How is breast cancer diagnosed?

Sep 27, 2010 10:22 AM by Linda Melone, CSCS

Posted in SheKnows Cares / Breast Cancer Awareness / Diagnosis & Treatment

Getting A
Diagnosis

More than 80 percent of breast lumps are harmless, but finding one can send you into a panic. Your first step: call your primary care physician. Steps to diagnose breast cancer (or ruling it out) don't necessarily require a mammogram. Often your doctor will start with an ultrasound to determine if it's a mass or a harmless, fluid-filled cyst. If you require a mammogram, your doctor will prescribe a diagnostic mammogram, a regular mammogram that focuses on the area of concern, allowing for a magnified, more detailed look that goes beyond normal screening.

Woman getting mamogram

Analog vs. digital

A traditional analog mammogram uses an X-ray to transfer an image onto film. If you have dense breast tissue that makes it more difficult to detect changes that may indicate breast cancer, your doctor may recommend a digital mammography. Digital mammography sends the image to a computer, allowing the technician to zoom in and manipulate the image. Both use radiation and may be used for screening as well as for diagnostic purposes. If the screening detects a problem, you will then be asked to return for additional evaluations.

Non-surgical testing

Once a cyst is ruled out, the doctor will determine if the mass is a non-cancerous, benign lesion, such as a milk duct growth or a fibroid tumor. This testing as a way to diagnose breast cancer required surgery in the past, but non-surgical procedures can now be done with a needle biopsy, an in-office procedure. The doctor inserts a thin needle into the breast to obtain a small sample of cells to test for cancer. However, in some cases, samples may be difficult to obtain. Improved technology includes an MRI-guided vacuum-assisted biopsy and Breast Lesion Excision System (BLES), which removes larger pieces of tissue for a more accurate diagnosis.

Determining a plan of action

If cancer is present, the doctor may perform a breast MRI. Using radio frequency, magnetic resonance imaging produces a three-dimensional image of the breast to determine the extent of the disease. "An MRI requires an IV contrast and is the most sensitive test," says Patricia de Leon, D.O., a physician with American Radiologist Consultants in Dallas, Texas. (While it seems as if every woman would benefit from an MRI screening initially, only high-risk patients, e.g., those with the BRCA gene abnormality, normally undergo them routinely; mammograms may find breast abnormalities not found in an MRI.) This crucial step determines the treatment plan. The MRI sometimes results in a change of treatment plan from the findings on a presurgical MRI and also may help find and treat cancers that were missed earlier. Early diagnosis and prompt, targeted treatment ensures the most favorable outcome.