If Abnormalities Are Found, What’s Next?
Unlike screening tests, diagnostic procedures help to further characterise breast
abnormalities such as a breast lump or a spot on a mammogram or MRI. These tests
help your doctor determine the need for a biopsy and may also be used to help guide
Types of Diagnostic Procedures
Ultrasound uses sound waves to create an image of your breast on a computer screen.
By analysing this image, your doctor may be able to tell whether a lump is a cyst
or a solid mass. Cysts, which are sacs of fluid, usually aren't cancerous, although
your doctor may recommend draining the cyst.
A biopsy — a small sample of tissue removed for analysis in the laboratory — is
the only test that can tell if cancer is present. Biopsies can provide important
information about an unusual breast change and help determine whether an operation
is needed and if so, the type of operation required. Types of biopsies include:
- Fine-needle aspiration biopsy. Your doctor uses a thin, hollow needle to
withdraw tissue from the lump. He or she then sends the tissue to a lab for microscopic
analysis. The procedure takes about 30 minutes and is similar to drawing blood.
- Core needle biopsy.A radiologist or surgeon uses a hollow needle to remove
tissue samples from a breast lump. As many as 15 samples, each about the size of
a grain of rice, may be taken and then sent to a pathologist to be analysed for
malignant cells. The advantage of a core needle biopsy is that it removes more tissue
for analysis. Sometimes your radiologist or surgeon may use ultrasound to help guide
the placement of the needle.
- Stereotactic biopsy.This technique is used to sample and evaluate an area
of concern, such as micro calcification, which can be seen on a mammogram but which
cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes
a core needle biopsy, using your mammogram as a guide. Stereotactic biopsy usually
takes about an hour and is performed using local anaesthesia.
- Wire localisation. Your doctor may recommend this technique when a worrisome
lump is seen on a mammogram but can't be felt or evaluated with a stereotactic biopsy.
Using your mammogram as a guide, a thin wire is placed in your breast and the tip
guided to the lump. Wire localisation is usually performed just before a surgical
biopsy and is a way to guide the surgeon to the area to be removed and tested.
- Surgical biopsy. This remains one of the most accurate methods for determining
whether a breast change is cancerous. During this procedure, your surgeon removes
all or part of a breast lump. In general, a small lump will be completely removed
(excisional biopsy). If the lump is large, only a sample will be taken (incisional
biopsy). The surgical biopsy is generally performed on an outpatient basis in a
clinic or hospital.
- Oestrogen and progesterone receptor tests
Malignant cells removed in a biopsy can be tested for the presence of hormone receptors.
If the cancer cells have receptors for oestrogen or progesterone or both, your doctor
may recommend treatment with a drug such as Tamoxifen, which prevents oestrogen
from binding to these sites.
Staging tests determine the size and location of your cancer and whether it has
spread. They also help with treatment planning. Cancer is staged using the numbers
0 through IV
See complete explanations
of breast cancer stages
- Genetic tests
If you have a strong family history of breast cancer or other cancers, blood tests
may help identify defective genes that are being passed through the family. But
these tests are often inconclusive and should only be done in select cases after
a thorough evaluation with a genetic counsellor.
- The decision-making consultation
If you are diagnosed with breast cancer, it is imperative that you communicate effectively
with your doctors as you navigate through the series of complex decisions surrounding
your treatment options.