For most women, breast cancer is found before you notice symptoms. During your annual office visit, your doctor should perform a physical breast exam. Plus, women over 40 should have a regular mammogram to see breast cancer that is too small to detect with an exam.
Studies have proven that breast cancer treatment is more likely to work well when the cancer is detected early.
Clinical Breast Exam
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your healthcare provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your healthcare provider checks your entire breast, underarm and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your healthcare provider also checks the lymph nodes near the breast to see if they are enlarged.
If you have a lump, your healthcare provider will feel its size, shape and texture. Your healthcare provider will also check to see if the lump moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests would be needed to make a diagnosis.
A mammogram is an x-ray picture of each breast and part of the chest wall. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.
The American Cancer Society recommends the following schedule for regular screening of average-risk women. However talk to you doctor about what’s best for you.
- Women ages 40 to 44 should start annual mammograms.
- Women age 45 to 54 should get a mammogram every year.
- Women 55 and older can switch to a mammogram every 2 years, or can continue yearly screening.
If the mammogram shows an abnormal area within the breast, your doctor may order clearer, more detailed images of that area. Doctors use diagnostic mammograms to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast rather than both breasts and chest wall imaged in a screening mammogram.
Other Breast Cancer Diagnostic Imaging
If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other imaging tests:
- Ultrasound: A woman with a lump or other breast change may have an ultrasound test. An ultrasound device sends out sound waves that people can’t hear. The sound waves bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer.
- MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.
A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to tell for sure if cancer is present.
You may need to have a biopsy if an abnormal area is found. An abnormal area may be felt during a clinical breast exam but not seen on a mammogram. Or an abnormal area could be seen on a mammogram but not be felt during a clinical breast exam.
In most cases your oncologist, or another healthcare provider, will recommend you have a biopsy performed by a breast cancer surgeon. When the time is right, the breast surgeon will remove fluid or tissue from your breast in one of several ways:
- Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump.
- Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue.
- Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin.
- Surgical biopsy: Your surgeon removes a sample of tissue. This is most often done when it’s time to remove the breast cancer, but additional testing of nearby lymph nodes is required.
- An incisional biopsy takes a part of the lump or abnormal area.
- An excisional biopsy takes the entire lump or abnormal area.
A pathologist will check the tissue or fluid removed from your breast for cancer cells. From this, the type of cancer can be determined with ductal carcinoma being the most common diagnosis.
Determining Hormone Receptors and HER2 Status
If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed:
- Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option. See the Hormone Therapy section.
- HER2 test: HER2 is a protein found in or on some breast cancer cells that fuels growth and can make the breast cancer spread quicker. If the test shows you are HER2 positive, a special drug targeting the HER2 protein is recommended.
All of these diagnostic tests may not happen at once. It can sometimes take a few weeks to get all of the information needed to fully develop the treatment plan for your type of breast cancer. However, this doesn’t mean treatment will necessarily wait that long. Most oncologists recommend a course of treatment plan that begins shortly after diagnosis to begin the process of shrinking the breast tumor.