How Is Breast Cancer Diagnosed
Magnetic resonance imaging may be used to diagnose breast cancer.
Doctors often use additional tests to find or diagnose breast cancer. They may refer women to a breast specialist or a surgeon. This does not mean that she has cancer or that she needs surgery. These doctors are experts in diagnosing breast problems.
- Breast ultrasound. A machine that uses sound waves to make pictures, called sonograms, of areas inside the breast.
- Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
- Breast magnetic resonance imaging . A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
- Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies .
Ontario Breast Screening Program
The Ontario Breast Screening Program is a province-wide organized screening program that aims to reduce breast cancer mortality through regular screening. The program provides screening for most women ages 50 to 74, and for women ages 30 to 69 who are confirmed to be at high risk of developing breast cancer.
The High Risk OBSP sites help women who may be at high risk of getting breast cancer to undergo genetic assessment. To learn about the eligibility requirements for the High Risk OBSP, see Breast Cancer Screening for Women at High Risk. For women who have been confirmed to be at high risk of getting breast cancer, High Risk OBSP sites offer yearly screening mammograms and breast magnetic resonance imaging . For women with abnormal screening results, the High Risk OBSP sites coordinate follow-up breast assessments .
What Is A Clinical Breast Exam
A clinical breast exam is a physical exam done by a health care provider. Its often done during your regular medical check-up.
A CBE should be performed by a health care provider well-trained in the technique. This may be a physician, nurse practitioner or other medical staff. Not all health care providers have this training.
The National Comprehensive Cancer Network recommends a trained health care provider carefully feel your breasts, underarm and the area just below your clavicle for any changes or abnormalities, such as a lump .
The health care provider should visually check your breasts while you are sitting up and physically examine your breasts while you are lying down.
If a CBE is not offered at your check-up and you would like one, ask your health care provider to perform one .
Sources for images: National Cancer Institute and Susan G. Komen®
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What Happens When You Find A Lump
If you find a lump during a routine breast exam, call your doctor, and try not to panic. Eight out of 10 lumps are benign, which means they are not cancer. Your doctor will examine the lump and order additional testing as needed. This testing may include mammograms, ultrasounds, or a biopsy to ensure cancer is not present.
Monthly breast self-exams are your first line of defense against breast cancer. When you combine them with regular breast exams at your doctors office and mammograms, you increase your chances of catching breast cancer while its still in the beginning stages and easy to treat. Talk to your doctor if you have questions about how regular breast exams can benefit you.
Doctor Visits And Tests
Typically, you should see your doctors every 3 months for the first 2 years after treatment ends, every 6 months during years 3 through 5, and then annually for the rest of your life. Your personal schedule will depend on your diagnosis.
Get regular mammograms. If you had a total mastectomy, you only need one of the other breast. Youâll likely need a mammogram within 6 12 months after finishing your breast cancer treatment and at least annually after that.
Routine chest X-rays and blood tests in women who have no symptoms of cancer arenât always reliable. If you had chemotherapy, youâll need regular blood tests to make sure that your body has recovered from it.
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There Is A History Of Cancer In My Family How Can I Make Sure Im Getting The Screenings I Need
If theres a history of cancer in your family, you might be at a higher risk of cancer. Its important to let your doctor know about the change in your family history so they can adjust their recommendations based on your current needs.
The urgency of your next screening depends on how long it is until your next checkup. If you have a wellness visit coming up, its probably fine to wait until that appointment. You can contact your doctor to let them know youd like to add the screening to your appointment.
If you dont have a wellness visit scheduled, or if youre not due for a checkup for many months, its a good idea to schedule a screening.
What You Need To Know About Breast Exams
If youre an adult woman who isnt doing a monthly breast self-exam, you may want to start. Breast self-exams help you to familiarize yourself with the health of your breasts over time and allow you to notice lumps, thickening tissues, or any other changes that can happen. Additionally, regular clinical breast exams at your doctors office give your doctor the opportunity to catch things you may not notice during your self-exams. Women older than 40 are also encouraged to have regular mammograms to catch breast lumps long before you can feel them. When combined, breast self-exams and mammograms help to stop breast cancer in time to treat it.
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Breast Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Breast
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures that filter lymph and store white blood cells that help fightinfection and disease. Groups of lymph nodes are found near the breast in theaxilla , above thecollarbone, and in the chest.
See the following PDQ summaries for more information about breast cancer:
Screening For Breast Cancer
Screening means checking for a disease in a group of people who dont show any symptoms of the disease. Screening tests help find breast cancer before any symptoms develop. When breast cancer is found and treated early, the chances of successful treatment are better. Follow breast screening guidelines even when you feel well and healthy.
Provincial and territorial screening programs use screening mammography. A mammography is a low-dose x-ray of the breast. It is the most reliable way to find breast cancer early in women.
Women should be aware of the benefits and limitations of screening mammography based on their age and risk factors to help decide if it is right for them. Talk with your doctor to help make your decision.
If you are 40 to 49 years old, talk to your doctor about your risk for breast cancer, along with the benefits and limitations of having a mammogram.
If you are 50 to 74 years old, have a mammogram every 2 years.
If you are 75 or older, talk to your doctor about whether having a mammogram is right for you.
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Start By Visually Examining Your Breasts
- Stand or sit topless in front of a mirror with your arms limp at your sides.
- Face forward. Look at your breasts and note any dimpling, puckering of the skin, or changes in breast size, shape or symmetry.
- Note whether your nipples are inverted .
- Press down on your hips with your hands and inspect your breasts for the same things as above.
- Raise your arms over your head. Press the palms of your hands together. Examine your breasts again, using the same checklist above.
- Raise your breasts with your hands. Check to see that any ridges underneath are symmetrical.
The Harms Of Mammography Include The Following:
False-positive test results can occur.
Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result is usually followed by more tests , which also have risks.
When a breast biopsy result is abnormal, getting a second opinion from a different pathologist may confirm a correct breast cancer diagnosis.
Most abnormal test results turn out not to be cancer. False-positive results are more common in the following:
- Younger women .
- Women who have had previous breast biopsies.
- Women with a family history of breast cancer.
- Women who take hormones for menopause.
False-positive results are more likely the first time screening mammography is done than with later screenings. For every ten women who have a single mammogram, one will have a false-positive result. The chance of having a false-positive result goes up the more mammograms a woman has. Comparing a current mammogram with a past mammogram lowers the risk of a false-positive result.
The skill of the radiologist also can affect the chance of a false-positive result.
False-positive results can lead to extra testing and cause anxiety.
If a mammogram is abnormal, more tests may be done to diagnose cancer. Women can become anxious during the diagnostic testing. Even if it is a false-positive test and cancer is not diagnosed, the result can lead to anxiety anywhere from a few days to years later.
False-negative test results can delay diagnosis and treatment.
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What To Do If You Find A Lump
Dont panic if you think you feel a lump in your breast. Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign . There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.
Dont hesitate to call your doctor if youve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor. The best healthcare provider to call would be one who knows you and has done a breast exam on you before for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor.
Make sure you get answers. Its important that your doctor gives you an explanation of the cause of the lump or other breast change and, if necessary, a plan for monitoring it or treating it. If youre not comfortable with the advice of the first doctor you see, dont hesitate to get a second opinion.
Symptoms Of Breast Cancer
As youre doing breast self-exams, look for the following symptoms:
- Thick tissue or lumps the size of a pea or larger in your breast or underarm
- Nipple discharge, tenderness, or an inverted nipple
- Pitting or ridges in the skin on your breast
- Unusual changes in the shape and size of your breast
- Changes in the way your breast looks or feels
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Symptoms For Specific Types Of Cancer
Each form of breast cancer develops in a different part of the breast and can affect different types of tissue.
Since many breast cancers cause no symptoms, people should attend regular screenings. This can help identify the disease in its early stages.
Below, we outline the types of breast cancer and their symptoms.
From General Surgeon To Breast Specialist: Dr Thomas Williams Path
At an appointment with her great-grandmothers cardiologist, Dr. Thomas Williams expressed interest in pursuing medicine. The surgeon, who is still her mentor today, invited her to join him in the operating room to watch one of his procedures. From that point on, she was sold!
Initially, she intended to pursue cardiovascular surgery. However, her path took a different turn during the third year of her surgical Residency. She met a young woman who had recently had a baby and had been diagnosed with breast cancer. It floored her that someone so young could have breast cancer.
She followed that patient through her entire course of treatment, and the experience transformed Dr. Thomas Williams vision for her future. After completing her surgical Residency, she pursued her Breast Fellowship at Yale and then went into private practice.
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Breast Cancer Is The Second Leading Cause Of Death From Cancer In American Women
Women in the United States get breast cancer more than any other type of cancer except for skin cancer.
Breast cancer is more likely to occur as a woman ages. It occurs more often in White women than in Black women, but Black women die from breast cancer more often than White women.
Breast cancer rarely occurs in men. Because men with breast cancer usually have a lump that can be felt, screening tests are not likely to be helpful.
I Dont Have A Family History Of Cancer Why Do I Need A Cancer Screening
Even though a family history of cancer increases your risk, its possible for anyone to develop cancer during their lifetime. Cancer screenings are recommended because theres evidence that early diagnosis can lead to better treatment outcomes. In some cases, like with breast cancer, cancer can be cured completely if caught early.
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Whether A Woman Should Be Screened For Breast Cancer And The Screening Test To Use Depends On Certain Factors
Women with risk factors for breast cancer, such as certain changes in the BRCA1 or BRCA2 gene or certain genetic syndromes may be screened at a younger age and more often.
Women who have had radiation treatment to the chest, especially at a young age, may start routine breast cancer screening at an earlier age. The benefits and risks of mammograms and MRIs for these women have not been studied.
Breast cancer screening has not been shown to benefit the following women:
- Elderly women who, if diagnosed with breast cancer through screening, will usually die of other causes. Screening mammograms for those aged 66 to 79 years may find cancer in a very small percentage of women, but most of these cancers are low risk.
- In women with an average risk of developing breast cancer, screening mammography before age 40 has not shown any benefit.
- In women who are not expected to live for a long time and have other diseases or conditions, finding and treating early stage breast cancer may reduce their quality of life without helping them live longer.
Who Needs Hormone Receptor Testing
Hormone receptor testing is generally recommended for all breast cancers, including DCIS. If your doctor orders this test, you may be asked to discontinue taking any prescribed hormones for a period of time before the breast tissue sample is obtained. Usually, the sample comes from a biopsy, but the test may also be performed on tissue removed during a lumpectomy or mastectomy. It is standard of care however to obtain these types of pathology results on biopsy tissue.
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Stage Of Breast Cancer
When breast cancer is diagnosed, your doctors will give it a stage. The stage describes the size of the cancer and how far it has spread, and is used to predict the outlook.
Ductal carcinoma in situ is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:
- stage 1 the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
- stage 2 the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
- stage 3 the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
- stage 4 the tumour is of any size and the cancer has spread to other parts of the body
This is a simplified guide. Each stage is divided into further categories: A, B and C. If you’re not sure what stage you have, talk to your doctor.
Do Cancer Screenings Hurt
While some screenings, like lung cancer screenings, are painless, others can cause feelings of discomfort or mild pain. Doctors and nurses do their best to keep you as comfortable as possible during screenings. And its important to remember that these screenings are an important part of maintaining your overall health and helping you find peace of mind.
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