How breast cancer in men is diagnosed
You’ll probably begin by seeing your GP who will examine your breast tissue.
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.
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 breast tissue and the lymph nodes in your armpits. They will then explain which tests you need. You will usually have a mammogram and an ultrasound, followed by a needle (core) biopsy and/or a fine needle aspiration. These procedures are explained in detail below, along with some other tests that may be used. Often, two or more tests are used.
Breast x-ray (mammogram)
Back to top
This is a low-dose x-ray of the breast tissue. To have this x-ray, you’ll need to take the clothes off the upper part of your body.
Then the radiographer positions you so that your chest is against the x-ray machine, and the breast tissue is gently but firmly compressed with a clear, flat 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.
To have an ultrasound, you’ll be asked to take your clothes off 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. Having an ultrasound is painless and only takes a few minutes.
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) then looks for cancerous cells in the tissue. There are different types of biopsy - 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. Any bruising should go away within a couple of weeks.
Needle (core) biopsy
This is the most commonly used 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 samples can then be taken at the same time. You may have some mild pain and bruising afterwards. Your doctor can give you painkillers to help with this.
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 it’s done as day surgery in some hospitals. It’s rare to have to remove the whole lump to find the cause because the needle biopsies are so accurate.
Fine needle aspiration (FNA)
This test is only used occasionally to take a sample of a breast lump. It’s mostly used to take samples from lymph nodes. It’s a quick and simple procedure carried out in the x-ray department. Using a fine needle, the doctor withdraws some cells from the lump into a syringe. The doctor uses x-ray or ultrasound guidance to make sure the cells are taken from the right area. 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
Back to top
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 or needle (core) biopsy on the node(s).
You’ll have blood taken to check your general health, the number of cells in your blood (blood count), and how well your kidneys and liver are working. Occasionally, a blood test may be used to check whether the breast cancer cells are producing certain chemicals (tumour markers), although this isn’t usually done.
Waiting for test results
Back to top
It may take up to two weeks for the results of your tests to be ready, and a follow-up appointment will be made for you. This waiting period can often be a very anxious time and it may help you to talk things over with a relative, close friend, your specialist nurse at the hospital, or you can speak to one of our cancer support specialists.
If your tests show you have cancer
Back to top
If the tests show that you have breast cancer, you may need further tests to see exactly where the cancer is and whether it has spread (the stage of the cancer). The results of all these tests help your doctors gather as much information as possible, so they can decide on the best treatment for you.
This uses x-rays to take a picture of your chest, to check your lungs and heart.
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. 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’ve 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 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’ll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is 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 will be able to hear, and speak to, the person operating the scanner.
Some men may need other tests to check whether the cancer has spread to other parts of the body.
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 this substance than normal bone and show up on a scanner. The scan pictures are usually taken 2-3 hours after the injection.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. The scan takes 10-30 minutes and is painless. It uses 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.
This scan is done to check the liver. The person doing the scan spreads a gel onto your tummy and moves a small handheld device, which produces sound waves, over the liver area.
The sound waves are converted into a picture by a computer.