- women have the choice to get mammograms starting at age 40 to 44 unless they are at high risk
- changes in your breasts, such as lumps, dimpling, and redness may indicate abnormal tissue
- women should be familiar with how their breasts feel and look so they can report changes to their medical professional
Breast cancer starts when abnormal cells develop and grow uncontrollably in breast tissue. Early detection is critical, because the outcome varies based on the extent and stage of cancer.
If you haven’t yet started getting regularly scheduled mammograms, you should still become familiar with your breasts to detect changes and report them to your doctor.
Breast cancer research from Johns Hopkins Medical Center suggests that at least 40 percent of breast cancers are found initially by women who feel a lump during a self-exam.
Different diagnostic tests help diagnose and detect breast cancer early. Learn more about these tests here.
Imaging tests use various machines or technology to look at the breast tissue. There are different types of imaging tests, such as:
Annual mammograms are recommended for women age 45 and older, but you can begin screenings as early as 40. A mammogram is an X-ray that only takes pictures of the breasts. These images help doctors identify abnormalities in your breasts such as masses, which could indicate cancer.
Keep in mind that an abnormality on your mammogram doesn’t necessarily mean you have breast cancer, but you may need further testing.
An ultrasound is a test that uses sound waves to produce images of the inside of your body. If your mammogram detects a mass, your doctor may order an ultrasound. Your doctor may also order an ultrasound if there’s a visible lump on your breast. An ultrasounds helps determine if the lump or mass is filled with fluid or if it’s solid. A fluid-filled mass is often a benign cyst that is not cancerous. However, this is not always the case.
Some masses can be a combination of fluid and solid, which is typically benign but could require short-term follow-up imaging or a sample, depending on what the ultrasound image looks like.
To perform a breast ultrasound, your doctor places gel on your breast and uses a handheld probe to create an image of your breast tissue.
A breast MRI scan isn’t a typical screening tool for breast cancer because of its higher risk for false positives. But if you have risk factors for breast cancer, your doctor may recommend MRI screenings with your annual mammograms.
This test uses a magnet and radio waves to produce a picture of the inside of your breasts. MRI allows the doctor to view the soft tissue of breasts, and are therefore typically used for those with dense or fibrotic breasts. It is commonly used for high-risk patient screening as well.
There are several ways to perform a breast biopsy, depending on the size and location of the tumor. If the tumor is small and not suspicious, a surgeon or radiologist may conduct a needle biopsy.
The doctor performing the procedure inserts the needle into your breast and removes a sample piece of tissue. This may be done with or without imaging guidance depending on your doctor’s recommendation.
You may need a surgical biopsy in certain circumstances. This removes all or part of the lump. The surgeon may also remove any enlarged lymph nodes.
These biopsies together form the gold standard for tissue evaluation and include the following:
Fine-needle aspiration biopsy
This type of biopsy is used when the lump is solid. The doctor inserts a thin needle and extracts a tiny piece of tissue for study by a pathologist. In some cases, the doctor may want to examine a suspected cystic lumpto confirm that there is no cancer in a cyst.
Core needle biopsy
This procedure involves using a larger needle and tube to extract a sample of tissue up to the size of a pen. The needle is guided by feel, mammography, or ultrasound. If a woman has a finding best seen by mammogram, then a mammogram-guided biopsy will be done. This is also known as a stereotactic breast biopsy.
Surgical (or “open”) biopsy
For this type of biopsy, a surgeon removes part (incisional biopsy) or all (excisional biopsy, wide local excision, or lumpectomy) of a lump for evaluation under a microscope. If the lump is small or hard to locate by touch, the surgeon may use a procedure called wire localization to map out a route to the mass prior to the surgery. A wire can be inserted by ultrasound guidance or mammogram guidance.
Sentinel node biopsy
A sentinel node biopsy is a biopsy from a lymph node where cancer is most likely to spread first. In the case of breast cancer, a sentinel node biopsy is usually taken from lymph nodes in the axilla, or armpit region. This test is used to help determine the presence of cancer in the lymph nodes on the side of the breast affected by cancer.
For an image-guided biopsy, a doctor uses an imaging technique such as an ultrasound, mammogram, or MRI to create a real-time image of a suspicious area that can’t be easily seen or felt through your skin. Your doctor will use this image to help guide a needle to the best spot.
These biopsies can help your doctor determine the grade of your cancer, the tumor’s features, and how your cancer will respond to certain treatments.
After you’re diagnosed with breast cancer, the next step is identifying your stage. Knowing the stage is how your doctor determines the best course of treatment. Staging depends on the size and location of the tumor and whether it has spread outside your breast to nearby lymph nodes and other organs. The speed of growth and the likelihood that the growth will spread is another component of staging.
Cancer cells that spread to lymph nodes can travel to different parts of your body. During the staging process, your doctor may order a complete blood panel including, liver function and kidney function tests, and a mammogram of your other breast to check for signs of a tumor. A doctor may also test for breast cancer tumor markers, CA 27-29 and CA 15-3.
Your doctor may also use any of the following tests to determine the extent of your cancer and assist with diagnosis:
- Bone scan: Breast cancer can spread to the bones. A bone scan allows your doctor to check your bones for evidence of abnormalities via a radionuclide tracer.
- CT scan: This is another type of X-ray for creating detailed images of your organs using iodine contrast. Your doctor may use a CT scan to see if cancer has spread to organs outside of the breast, like your chest, lung, or stomach area.
- MRI scan: Although this imaging test isn’t a typical cancer screening tool, it’s effective for staging breast cancer. An MRI creates digital images of different parts of your body. It can help your doctor determine whether cancerous cells have spread to your spinal cord, brain, and other organs.
- PET scan: A PET scan is a unique test. Your doctor injects a dye into your vein. As the dye travels through your body, a special camera produces 3-D images of the inside of your body. This helps your doctor identify the location of tumors.
Getting a second opinion during your cancer care process is common. It’s a good idea to get your second opinion before starting treatment, because a second opinion can alter your diagnosis and thus your treatment. However, you can get a second opinion at any point during treatment.
During your cancer care, consider asking for a second opinion in these instances:
- after your pathology report is complete
- before surgery
- after your staging work is complete, if you are uncomfortable with the treatment plan your doctor recommends
- while planning treatments following surgery
- during treatment, if you believe there may be a reason to change the course of your treatment
- after completing treatment, especially if you didn’t ask for a second opinion prior to starting treatment
Genetics is a risk factor for breast cancer. Medical professionals estimate that 5%-10% of breast cancers are a result of genetics. If you are concerned about your risk for developing breast cancer, you may want to see a genetic counselor and discuss getting a genetic test.
These tests are performed by collecting blood, saliva, or a cheek scraping. If you find that you are at high risk for breast cancer, there are preventive measures you can take.
You may want to get early and frequent breast cancer screenings, make lifestyle changes such as consuming less alcohol and exercising, get preventive surgery such as a mastectomy, and more.
If your mammogram or clinical exam raises concerns, follow up with other diagnostic tests. Breast cancer is treatable, but it can also be life-threatening if not detected early.
Talk to your doctor for information on annual screening, especially if you have a personal or family history of breast cancer.