Breast Cancer Diagnosis

A breast cancer diagnosis can involve a number of different exams and/or tests. Some of these, such as breast exams and mammograms, are primarily screening tests that aim to detect breast cancer before it is outwardly obvious or symptomatic. Other types of diagnostic tests include those that are used to work up a patient after the initial detection of the tumor in the breast. These aim to further classify the type of tumor, its stage of development and other factors.

Diagnosing Breast Cancer: Screening Tests and Exams

The first identification of a breast cancer is often by a screening test or exam that helps identify the tumor in a patient without symptoms. These can include breast examinations, either performed by a nurse or doctor or by yourself as a self breast exam, as well as imaging tests that identify abnormal masses in the breast, such as a mammogram.

Physical breast examination, either by yourself or by a medical professional, can potentially identify abnormal breast masses which could be cancer. However, their sensitivity and specificity are not that great. In other words, some masses cannot be easily felt on exam and therefore can be missed. Additionally, there are frequent false positives, meaning that a mass is felt but further work-up reveals that it is benign. This is particularly true because many women have lumpy or cystic breasts that do feel like they have lumps in them, even though they are not cancer. If a mass is detected, further testing is often indicated to work it up and determine what it is. For example, a mammogram may be indicated at that time or a biopsy, either a fine needle aspiration or a surgical biopsy, may be needed to determine what the mass is.

The other common screening test done to detect abnormal masses in the breast is a mammogram. This is essentially an x-ray of the breast that aims to identify abnormal tissue which could be cancerous. This is a fairly good test for distinguishing cancer from other things and therefore is often recommended as a screening test as women get older. If you want to know if you should be doing breast exams or getting mammograms, discuss these with your own physician to get their recommendations for your particular case.

Breast Cancer Diagnosis: Further Work-Up

After an abnormal mass is identified in the breast, further testing is usually required to determine what exactly the mass is. These tests can both help to confirm that it is cancer and not some other benign lesion and they help to determine the specific type and stage of cancer.

These tests are generally various forms of biopsy which removes some tissue from the breast so that a pathologist can analyze it. The simplest of these is a need biopsy or fine needle aspiration. When a mass is identified, sometimes just sampling a few cells with a needle are enough to determine if the mass is cancer or not. In other circumstances, a more invasive biopsy may be recommended. A surgeon cuts out some or all of the mass and sends it to pathology for diagnosis. In some of these surgeries, lymph nodes in the area of the arm pit are examined and removed as well to screen for any spread (metastases) to the lymph nodes which would indicate that the cancer has spread from its original site.

Some of these more extensive surgeries act as both a breast cancer diagnosis tool, because tissue can be sent to a pathologist to determine what the tumor is, as well as a part of the treatment. In particular, if the entire lump or more is removed, this is also a treatment surgery. Depending on your specific tumor type and spread, other treatments may be required as well. These can include chemotherapy and/or radiation treatments as well as others like hormone therapy. In other words, with these types of surgeries, the line between breast cancer diagnosis and treatment gets blurred and they are part of the same thing.