Breast Cancer Diagnosis
If you notice changes to your breasts, experience symptoms of breast cancer, or have an abnormal mammogram result, your doctor will need to investigate further to make a diagnosis. Your doctor may start by performing a breast exam, which involves manually checking your breasts and armpit for lumps and abnormalities. If your doctor suspects breast cancer, they may order imaging tests to take a better look.
Imaging exams
Many breast cancers are found through routine screening exams. These are usually done with a mammogram or ultrasound.
- In a mammogram, X-ray pictures will be taken of the breasts from a few different angles. Your doctor can examine these images for signs of breast cancer.
- In an ultrasound, a device bounces high-energy sound waves off your tissue. The echo patterns create a picture referred to as a sonogram, which can be seen on the ultrasound machine.
Occasionally, doctors will use magnetic resonance imaging (MRI) or other specialized examinations.
Biopsy
If the imaging exam shows an unusual or suspicious mass or skin thickening, doctors will need a tissue sample to make a diagnosis. The process of retrieving and examining this tissue under a microscope is called a biopsy. A biopsy is the only way to definitively diagnose breast cancer.
For breast cancer, patients usually undergo an image-guided core needle biopsy. During this procedure, a live image of the breast tissue is used to help doctors guide the needle to the suspected cancer tissue. In many cases, this biopsy is performed during the initial imaging exam in order to speed up the diagnosis.
If the biopsy reveals cancerous tissue, additional images and biopsies may be needed to determine the exact scope of the disease. This part of the diagnosis shows whether the cancer has spread to nearby lymph nodes or other parts of the body.
Molecular diagnosis
If you are diagnosed with breast cancer, doctors will also analyze the cancer cells to determine the disease’s molecular receptor subtype, including HER2-positive, hormone receptor-positive and triple negative. By understanding the subtype, they can develop a comprehensive, personalized treatment plan. If you have metastatic breast cancer, you may get additional testing to help find the best targeted therapies to treat your cancer.
9 things to know about breast biopsies
Getting a breast biopsy? You might be wondering what it is and how it works.
A breast biopsy is a diagnostic procedure in which a doctor removes a small amount of breast tissue to examine under a microscope. If the tissue sample shows cancer, the physician can have it analyzed further to provide the most accurate diagnosis — a critical first step in getting patients the best treatment possible for their particular type of breast cancer.
A biopsy may be ordered when:
- a mammogram or other breast imaging, such as an ultrasound, reveals an abnormality
- you feel a lump in your breast, and/or
- your doctor notices something suspicious, such as dimpling or a change in skin texture, during a clinical exam.
We spoke with breast surgical oncologist Makesha Miggins, M.D., to learn more. Here’s what she had to say.
What are the types of breast biopsies?
There are two main types of breast biopsy:
- A surgical breast biopsy is performed by a surgeon or radiologist in an operating room. It involves making an incision in the skin.
- A needle biopsy is performed by a radiologist in an exam room or radiology suite. It is done by inserting a needle through the skin.
There are two main subtypes of breast needle biopsy:
- fine needle aspiration uses a thin, hollow needle attached to a syringe, and
- core needle biopsy uses a larger needle that removes a small, tube-shaped piece of tissue with a spring-loaded device or a vacuum-assisted device.
It’s important to pinpoint all areas of concern and pull tissue from those exact spots. That's why doctors sometimes use an ultrasound — or a mammogram or MRI, in some cases — to guide a breast needle biopsy. Mammogram-guided biopsies are also sometimes called stereotactic biopsies.
Small metallic markers called clips may be placed in your breast and left there. This allows doctors to know the exact location of a previous biopsy, in case more tissue needs to be removed for analysis.
How painful is each kind of biopsy, and how long does it take to recover?
It’s hard to say how painful a breast biopsy is. Pain is so subjective, and each patient tolerates discomfort differently.
But most patients describe the sensation they feel during a biopsy as pressure, rather than pain. And radiologists and/or technicians are always on hand during needle biopsies to make sure patients feel calm, safe and comfortable during the procedure.
Most people have a short recovery time, but it can vary depending on the amount of bleeding and/or bruising. Core needle biopsies are more likely to result in bruising than breast fine needle biopsies, and it can take several weeks for that to go away.
Your doctor can answer questions about your specific recovery time and how to take care of an area that’s been biopsied.
Do any breast biopsies require general anesthesia or an overnight stay in the hospital?
A breast needle biopsy is done with local anesthesia, so it does not require general anesthesia. That means most people can return to their normal activities as soon as a needle biopsy is over.
A surgical breast biopsy may require general anesthesia but typically won’t require an overnight hospital stay. So, if you undergo that type of biopsy, you should feel ready to resume normal activities by the next day.
How do doctors determine which biopsy is best for a particular patient?
Radiologists determine how much tissue is needed and what kind of imaging will best allow them to see it for a needle biopsy.
Surgical biopsies are only needed if an area of concern can’t be needle-biopsied or more tissue is needed to make an accurate diagnosis.
Is there ever a time when a patient should ask their doctor for a biopsy?
In most cases, you should not have to ask for a breast biopsy. Doctors only want to do one when it’s absolutely necessary. So, they will only recommend it if there’s a suspicious finding on a mammogram, ultrasound or MRI, or a concerning clinical finding.
If your scans are normal and you don’t have any worrisome symptoms, there’s no need for a biopsy.
