Going to your GP
If you have changes in your breast that worry you, you usually start by seeing your GP. Your GP will examine you and if necessary refer you to a specialist breast clinic for advice or treatment.
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.
At the hospital or breast clinic
The doctor or breast care nurse will take your medical history before doing a physical examination. They will
(a) Examine your breasts
(b) Feel for any enlarged lymph nodes under your arms and at the base of your neck
After your examination, you may need some tests. The tests used to diagnose breast cancer are described below. You may have these tests on your first visit to the hospital or breast clinic. Or your nurse may arrange further appointments for you.
A mammogram is an X-ray of the breasts.
Mammography is 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. If you are under 35, your specialist is likely to suggest that you have an ultrasound instead of a mammogram. Mammography is possible in women who have had breast implants but may take a little longer.
Mammography 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. The pressure doesn’t harm the breasts.
There is detailed information about having a mammogram in the breast cancer screening section. You may also be interested in the questions for your doctor page for suggestions for questions to ask about mammography.
Breast ultrasound scans
Ultrasound scans use sound waves to make a picture of the inside of the body. Breast ultrasound is painless and takes just a few minutes. It is usually used for women under 35 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.
Ultrasound can also show if a breast lump is solid, or if it contains fluid. A fluid filled lump is called a cyst.
There is information about having an ultrasound scan in the cancer tests section.
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
1. Needle aspiration
2. Needle biopsy
3. Vacuum biopsy
4. Punch biopsy
5. Excision biopsy (surgical)
6. Wire guided biopsy
You may hear this called fine needle aspiration cytology or FNAC. You have this quick test in the outpatient clinic. The doctor uses a fine needle and syringe to take a sample of cells from the breast lump. They may also use this test to drain fluid from a benign cyst.
Needle biopsy is also called a core biopsy or Tru Cut biopsy. You may have this test under a local anaesthetic. The anaesthetic 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.
After giving you a local anaesthetic, 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 or MIBB, which stands for Minimally Invasive Breast 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 general anaesthetic. Many hospitals do this type of biopsy as a day case. In others, you may need to stay in hospital overnight.
Wire guided biopsy
A wire guided biopsy is also called a wire localisation. Doctors usually use this technique if you have calcium specks 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 area containing the calcium specks. The doctor makes sure the tip of the wire is right in the centre of the abnormal 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.
Specialised 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. Each clinic has a standard for waiting times. You can ask the breast specialist or breast care nurse when you should expect your results.