A diagnosis will help tell us several things: the stage, the type, the speed at which the cancer is growing, which receptors it has, or if the cancer has spread. Testing will depend on your situation, and not everyone requires the same examinations to determine a diagnosis, but in many cases, a combination of these tests will be used to ensure the most accurate treatment plan. For the most accurate diagnoses, tests may include:
- Physical examination: If you notice any changes in your breasts, a physical exam will be your first test. Your doctor will check your breasts and lymph nodes in the armpit and above the collarbone for lumps or other changes. If your GP is concerned that the changes may relate to breast cancer, you will be sent for further tests.
- Mammogram: This low-dose X-ray can detect small changes in the breast tissue that may not be felt during a physical examination. This exam may feel uncomfortable for a few seconds while your breasts are placed between two X-ray plates and pressed together to help get a clear picture of the breast tissue.
- Tomosynthesis: This test is useful in denser breasts and may pick up smaller cancers that conventional 2D mammograms may miss. During this exam, the tomosynthesis machine uses slightly more radiation time and 3D reconstruction of the x-ray images to produce better quality pictures which will increase the cancer detection rate and reduce false positive rate. Tomosynthesis is now routinely performed with a mammogram at most radiology practices for diagnostic workups. These are not routinely performed at government-funded BreastScreen programs.
- Ultrasound: This non-invasive, painless test without radiation is used if your doctor feels a lump during the physical examination or a mammogram picks up unusual changes in the breast tissue. An ultrasound uses high-frequency sound waves to create an image of the inside of the breast and the armpit. It can help determine whether a lump is solid or filled with fluid. This scan does not use radiation.
- Breast MRI: This test involves injecting a contrast dye to illuminate any cancerous cells during the scan. It uses magnets and radio waves to produce an image of the breast tissue and show any abnormalities in the blood vessels. Your breast specialist may request a breast MRI if you have implants or highly dense breast tissue.
- Biopsy: A biopsy will only be required if a mammogram shows abnormalities or your GP suspects you have breast cancer after undergoing other examinations. This test involves the removal of a tiny sample of breast tissue for examination under a microscope. A biopsy is safe, and all patients require a biopsy prior to treatment. Any palpable (easily felt) breast lump should also undergo a biopsy. A biopsy is the only way to confirm the presence of breast cancer and may include a few different methods:
- Fine needle aspiration (FNA) - This is a test where a doctor uses a thin, long needle to take a small sample of cells from a lump or growth in your body. The cells will then be looked at under a microscope to see if they are cancerous. FNA is usually done quickly and easily in the doctor's office or by radiologist under imaging guidance. This type of biopsy is not generally used for a formal diagnosis of breast cancer. A core biopsy is the main type of biopsy that is needed for diagnosis. A FNA biopsy can be insufficient in some cases.
- Core biopsy- A doctor uses a slightly longer and wider needle than the FNA to take a small sample of cells from a lump or growth. This method allows for a larger sample and is guided by ultrasound, mammogram, or MRI scan. The cells are then looked at under a microscope to see if they are cancerous. This test is done in the radiology department and the doctor uses a local anaesthetic to numb the area. This is the main form of biopsy required to diagnose breast cancer.
- Vacuum-assisted core biopsy - Uses a suction-equipped needle inserted through a small cut in the breast to remove tissue for examination. It's more accurate than a fine needle aspiration, and a mammogram, ultrasound or MRI guides the needle placement. The procedure is performed with a local anaesthetic by a radiologist in a radiology practice or BreastScreen. It is generally done for calcifications seen on mammograms.
- Surgical biopsy - Surgical removal of abnormal tissue is done if the needle biopsy is unsuccessful or the results are unclear. During this procedure, a doctor removes all or part of a lump or growth to see if it's cancerous. This test is usually done in a hospital or outpatient centre and will be done under general anaesthesia. It is generally done as a day surgery procedure and involves a small incision on the breast.
If previous tests confirm breast cancer, your doctor may refer you for some or all of the below to determine whether the cancer has spread.
- Blood tests: to check your overall health.
- Bone scan, CT chest/abdomen/pelvis, or whole-body PET/CT scan: Each scan is relatively similar but checks for cancer cells slightly differently. Each scan involves a large scanning machine and the injection of contrast dye to help make the image clearer and illuminate any cancerous cells within the body. These scans are used for staging to look for cancers that may have spread beyond the breast. Your surgeon may use one or a combination of the above for staging purposes. Staging scans are not required for women with a new diagnosis of breast cancer. It is used selectively for some women, especially those who have been found to have lymph node involvement.