What are the potential risks of a breast needle biopsy?
All medical procedures come with some element of risk. The most common ones following any type of breast biopsy are:
- pain
- bleeding
- infection
The risk of infection at the biopsy site is very small, and any bleeding is usually minor and resolves on its own. Pain and discomfort can normally be managed with over-the-counter pain relievers, such as Tylenol or ibuprofen.
Keep in mind that we won’t recommend a breast biopsy unless it’s really needed. So, if your doctor suggests one, you can trust that it’s because the benefits of getting a breast biopsy far outweigh the risks.
How long does a breast biopsy take?
The actual biopsy itself is very short. It only takes about a minute or so.
But first, we have to find the right area, then perform the biopsy, and then take another image to confirm that any clips we left behind are in the right place(s).
The entire process can take a couple of hours.
Why should you have your breast biopsy done at MD Anderson?
Our radiologists receive specialized training in both breast imaging techniques and how to perform breast biopsies.
Our pathologists specialize in specific diseases as well, so they are incredibly skilled at identifying abnormalities in breast tissue.
Each year, our breast radiologists perform more than 2,000 ultrasound-guided biopsies, 750 stereotactic biopsies and 250 MRI-guided breast biopsies. So, our doctors perform virtually every type of breast biopsy routinely.
MD Anderson also provides comprehensive cancer care. That means if a breast biopsy reveals cancer, our specialized team of breast surgical oncologists, medical oncologists and radiation oncologists will work together to develop a treatment plan personalized for you.
Our team approach ensures that you'll have access to any additional support services you might need, such as physical therapists, dietitians and social work counselors. So, patients who come to MD Anderson can expect to receive expert care from people who specialize in breast cancer from diagnosis to treatment and survivorship. We’re experts at every stage of cancer care.
Is there anything else readers should know about breast biopsies?
If you hear odd noises during your breast biopsy, don’t be alarmed. A loud snap or pop is usually just the needle being deployed. And a drilling sound is very common with vacuum-assisted devices.
Remember: most breast biopsies do not end in a cancer diagnosis. Between 75% and 80% of all breast biopsies turn out to be benign. That means they’re not cancerous.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Mammogram vs. breast ultrasound: What’s the difference?
Regular breast cancer screenings can detect breast cancer early when it’s easier to treat. While mammograms are considered the gold standard test for finding breast cancer, you may also get other screening tests, such as a breast ultrasound.
So, what’s the difference between a mammogram and a breast ultrasound? And when might you need both tests? Below, I’ll answer these questions and more.
Mammogram vs. breast ultrasound: How does each test work?
Mammogram and breast ultrasound are both screening tests to help detect breast cancer. But the tests work differently and look for different things.
Mammogram
A mammogram is an X-ray of the breast. We do mammograms for two reasons:
- Screening: A screening mammogram takes two X-ray views of each breast. If we see something abnormal, then we move to a diagnostic mammogram.
- Diagnosis: A diagnostic mammogram focuses more closely on the area(s) of concern. We will get more X-ray views of the concerning area. We perform a diagnostic mammogram any time a patient comes in with symptoms of breast cancer or after an abnormal screening mammogram.
Both exams can be done with breast tomosynthesis (3D mammography). This technology takes images of breast tissue to create a picture of the breast. This allows us to look at the breast tissue in more detail.
Breast ultrasound
A breast ultrasound uses sound waves that reflect off the breast tissue to create detailed images of the breast. There is no radiation involved.
When would you need a mammogram and a breast ultrasound?
You may also get a breast ultrasound if we notice something unusual on your mammogram. Normal breast tissue and cancerous tissue both appear white on a mammogram. An ultrasound can help us see small cancers that may be hiding amongst normal breast tissue because normal breast tissue and cancer are not the same color on the ultrasound image. This is especially useful for women with dense breasts, meaning they have more glandular tissue and less fat within their breasts. Breast ultrasounds can detect small tumors that may be hiding in the tissue.
Can you see breast cancer on an ultrasound?
You may get an ultrasound after a mammogram for additional screening if you have dense breasts. Sometimes, an ultrasound helps us find breast cancer that was not easily visible on a mammogram.
Would you ever need a breast ultrasound instead of a mammogram?
A breast ultrasound is not recommended as a replacement for a mammogram. This is because a mammogram is the only imaging that has been proven to save lives by screening.
Ultrasound is not as good at detecting stage 0 breast cancer. This is when breast cancer is non-invasive. We want to be able to detect breast cancer early, so it’s easier to treat.
Screening mammograms detect about 4 to 6 cases of breast cancer per 1,000 women. When a breast ultrasound is done on top of that, we detect about 2 to 3 more cases. So, breast ultrasound is a valuable screening tool we use in addition to a mammogram.
Why is it important to get screened for breast cancer?
It’s simple. Breast cancer screening saves lives. When we find cancer early, we have a greater chance of successfully treating the disease.
Women at average risk for breast cancer should get a mammogram and clinical breast exam each year, starting at age 40. Women with dense breast tissue may also need additional tests.
If you have an increased risk for breast cancer, you may need to start screening earlier, get additional tests and/or be tested more often. Talk to your doctor about what is best for you.
Ethan Cohen, M.D., is a breast radiologist at MD Anderson.
Schedule your mammogram at MD Anderson online or call 1-844-240-7092.