Making the Diagnosis?
There are two ways of meeting
difficulties. You alter the difficulties
or you alter yourself to meet them.
— Phyllis Bottome
At the present time, finding
breast cancer early is the best way to increase
the chances of surviving the disease. Cancer
found early can usually be treated successfully.
Mammography, clinical breast examination
and breast self-examination are three methods
that are used to detect breast cancer early.
These methods are described in Who’s
at Risk and What Can You Do on page 14. However,
those methods alone cannot diagnose breast
Other tests, such as ultrasound
and MRI, are used to get a clearer picture
of a breast lump or problem. If required,
biopsies are used to find out whether a breast
lump is benign (not cancer) or malignant
(cancer). The only definite way to tell if
breast cancer is present is with a biopsy.
Does breast cancer start as a lump in the
Sometimes, but not always.
Breast cancer can cause the following symptoms:
change in how the breast or nipple
- A lump or thickening in or near the
breast, or in the underarm area
- A change in how the breast
or nipple looks
- A change in the size or
shape of the breast
- The nipple or skin
is turned inward into the breast
- The skin
of the breast, areola or nipple may be
scaly, red or swollen. It may have ridges
or pitting so that it looks like the
skin of an orange.
- Nipple discharge
Can breast cancer cause breast
In most cases, early breast cancer does
not cause pain. However, see your doctor
or healthcare provider about breast pain or any other symptom
that does not go away.Most often,
these symptoms are not cancer, but it is important to see
your doctor so that any problems
can be checked and treated as early as possible.
Mammograms - A New Kind of Mammogram
Digital mammography takes electronic
pictures of the breast and stores them
on a computer (regular mammograms are
created directly on film). A recent,
large, clinical trial found that digital
mammograms are better than regular
- women with dense
- women who haven’t
gone through menopause or who just
stopped having periods, and
- women who are younger
than age 50.
However, digital mammograms are
not widely available yet, and the
equipment costs much more than regular
mammograms. If you have questions
about mammograms, ask your doctor.
What do I do if I have
a lump or some other change in my breast?
your doctor. Your doctor can find out whether the lump is benign
or something more serious, such as
breast cancer. The doctor may want
to do a physical exam, and may ask
for your personal and family medical
history. Most likely, you will need
a diagnostic mammogram and an ultrasound.
A radiologist (a doctor who
reads mammograms) will read the mammogram
result and decide if you need further tests.
In some cases, no further tests are needed,
and no treatment is necessary. However,
often a radiologist cannot say for
sure whether the lump is or is not
cancer based on the mammogram alone.
breast lumps that are biopsied are
not cancer. Many of these lumps are
harmless changes of normal tissue.
Others may indicate a condition that
other breast “imaging” tests
are sometimes used along
with a mammogram:
is a painless test using high-frequency sound
waves. A handheld probe is pressed
against the breast to show whether
a lump is a fluid-filled cyst (not
cancer) or solid tissue (may or
may not be cancer).
Resonance Imaging (MRI). A powerful
magnet linked to a computer is used to
make detailed pictures of tissue inside
the breast. MRIs do not use X-rays. Dye
is injected into a vein, and the patient
lies on her stomach with her breast in
a special “breast
coil.” Then, the
patient is moved in and
out of a narrow tube.
is expensive and only available
in certain areas. It is
used in special cases,
such as checking younger
women at very high risk for
breast cancer, finding a
lump that can be felt but
seen by mammograms or ultrasound,
or seeing the difference between
breast scar tissue and a possible cancer.
to Ask Your Doctor
Adapted from What You Need to Know
About Breast Cancer,
National Cancer Institute,
800.4.CANCER or www.cancer.gov.
- What type
of biopsy do you recommend?
- How long will it take? Will I
be awake? Will it hurt? Will I
have anesthesia to numb the breast
(local) or anesthesia to put me to
- How soon will I know the results?
there any risks? What are the chances
of infection or bleeding after
- If I do have cancer, who
will talk with me about treatment options? And when?
OTHER DIAGNOSTIC TOOLS FOR
Breast images alone (such as
mammograms, ultrasound, MRI) are helpful,
but they are often not enough to tell for
sure whether a lump is benign or whether
it is cancer. A doctor must remove fluid
or tissue from the breast to learn whether
cancer is present. This is called a biopsy.
A diagnosis of breast cancer can only be
made after seeing cancer cells in biopsied
breast tissue under a microscope.
can remove tissue from the breast in several
doctor uses a thin needle to remove fluid
and/or cells from the breast lump. Depending
on what the sample looks like, it may or
may not go to the lab where a pathologist
looks at it with a microscope to check
for cancer cells.
doctor uses a thicker needle to remove
tiny samples of tissue from the breast
lump. The tissue is sent to a lab to
check for cancer cells. The doctor may first
numb your breast in the area of the lump.
biopsy. In an incisional biopsy,
the surgeon removes a small sample of
the lump. In an excisional biopsy, the
surgeon removes the entire lump and some
surrounding tissue. In either biopsy,
the tissue is sent to a lab to check
for cancer cells.
