Breast cancer starts when abnormal cells develop and grow uncontrollably in breast tissue. The outcome is different for each woman, so early detection is critical.

The American College of Physicians recommends that women between the ages of 40 and 49 speak to their doctor about whether to start getting mammograms before the age of 50. They also recommend that women of average risk of breast cancer between the ages of 50 and 74 get screened every other year.

The American Cancer Society outlines slightly different recommendations for breast cancer screenings, with annual mammograms beginning at age 45 (or sooner if you have a family history of breast cancer).

If you’re a younger woman who hasn’t yet started getting regularly scheduled mammograms, it’s still important to become familiar with your breasts so that you can detect any changes in them and report them to your doctor.

This can aid you in being aware of lumps, dimpling, an inverted nipple, redness, and other changes to your breasts. Your doctor may also conduct a clinical breast examination at annual checkups.

Different diagnostic tests help to diagnose and detect breast cancer early. Read on to learn more about these tests.

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 to further characterize the mass. Your doctor may also order an ultrasound if there’s a visible lump on your breast.

Ultrasounds help doctors determine whether a lump or mass is a fluid or a solid. A fluid-filled mass indicates a cyst, which is noncancerous.

Some masses can be a combination of fluid and solid, which is typically benign but could require short-term follow-up imaging or even 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 biopsy removes a sample of tissue from a lump or mass to determine whether it’s cancerous or benign. This is usually an outpatient surgical procedure.

There are several ways to perform a breast biopsy, depending on the size of the tumor. If the tumor is small and not very 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:

  • Fine-needle aspiration biopsy: This type of biopsy is used when the lump is solid. The doctor inserts a thin needle and retracts a tiny piece of tissue for study by a pathologist. In some cases, the doctor may want to examine a suspected cystic lump to 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.
  • Image-guided biopsy: 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 for collecting suspicious cells.

Analysis of 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.

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, as a precaution 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.

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 of the tumor and whether it has spread outside your breast.

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 count and perform a mammogram of your other breast to check for signs of a tumor.

Your doctor may also use any of the following tests to determine the extent of your cancer as well as to assist with diagnosis:

  • Bone scan: Metastasized cancer can spread to the bones. A bone scan allows your doctor to check your bones for evidence of cancerous cells.
  • CT scan: This is another type of X-ray for creating detailed images of your organs. 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 very 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 your treatment.

During your cancer care, consider asking for a second opinion in these instances:

  • after your pathology report is complete
  • before surgery
  • 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

If your mammogram or clinical examination raises concerns, make sure you 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.