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 a lump or other change found by the physical examination. It can also show changes that can’t be felt during a physical examination.
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. If you have breast implants, let staff know before you have the mammogram.
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 image. This form of breast imaging may be more accurate in some situations such as finding small breast cancers, particularly in dense breast tissue.
An ultrasound uses soundwaves to create a picture of breast tissue. It will often be done if a mammogram picks up breast changes, or if you or your GP can feel a lump.
The person performing the ultrasound will spread a gel on your breast, and then move a small device called a transducer over the area and the lymph nodes in your 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 about 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 implants. It may also be used if imaging tests results are not clear and to help plan breast surgery.
Before a breast MRI, you will 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 the machine, which is large and shaped like a cylinder. The scan may take 30–40 minutes. It is painless but can be noisy. You will usually be offered earplugs or headphones to listen to music.
Some people feel anxious or claustrophobic in the cylinder. If you think you may become distressed, mention it beforehand to your medical team. You may be given a mild sedative to help you relax.
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 examines the sample and checks it for cancer cells under a microscope.
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 to your breast is common after any type of biopsy.
If tests on the biopsy sample show that it is breast cancer, extra tests will be done.
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.
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 found on a screening mammogram or other imaging technique. 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.
Samples may be taken to check your general health, and to look at your bone marrow and liver function for signs of cancer.
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 areas of bone where there is cancer. After a few hours, the bones are viewed with a scanning machine, which sends pictures to a computer. A bone scan is painless and the radioactive material is not harmful. You should drink plenty of fluids on the day of the test and the day after.
A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of the body. It is used to look 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, known as contrast, makes the pictures clearer. For the scan, you will lie flat on a table while the CT scanner, which is large and shaped like a doughnut, takes pictures. This painless test takes 30–40 minutes.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you are diabetic, have kidney disease or are pregnant.
Podcast: Tests and Cancer
Prof Bruce Mann, Professor of Surgery, The University of Melbourne, and Director, Breast Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Dr Marie Burke, Radiation Oncologist, and Medical Director GenesisCare Oncology, QLD; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Ruth Groom, Consumer; Julie McGirr, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Catriona McNeil, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Dr Roya Merie, Staff Specialist, Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, NSW; Dr Eva Nagy, Oncoplastic Breast Surgeon, Sydney Oncoplastic Surgery, NSW; Gay Refeld, Clinical Nurse Consultant – Breast Care, St John of God Subiaco Hospital, WA; Genny Springham, Consumer.
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