Diagnosing breast cancer

This page tells you about the tests you may have if you have symptoms of breast cancer.

 Going to your GP

If you notice a change in your breasts that worries you, make an appointment to see your GP without delay. Most lumps and changes are benign (non-cancerous) but it is important to see your GP to be sure.

Your GP will examine your breasts to see the change and may ask you about your family history and other symptoms.

In some situations the GP may ask you to go back again in a couple of weeks’ time. This is because some non-cancerous breast tissue changes naturally disappear after a menstrual period. Waiting a couple of weeks may make you anxious. But your GP wouldn’t suggest this if there were any obvious signs of cancer.

If you have symptoms that could be due to a breast cancer your GP will refer you to a specialist breast clinic at the hospital for advice or treatment.

You will likely receive a letter in the post with your appointment details. The length of time you will have to wait for a clinic appointment will depend on the type of signs and symptoms you have presented with to your GP. Urgent referrals are seen within 2 weeks, early referrals will be seen within 6 weeks and routine referrals will be seen within 12 weeks as per the National Cancer Control Programme Guidelines. It is important for the specialist in breast care to take a full history of your signs and symptoms, to be aware of the duration of your symptoms, to carry out a breast examination of both the right and left breasts and to ask about your past medical history before deciding what tests are required in your case. Every breast center will have breast nurse specialists and you will be given the name and contact details of their service so that you can have contact with them going forward.

 At the hospital or breast clinic

Again, the doctor or breast care nurse will take your medical history before doing a physical examination. They will

  • Examine your breasts
  • Feel for any enlargedlymph nodes under your arms and at the base of your neck. This is because breast tissue extends to these areas also

After your examination, you may need some tests. The tests used to diagnose breast cancer are described below. You may have some of these tests on your first visit to the hospital or breast clinic. Your nurse will keep you informed of the next step in the process, for example, arranging further tests for you.

 

 Mammograms

diagram showing a woman having a mammogram

A mammogram is an X-ray of the breasts.

Mammograms are useful for finding early changes in the breast, when it may be difficult to feel a lump. It isn’t as helpful in younger women though or in women who are on hormone replacement therapy (HRT) because the breast tissue is denser and more difficult to find abnormalities. If you are under 35, your specialist is likely to suggest that you have an ultrasound instead of a mammogram.

If you have breast implants, it is possible to have a mammogram, but it may take longer.

Having a mammogram can be uncomfortable because the breasts are put between two metal plates and a little pressure is applied. But most women describe this as mild to moderate discomfort. It only lasts a few minutes and the pressure does not harm the breasts.

Breast ultrasound scans

Ultrasound scans use sound waves to make a picture of the inside of the body. Breast ultrasound is painless and only takes a few minutes. It is usually used for women under 35 and women on hormone replacement therapy (HRT) whose breasts are too dense or solid to give a clear picture with mammograms. You may also have an ultrasound if you have a lump in the breast that doesn’t show up on the mammogram. It is not unusual to have both mammogram and ultrasound.

Ultrasound can also show if a breast lump is solid, or if it contains fluid. A fluid filled lump is called a cyst.

 Having a biopsy

A breast biopsy means taking a small sample of cells or tissue from your breast. Your doctor sends the sample to a laboratory and a specialist doctor called a pathologist examines it under a microscope. The pathologist can see if the sample contains areas of cancer.

There are different ways of taking biopsies. These include:

  • Needle aspiration
  • Needle biopsy
  • Vacuum biopsy
  • Punch biopsy
  • Excision biopsy (surgical)
  • Wire guided biopsy

 Needle aspiration

This is also sometimes called a fine needle aspiration cytology or FNAC. You have this test in the outpatient clinic. The doctor uses a fine needle and syringe to take a sample of cells from the breast lump specifically. They may also use this test to drain fluid from a benign (non-cancerous) cyst. All tissue will be analysed and your doctor or nurse will discuss the results with you.

Needle biopsy

Needle biopsy is also called a core biopsy or Tru Cut biopsy. You usually have this test under a local anaesthetic. This numbs the area and allows the doctor to take a core of tissue from the lump using a needle that is the same thickness as a pencil lead. In this type of biopsy the pathologist can see the cells in place within the piece of breast tissue that has been removed. So it is possible to tell a non-invasive cancer (DCIS) from invasive breast cancer with this test. It can also show how abnormal the cancer cells are (the grade) and whether they have receptors for hormones or particular treatments.

Sometimes you may have this test while lying on your front or during a mammogram.

 Vacuum biopsy

After giving you a local anaesthetic to numb the area, the surgeon makes a small cut in your breast tissue. Guided by an ultrasound or X-ray, the surgeon uses a small vacuum assisted probe to take a biopsy from the suspicious area. This type of biopsy removes a slightly larger sample of breast tissue than a needle biopsy. It can sometimes cause quite a lot of bruising. It is sometimes called Mammotome biopsy or MIBB, which stands for Minimally Invasive Breast Biopsy.

 Punch biopsy

A punch biopsy is when the doctor removes a small circle of skin tissue to biopsy. You might have this type of biopsy if your doctor thinks you could have inflammatory breast cancer or Paget’s disease of the nipple.

 Excision biopsy (surgical)

Excision biopsy is also called a surgical biopsy. In this biopsy, you have a minor operation to remove the whole lump under local or general anaesthetic.

 Wire guided biopsy

A wire guided biopsy is also called a wire localisation. Doctors usually use this technique if you have calcium deposits showing up on your mammogram, but no clear lump. In these cases, the surgeon can’t really see or feel which area needs to be removed. So during a mammogram or ultrasound, the doctor puts a fine wire into the suspicious area. The doctor makes sure the tip of the wire is right in the centre of this area and then secures the wire firmly.

The wire stays in until you have your biopsy, which is usually the same day but may be the next day. Your surgeon knows that where the wire ends is where they need to take a biopsy of the tissue.

 Getting your test results

Waiting for test results is always an anxious time. It may take several working days to get the results because the hospital or clinic will need to carry out various tests on your biopsy samples.

Specialized tests to find out the type of cancer can take quite a few days to carry out. So you may have to wait longer for these results. These test results are then discussed at a Multidisciplinary Team Meeting together with your clinical presentation and examination findings and an optimal treatment plan recommended for you. This will be discussed with you at your clinic appointment.  Each clinic has a standard for waiting time. You can ask the breast specialist or breast care nurse when you should expect your results.

While you are waiting for results it may help to talk to a close friend or relative about how you feel. Or you may want to contact a cancer support group in your local area to talk to someone who has been through a similar experience.

If you have questions about the tests that you are getting or would like to speak to a nurse, you can use our free and confidential Ask the Nurse service by clicking here.