Breast Cancer Tests: What You Need to Know About Your Breast Health

Imaging tests

Imaging tests use various machines or technology to examine breast tissue. There are several different types of imaging tests.

Mammogram

Annual mammograms are recommended for women starting at age 40, but you have the option to wait until you’re 45. You should start getting a yearly mammogram at age 45.

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.

Learn more about breast mammogram.

Breast ultrasound

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 ultrasound 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 scanner to create an image of your breast tissue.

Learn more about breast ultrasound.

Breast MRI scan

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 it’s typically used for those with dense or fibrotic breasts. It’s also commonly used for high risk patient screening.

A breast MRI scan isn’t a typical screening tool for breast cancer because of its higher risk of false positives. But if you have risk factors for breast cancer, your doctor may recommend MRI screenings with your annual mammograms.

Learn more about breast MRI.

Biopsies

A biopsy removes a tissue sample from a lump or mass to determine whether it’s cancerous or benign. This is usually an outpatient procedure often performed in the radiology department or a surgeon’s office.

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 perform a needle biopsy.

Local anesthetic is used to numb the area before the biopsy begins. Then 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.

Very rarely, 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. It isn’t used very often anymore to diagnose cancer because the cancer cells do not have enough tissues to run receptors.

The doctor inserts a thin needle and extracts a tiny piece of tissue for a pathologist to study. In some cases, the doctor may want to examine a suspected cystic lump to confirm that there’s no cancer in the cyst.

A fine-needle aspiration biopsy can also be used to diagnose if a lymph node has cancer in it.

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
• ultrasound

If a person with breasts has a finding best seen by a 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 before the surgery. A wire can be inserted by ultrasound guidance or mammogram guidance.

A lumpectomy, however, is very rarely used now for diagnosis.

Sentinel node biopsy

A sentinel node biopsy is a removal of sentinel lymph nodes where cancer is most likely to spread first. This is used to help determine the presence of cancer in the lymph nodes on the side of the breast affected by cancer.

In the case of cancer of the breast, a sentinel node biopsy removes the sentinel lymph nodes, which are the first lymph nodes that drain the lymphatic fluid from the breast.

A doctor identifies these lymph nodes using blue dye or radioactive isotope that they inject into the breast. The dye then travels to the sentinel lymph nodes, which are located in the axilla, or armpit region.

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.

These biopsies can help your doctor determine:

• the grade of your cancer
• the tumor’s features
• how your cancer will respond to certain treatments

Tests to stage breast cancer

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.

Other components of staging include the speed of growth and the likelihood that the growth will spread. Cancer cells that spread to lymph nodes can travel to different parts of the body.

During the staging process, your doctor may order a complete blood panel, including liver and kidney function tests.

A doctor may also test for breast cancer tumor markers called CA 27-29 and CA 15-3. However, these tumor markers are only used to monitor response to treatment once a patient is metastatic (spread). They aren’t routinely used in early stage breast cancer.

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 of the chest, abdomen, or pelvis to see if cancer has spread to organs outside of the breast, like your lungs, liver, or bones.
• 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 radioactive tracer into your vein to evaluate whether the cancer has spread. Seeing where the dye spreads helps your doctor identify the location of tumors.

Learn more about breast cancer stages and grading.

Genetic tests

Genetics are risk factors for breast cancer. Medical professionals estimate that 5% to 10% of breast cancers are a result of genetics.

If you’re concerned about your risk of developing breast cancer, you may want to see a genetic counselor and discuss getting a genetic test.

These tests are performed by collecting samples of any of the following:

• blood
• saliva
• cells from inside of the cheek

If you find that you’re 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.

Learn more about genetic testing for breast cancer.

The takeaway

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 with your doctor for information on annual screening, especially if you have a personal or family history of breast cancer.