Breast cancer diagnosis

Before an examination takes place, your healthcare provider will talk to your about your medical history, recent symptoms and the reason for your referral. If required, the healthcare provider will explain the steps of the examination, ask for your consent and perform a physical examination of your breasts. If not already present, they may arrange for a chaperone (another person to be present during the examination).

If you have questions or concerns about having this exam, please discuss these with your healthcare provider prior to the exam. Steps can be taken to ensure your comfort and privacy.  

If your regular healthcare provider is male you may feel more comfortable requesting to see a female one.

The examination usually involves lying on a table or sitting in a chair and having one breast uncovered at a time. The person doing the examination will palpate (press) into the breast tissue, moving around the breast in a pattern like the face of a clock. Next they may feel under your armpit and along your collarbone before covering your breast and moving on to examine the other.

Mammogram

A mammogram is a breast X-ray. It will give your healthcare provider more information about any lump or other change noticed. Occasionally, a lump that can be felt is not seen on a mammogram. Such a lump should not be ignored. Other tests will need to be done. Read more about mammograms.

Ultrasound

An ultrasound is a test using high-frequency sound waves to help detect lumps or other changes. Read more about ultrasound.

Magnetic resonance imaging (MRI)

An MRI scan is a scan that uses magnetic resonance to detect abnormalities in the breast. This type of scan is sometimes used in lobular carcinomas to make sure there is not more than one cancer present, and it can check the other breast as well. It can also be used to check the breast if a mammogram is negative but the specialist is concerned about the lump or changes in the breast. Read more about MRI scans.

Fine needle aspiration

A fine needle aspiration can be done in your specialist's rooms, a hospital outpatient department, or at a laboratory by a pathologist. A very narrow needle is used to take some cells from the lump. These cells are then sent to a laboratory for examination.

A fine needle aspiration may cause a little discomfort but isn't usually any more painful than a blood test. Results from this test may be available immediately or may take some time, depending on where it is done.

Biopsy

Sometimes a biopsy will be necessary. A biopsy is the removal of a sample of a lump or the entire lump for examination under a microscope.

Core biopsy

A larger needle than that used for fine needle aspiration is used to obtain a sliver of tissue from the lump. This is done with a local anaesthetic. A core biopsy can be done by a radiologist under ultrasound guidance or in a mammogram machine (stereotactic core biopsy). Sometimes it's done by palpation (feeling) of the lump by the specialist.

Open biopsy

Sometimes, a surgical or open biopsy is necessary to remove the whole lump. This small operation is usually done under general anaesthetic, although occasionally a local anaesthetic is all that's needed. To have an open biopsy, you may need to stay in hospital overnight.

Hook wire biopsy

If the abnormality in the breast can only be detected by the mammogram (your healthcare provider can't feel the lump), a guide wire may be inserted in your breast to mark the area to be removed in the biopsy. This procedure takes place in the radiology department.

The placement of the wire is done under local anaesthetic, and the abnormality is then removed, as in an open biopsy, under general anaesthetic. It's then sent to the laboratory for testing.

Hormone-receptor tests

If the lump is a cancer, hormone tests will be done using immuno-histochemistry (IHC), on the sample that was removed. These tests show whether the cancer cells have special 'markers' on them called 'hormone receptors' (oestrogen/progesterone). If these markers are present, the cancer is described as 'hormone receptor positive' and the cancer is more likely to respond to hormone treatment if this is needed later.

HER2 tests

HER2 is a growth factor protein which tells breast cancer cells to grow. Approximately 1 in 5 females with breast cancer test 'HER2 positive', which means their cancer is more aggressive.

Two tests (IHC and FISH) are available to check HER2. The IHC test is used first and if this is only weakly positive, then the FISH test is used. If tests show you have HER2 positive cancer, this will influence future choices of chemotherapy, hormones, or monoclonal antibodies. A monoclonal antibody drug called trastuzumab (Herceptin®, Herzuma®) targets the growth factor so that breast cancer cells stop growing. 

‘Staging’ is a process of assessing the extent of a tumour. Other tests may also be necessary if cancer is diagnosed. These include blood tests and a chest X-ray. In some situations, a bone scan and a liver scan may be done.

The complete results from the biopsy and any further tests will help to determine the best treatment for you. With this information, your healthcare providers will know if you have an early breast cancer, locally advanced breast cancer, or metastatic (secondary) breast cancer.

The pathologist (doctor who looks at cancers in the laboratory) ‘grades’ the cancer, from 1 to 3, according to the way the cancer cells look and behave.

The cells of a Grade 1 breast cancer look more like normal breast cells, whereas the cells of a Grade 3 breast cancer look very abnormal, indicating a faster-growing cancer.

The treatment choices you are offered will be based on all the information the healthcare providers have about your cancer.