Tests for breast cancer
Checking for breast cancer usually involves a number of tests. The tests you have depend on your specific situation.
Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a health professional, or call 13 11 20.
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A mammogram is a low-dose x-ray of the breast tissue. It can check any lump or other breast changes found during a physical examination. It can also show changes that are small or can’t be felt during a physical examination. If you have breast implants, it’s important to let staff know before you have the mammogram.
Your breast is placed between two x-ray plates. The plates press together firmly for a few moments to spread the breast tissue out so that clear pictures can be taken. You will feel some pressure, which can be uncomfortable. Both breasts will be checked.
Also known as three-dimensional mammography or digital breast tomosynthesis (DBT), tomosynthesis takes x-rays of the breast from many angles and uses a computer to combine them into a three-dimensional (3D) image. Tomosynthesis may be better for finding small breast cancers, particularly in dense breast tissue.
An ultrasound uses soundwaves to create a picture of breast tissue. It is often done if a mammogram picks up breast changes, or if you or your GP can feel a lump.
The person doing the ultrasound will spread gel on your breast, and then move a small device called a transducer over the breast area and armpit. This sends out soundwaves that echo when they meet something dense, like an organ or a tumour. A computer creates a picture from these echoes. The scan is painless and takes 15–20 minutes.
A magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to create pictures of the breast tissue on a computer. Breast MRI is mainly used for people who are at high risk of breast cancer or who have very dense breast tissue or breast implants. It may also be used if other imaging test results are not clear or to help plan breast surgery.
Before the MRI, you will usually have an injection of a contrast dye to make any cancerous breast tissue easier to see. You will lie face down on a table with cushioned openings for your breasts. The table slides into a large machine, shaped like a cylinder. The scan can take 30–40 minutes. It is painless but loud, so you’ll wear earplugs. Some people feel claustrophobic. If you think you may feel anxious, speak to your doctor before the appointment. You may be offered a mild sedative.
A national program gives free access to breast cancer screening tests for all women over 40. Call 13 20 50 or see the Government’s BreastScreen Australia Program.
If breast cancer is suspected, a small sample of cells or tissue is taken from the lump or area of concern. A specialist doctor called a pathologist checks the sample under a microscope for any cancer cells.
There are different ways of taking a biopsy and you may need more than one type. The biopsy may be done in a specialist’s rooms, at a radiology practice, in hospital or at a breast clinic. Bruising and soreness to your breast is common after any type of biopsy.
Core biopsy – The piece of tissue (a core) is removed with a needle. Local anaesthetic is used to numb the area, and a mammogram, ultrasound or MRI scan is used to guide the needle into place.
Vacuum-assisted core biopsy – A needle attached to a suction-type instrument is inserted into a small cut in the breast. A larger amount of tissue is removed with a vacuum biopsy, making it more accurate in some situations. The needle is usually guided into place with a mammogram, ultrasound or MRI. This biopsy is done under a local anaesthetic, but you may feel some discomfort.
Fine needle aspiration (FNA) – A thin needle is inserted into an abnormal lymph node or other tissue, often with an ultrasound to help guide the needle into place. A local anaesthetic may be used to numb the area where the needle is inserted.
Surgical biopsy – If a needle biopsy is not possible, or if the biopsy result doesn’t provide a clear diagnosis, you may have a surgical biopsy to remove all or part of a lump. A wire or other device is inserted to act as a guide during the surgery, and then the tissue is removed under general anaesthetic. This is usually done as day surgery.
If the above tests show that you have breast cancer, you may have further tests to check whether the cancer has spread to other parts of your body. Not everyone will need all these tests.
Blood tests – A blood sample may be taken to check your general health, bone marrow and liver function, and to test for specific tumour markers.
Bone scan – A bone scan may be done to see if the breast cancer has spread to your bones. A small amount of radioactive material is injected into a vein, usually in your arm. This material is attracted to abnormal areas of the bone. After a few hours, the bones are viewed with a scanning machine, which sends images to a computer. A bone scan is painless and the radioactive material is not harmful. You should drink plenty of fluids the day of the test and the day after it.
CT scan – A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of the body. It looks for signs that the cancer has spread. Before the scan, you will be given an injection of dye into a vein in your arm. This dye, called contrast, makes the pictures clearer. For the scan, you lie flat on a table while the CT scanner, which is a large doughnut shape, takes pictures. It is painless and takes about half an hour.
PET scan – In a PET (positron emission tomography) scan, a small amount of low-level radioactive solution is injected into a vein in the arm or hand. Any cancerous areas take up more of the radioactive solution and show up brighter in the scan.
Before a scan, tell the doctor if you have any allergies or had a reaction to dyes during previous scans. Also tell them if you have diabetes or kidney disease or are pregnant or breastfeeding.
Podcast: Tests and Cancer
A/Prof Elisabeth Elder, Specialist Breast Surgeon, Westmead Breast Cancer Institute and The University of Sydney, NSW; Collette Butler, Clinical Nurse Consultant and McGrath Breast Care Nurse, Cancer Support Centre, Launceston, TAS; Tania Cercone, Consumer; Kate Cox, 13 11 20 Consultant, Cancer Council SA; Dr Marcus Dreosti, Radiation Oncologist and Medical Director, GenesisCare, SA; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Dr Hilda High, Genetic Oncologist, Sydney Cancer Genetics, NSW; Prof David W Kissane AC, Chair of Palliative Medicine Research, The University of Notre Dame Australia, and St Vincent’s Hospital Sydney, NSW; Prof Sherene Loi, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr W Kevin Patterson, Medical Oncologist, Adelaide Oncology and Haematology, SA; Angela Thomas, Consumer; Iwa Yeung, Physiotherapist, Princess Alexandra Hospital, QLD.
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