to top

At the hospital the specialist will ask you about your general health and about any previous medical problems you may have had. They will examine your breast tissue and feel for enlarged lymph nodes under your arms and at the base of your neck.

Many hospitals have a special ‘one stop’ breast cancer clinic. These clinics can carry out all the tests you need and give you the results on the same day. In other hospitals it can take longer for the results to come through. Guidelines recommend that any tests you need should be carried out and the results made available within three weeks of you being seen in the clinic.

You may want to take your partner or a friend or relative with you when you go for tests or to get your results.

Tests Back to top

The following tests may be used to diagnose breast cancer. Often, two or more tests are used:

A breast x-ray (mammogram)| This is a low-dose x-ray of the breast tissue. You take off the clothes from the top part of your body. Then the radiographer positions you so that your breast tissue is against the x-ray machine and gently but firmly compressed with a flat, clear, plastic plate. Two mammograms are taken of each breast from different angles. The breast tissue needs to be squashed to keep the breast still and to get a clear picture. You may find this uncomfortable. You’ll need to stay still for a few seconds while the picture is taken.

An ultrasound uses sound waves to build up a picture of the breast tissue. It can show whether a lump is solid or is filled with fluid (a cyst). It can also show whether a solid lump is regular or irregular in shape. You’ll be asked to take off your clothes from the upper part of your body and lie down on a couch. An ultrasound specialist will then put gel onto your breast tissue and gently rub a small microphone-like device over the affected area. This produces a picture of the tissue inside your breast on a screen. Ultrasound is painless and only takes a few minutes.

Tissue sample (biopsy) Tissue is taken from the lump or abnormal area so that it can be tested for cancer. The tissue samples are sent to a laboratory to be examined by an expert in diagnosing illness by looking at tissue under a microscope (a pathologist). The breast tissue may be bruised and sore afterwards, depending on the number of biopsies taken. It can take a few weeks for the bruising to completely disappear.

There are different methods for taking tissue samples:

• Core needle biopsy In this test small samples of breast tissue are taken using a hollow ‘core’ needle. If the lump can’t be easily felt the doctor will use an ultrasound scan to guide them to the suspicious area. You will have some local anaesthetic injected into the breast tissue first. This will sting for a few seconds before numbing the area. The samples will then be taken. About 3–6 separate samples may be needed. During the biopsy there may be a little soreness or a sensation of pressure, but this should last only for a short time. You may also hear clicks from the needle and sampling instrument as the samples are taken. It usually only takes a few minutes to have a core needle biopsy. It may cause some bruising but doesn’t usually leave a scar.
• Fine needle aspiration (FNA) This is a quick, simple procedure, which is done in the outpatient clinic. Using a fine needle and syringe, the doctor takes a sample of cells from the lump and sends it to the laboratory to see if any cancer cells are present. You may feel some discomfort while this is being done. You may have some bruising and soreness in the area the sample was taken from for a week or so afterwards. If the lump is small or difficult to feel, a needle aspiration may be done in the x-ray department. The doctor uses x-ray or ultrasound guidance to make sure that the needle takes cells from the abnormal area of the breast.
• Excision biopsy This involves removing the whole lump under a general or local anaesthetic. The biopsy is then sent to a laboratory for examination under a microscope. It may involve an overnight stay in hospital, but is done as day surgery in some hospitals. It is rare to have to remove a lump to find the cause, because the needle tests are so accurate.

Blood tests Samples of your blood will be taken to check your general health, the number of cells in your blood (blood count) and to see how well your kidneys and liver are working.

Further tests Back to top

If you are diagnosed with breast cancer, your doctor may arrange for you to have some additional tests to help plan your treatment. These tests may be done to find out more about the size of the cancer and whether it has spread. This process is called staging.| Tests may include:

An ultrasound scan to check the lymph nodes in your armpit (axilla) for signs of cancer. The ultrasound operator will put gel onto your armpit and rub a small microphone-like device over it. This shows a picture of the lymph nodes in your armpit on a screen.

If any lymph nodes look abnormal on the scan your doctor may suggest taking a sample of cells from the suspicious nodes with a fine needle (fine needle aspiration). This may be done at the same time as the ultrasound or at a later date.

Fine needle aspiration of the lymph nodes Using an ultrasound to guide them the doctor places a fine needle into any node which looks enlarged and withdraws a sample of cells. You may feel some discomfort when this is done (similar to having a blood sample taken). Usually the doctor injects a local anaesthetic into the area to numb it before taking the sample. The sample is sent to a laboratory to be checked for cancer cells. If they are present the surgeon will take out all of the lymph nodes in your armpit during the operation to remove your breast cancer.

A CT scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given an injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand. You will probably be able to go home as soon as the scan is over.

An MRI scan (magnetic resonance imaging) test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan because the scanner is a powerful magnet. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, bone pins etc. You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body.

If you do have any metal in your body it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.

Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You’ll be able to hear, and speak to, the person operating the scanner.

A bone scan can be used to check the bones for signs of cancer spread. A small amount of a mildly radioactive substance is injected into a vein, usually in the arm, and is carried around the body in the bloodstream. Abnormal areas of bone absorb more of the substance than normal bone and show up on a scanner. The scan pictures are usually taken 2-3 hours after the injection.

Bone scans can’t always tell whether an abnormal area is due to cancer or other conditions such as arthritis. For this reason, more detailed scans such as CT or MRI scans may be needed.

Waiting for your test results Back to top

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.