Diagnosis Explained
Breast cancer diagnosis involves a series of careful examinations and tests designed to confirm the presence of cancer, determine its type, and guide treatment decisions.
1. Initial Assessment:
People with breast symptoms such as a lump, changes in breast shape, nipple discharge, or skin changes should visit their doctor (often a General Practitioner) for a physical examination of the breasts and surrounding lymph nodes and medical history, which may include family history of breast or ovarian cancer.
If breast cancer is suspected, you will be referred to a specialist breast clinic for a more detailed assessment. Sometimes, abnormal findings in breast screening mammograms also lead to such referrals.
2. Imaging tests for detection:
Mammogram: It is the primary screening tool for early detection in women because it can find tumours that are too small to be felt. The mammogram provides detailed images that help identify suspicious areas requiring further investigation. It is quick but may cause mild discomfort due to breast compression. There are different types of mammograms, including digital and 3D mammography (digital breast tomosynthesis), which may improve detection in certain patients.
Ultrasound: Ultrasound is often used to distinguish between a solid mass (possible cancer) and a fluid-filled cyst. This is especially useful for women with dense breast tissue where mammograms may be less clear. Ultrasound is also used to guide biopsies for accurate sampling.
3. Biopsy:
This is the definitive test for diagnosing breast cancer as collecting a biopsy allows pathologists to examine the tissue microscopically to confirm cancer, identify the cancer subtype, grade (aggressiveness), and hormone receptor status. If these tests are not done patients cannot benefit from more advanced and directed treatments, which may impact survival and quality of life.
4. Additional Imaging:
If cancer is confirmed, further imaging may be performed such as MRI or CT (computed tomography) and bone scans. MRI provides detailed images to determine the tumour’s size and location and check if it has spread in the breast or to lymph nodes. CT and bone scans help assess spread (metastasis) to other organs or bones, which is key for staging and treatment planning.