Diagnosis Of Breast Cancer

How is Breast Cancer Diagnosed?

Diagnosis of breast cancer is different from breast cancer screening. Screening is performed to detect breast abnormality (breast cancer) in its pre symptomatic phase , whereas diagnosis is performed to confirm whether an abnormality that has already been detected, is cancerous or not. Contrary to popular opinion, an abnormal finding on a screening mammogram or the self-discovery of a lump or other breast changes does not necessarily confirm that someone has breast cancer.

There is only one way to confirm if an abnormality in the breast is cancerous; through breast tissue biopsy and histopathological examination.

What are the steps involved in the diagnosis of breast cancer?

In our articles on breast cancer screening, we have examined the following types of imaging tests that help doctors detect an early abnormality, in the absence of symptoms:

Clinical breast examination:

A doctor will check both of your breasts and lymph nodes in your underarm area, to feel for lumps or other abnormalities.

Screening mammogram:

A mammogram is an X-ray picture of the breast. It is commonly used in breast cancer screening. If an abnormality is seen during a screening mammogram, doctors generally recommend a diagnostic mammogram to further inspect the problem.

Breast MRI:

MRI scan of the breast is usually recommended for patients who exhibit doubtful lesions or multiple small lesions seen on breast mammograms, and for women with high risk genes (BRCA 1/2).

After the detection of abnormalities, either during routine screening or during a doctor-advised checkup, the following tests are usually performed to further diagnose and confirm breast cancer. Please note that the diagnosis remains incomplete without a breast biopsy.

Further diagnostic testing:

Diagnostic mammogram

This is an advanced form of a mammogram. To generate this image, the patient’s breasts are put, one at a time, between two special plates and compressed (pressed down) between these plates by an X-ray machine momentarily, while the X-rays are taken. A minimum of two views of each breast are taken.

Both the mammography and the compression are performed by a specially trained radiographer (medical imaging technologist). While the compression might be uncomfortable for some women and sometimes painful, it lasts only for a few seconds. Without compression, the diagnostic mammogram X-rays can become blurry, which makes it hard to confirm the nature of any abnormality. The act of compression also reduces the total amount of radiation needed for a diagnostic mammogram.

Breast ultrasonography (USG)

This process uses sound waves to render images of structures deep within the breast area. Ultrasound technology can be used to confirm whether a new breast lump is actually a solid mass (potentially cancerous) or just a fluid-filled cyst. Breast USG is helpful in young females with dense breasts.

Breast biopsy

This is the gold standard test for confirming breast cancer. After all abnormalities found through either self exams or screening are inspected using various scans, if a doctor suspects the presence of cancer, a biopsy is advised. During a breast biopsy, doctors use a special needle to extract a piece of tissue from the area of concern. Sometimes during a breast biopsy, a small metal marker is left at the site of suspicion within the breast, so that the area can be easily identified later for future imaging investigations.

Biopsy samples (tissue samples extracted during a biopsy) are then sent to a laboratory for a thorough analysis, where experts determine whether the cells in that tissue sample are cancerous. A biopsy sample can also help to find out the aggressiveness of breast cancer, and to understand whether hormone receptors are present in a specific patient.

A biopsy is also the first step towards establishing the overall disease prognosis. This information will help any oncologist (medical, radiation and surgical oncology experts) to determine the best course of treatment.

Breast Cancer Screening And Self Examination

How to check for breast cancer by yourself?

Breast cancer screening refers to the process of looking for breast cancer before the symptoms are experienced. This facilitates early detection and timely treatment. If abnormal tissue or cancerous growth is detected early, it becomes easier to treat. The disadvantage of not screening regularly for breast cancer is that by the time the symptoms are seen or felt, the cancer may have already progressed to an advanced stage. An advanced stage involves the spread of the cancer from the primary site to another site within the body.

Breast cancer screening methods have begun to evolve. Scientists are trying to develop a better understanding of the genetic profile of women who are more susceptible to experiencing the symptoms at a later stage than earlier. Researchers are also in the process of studying different consumption and lifestyle behaviors to figure out if these contribute to cancer risk, and if a certain risk category of women should be screened earlier, and to establish screening frequencies best suited for different women.

What is the difference between breast cancer screening and breast cancer diagnosis?

Please note, that when a doctor recommends you to get screened, they do not necessarily think that you have breast cancer. Screening tests (including routine screening mammograms) are generally administered in the absence of symptoms and after a particular age.

When screening tests yield abnormal results, further testing becomes necessary in order to probe better and confirm the presence of cancer – those are called diagnostic tests (biopsies, other imaging modalities etc).

How is breast cancer screened?

There are two established, scientific methods of breast cancer screening: mammography and breast MRIs.

What is mammography?

Mammography refers to the process of creating a mammogram, or an X-ray image of the breasts. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if someone discovers a lump in the breast or experiences any other symptoms of breast cancer. Mammography is recommended for women who are at standard risk or at high risk for breast cancer.

What is a breast MRI?

Magnetic resonance imaging (MRI) of the breast uses a powerful magnetic field, radio waves, and a computer that can produce detailed pictures of the internal structures within the breast. It is used as a supplemental breast screening tool along with mammography. It can be used to screen women who are considered to be at high risk for breast cancer, or to screen women with dense breast, or to further examine abnormalities observed during routine mammography.

How frequently should one get screened for breast cancer?

Most medical organizations, government advisory panels, breast cancer advocacy groups and cancer research organizations such as the National Cancer Institute, American Cancer Society, Breast Cancer Foundation, NHS (United Kingdom), and American Institute of Cancer Research urge elderly to undergo regular screening to detect breast cancer early.

According to the NCCN (National Comprehensive Cancer Network), which is an alliance of the most advanced cancer care centers, all women above the age of 40 should go for annual screenings (mammograms).

After a woman has attained the age of 55, they should either continue annual mammograms, or switch to one mammography test every two years. Women aged above 75 have the option of discontinuing annual/biannual mammograms at their own discretion.

It is also recommended that women who have been identified to be at higher risk for breast cancer, owing to either genetic predisposition or sporadic factors, should start screening as early as the age of 30. This includes women with a known breast cancer gene mutation, or those with a first degree relative who has inherited a breast cancer gene mutation.