Sometimes a lump that
is found on a mammogram cannot be felt
by you or your doctor. In these cases,
the doctor can use different methods
to help locate the lump in order to get
a sample of the breast tissue. These
doctor uses a special biopsy needle, directed
by a mammogram machine, to take a tissue
sample. The area is first numbed well before
inserting the biopsy needle. A small cut
that does not require stitches is made
for this biopsy. Using this method, a generous
sample of tissue can be removed without
is the same type of biopsy as stereotactic
biopsy, except that ultrasound is used
to guide the biopsy needle instead
of a mammogram machine.
biopsy. A radiologist places a
very thin wire (about the size of a thick
strand of hair) into the lump, which
has been located using mammogram or ultrasound,
whichever method finds the area best.
A surgeon then performs an excisional biopsy.
Not all breast cancer involves a lump. Inflammatory breast cancer (IBC)
is an aggressive form of breast cancer that usually grows in sheets rather
than a solid tumor. It can spread throughout the breast without a detectable
Symptoms are similar
to those of mastitis, a benign breast
infection. IBC is frequently misdiagnosed.
For more information, see the Advanced
Breast Cancer chapter on page 66.
is a PET scan?
PET (positron emission tomography)
imaging is a diagnostic exam that takes
pictures of biological changes in your
body. A PET image can help tell your
doctor whether a tumor is benign or
malignant, and if cancer has spread
to other parts of your body. It can
also be used to examine the effects
of cancer therapy by looking at biochemical
changes in the cancer. A radiologist
specially trained in PET interprets
the results of your scan and provides
them to your doctor. PET scans can
be more valuable when they are part
of a larger diagnostic work-up, such
as comparing the PET scan with other
diagnostic imaging studies (CT scan
On the path to diagnosis,
or when having any kind of medical tests,
it is highly recommended that you ask
questions to help you understand why
a test is being done and what it will
tell you and your doctor. The more informed
you are, the better you will feel about
making decisions for treatment, if
Advances in breast cancer diagnosis
and treatment are constantly being
made. One interesting new breakthrough
is the Oncotype DX™ lab test.
It is ordered by doctors for certain
women with early stage breast cancer.
The test analyzes 21 genes in tumor
tissue and is used to predict
how an individual’s
cancer is likely to behave
in the future. This helps doctors tailor
treatment to the individual patient.
in this section was gathered, in
part, from National Cancer Institute
educational publications (800.4.CANCER or www.cancer.gov.)
American Cancer Society (ACS)
800.ACS.2345 or 866.228.4327 (TTY)
Provides information and services for all
forms of cancer, diagnosis, treatment and
many other topics. Has free booklets relating
to breast cancer, including mammography,
biopsies, and talking with your doctor.
American College of Radiology (ACR)
703.648.8900 or 800.227.5463
Provides information about mammography
and other tests used to detect breast cancer.
Has informational materials about breast
cancer, breast lumps, breast pain and breast
discharge available as books and teaching
Cancer Information Service
800.4.CANCER (800.422.6237) or 800.332.8615
One of the best resources available for
cancer patients, this government organization
provides the toll-free hotline above in
English and Spanish, and booklets to answer
questions about any type of cancer, including
breast cancer, mammograms, breast changes
and other topics.
Susan G. Komen Breast Cancer Foundation
This foundation for breast cancer research,
education, screening and treatment has
a toll-free helpline
(above) and booklets for callers with breast
Y-ME National Breast Cancer Organization
312.986.8338 or 800.221.2141
Y-ME offers breast cancer education, support
and a national 24-hour toll-free breast
cancer information hotline. Free information
includes,“Understanding Your Pathology
Books and More
Bosom Buddies: Lessons and Laughter on
Breast Health and Cancer,
by Rosie O’Donnell
and Deborah Axelrod, MD, FACS, with Tracy
Chutorian Semier (1999).
about breast health and breast cancer
in an easy-to-read and lighthearted manner.
Breast Book, 4th rev. ed.,
by Susan M.
Love, MD, with Karen Lindsey (2005).
Discusses all conditions of the breast,
including breast cancer. An excellent
The Breast Book,
by Miriam Stoppard, MD
guide to breast care provides women with
useful information about all stages of
the disease, with particular emphasis on
early detection and treatment of breast
The Complete Book of Breast Care,
H. Lauersen, MD, PhD, and Eileen Stukane
A good general reference on the
breasts covering everything from exercise
and nutrition through treatment and research.
Working With Your Doctor: Getting the
Healthcare You Deserve (Patient-Centered
by Nancy Keene (1998).
how to get the most out of your relationship
with your doctor and how to be an active
participant in your healthcare with many
examples from patients and doctors.
Biopsy Report: A Patient’s
Has information on types of biopsies, procedures
and a glossary of pathology terms.
This web site has comprehensive information
about prevention, BSE, mammography, diagnostic
tests, treatment and many other issues.
Information is written by oncology doctors
Breast Cancer: Help Me Understand It!
Written by a physician who had breast cancer
to clarify information about breast cancer
and to help women make choices about treatment.
Public information site designed to anser
questions related to many radiologic procedures
and therapies available. Developed jointly
by the American College of Radiology and
the Radiological Society of North America.