Diagnosing Breast Cancer
Breast cancer usually is found one of two ways: by a screening mammogram image or by a change in the breast found by a woman, her partner or her healthcare provider.
Women have screening mammograms to find breast cancer early, when it is most treatable. Screening mammograms are done on women without current breast issues or concerns.
Sometimes, the radiologist will find an area of concern on a screening mammogram. The patient will be asked to return for additional images of the area or diagnostic imaging. This will include magnified and/or special views and may include breast ultrasound to examine the area.
On closer examination, the radiologist may be able determine that the breast tissue appears normal or may say that a biopsy is needed. A biopsy involves taking a small piece of tissue from the area of concern. This tissue will be looked at under a microscope.
Self-Detected Breast Change
Women are encouraged to be aware of their breasts and to notice any changes that may indicate a problem. Changes may include:
- A lump or thickening in or near the breast or in the underarm area
- A change in the size or shape of the breast
- Dimpling or puckering in the skin of the breast
- New nipple retraction
- Unexplained discharge (fluid) from the nipple, possibly bloody
- Scaly, red or swollen skin on the breast, nipple or areola (the dark area of skin at the center of the breast)
- Skin that may have ridges or pitting so that it looks like the skin of an orange
Women experiencing these changes should see a healthcare provider.
The provider may order a diagnostic mammogram and possibly a breast ultrasound to help understand the issue. This may allow the provider to determine that the change is normal or benign, or that a biopsy is needed.
Healthcare Provider Finding
Women are encouraged to have a clinical breast exam as part of their routine physical performed by a healthcare provider. Sometimes, a healthcare provider will notice a change in the appearance of a woman’s breast or will feel a lump in the breast.
In this case, the healthcare provider will order a diagnostic mammogram and possibly an evaluation with a provider in the UW Health Breast Center.
A breast biopsy most often involves using a needle to remove a sample of tissue in the area of concern. The biopsy is performed in the Breast Imaging Department by a doctor (radiologist) with expertise in breast imaging. During the procedure, the breast is numbed with medication so that the patient does not feel pain.
If the area of concern can be seen using ultrasound, the biopsy will most likely be conducted using ultrasound guidance. The radiologist will use ultrasound images to guide the biopsy needle into the area of concern and remove tissue. Ultrasound-guided biopsy is the most common type of breast biopsy.
Sometimes, the area of concern can be seen only with a mammogram. In these instances, the biopsy may be performed using a process called stereotactic guidance. During a stereotactic breast biopsy, the breast is compressed like it is during a mammogram. Pictures are taken to help the radiologist decide where to insert the needle. Using the needle, the radiologist will remove samples of tissues from the area of concern.
In all cases, the tissue removed during the breast biopsy is sent to the UW Health Pathology Department. A doctor (pathologist) reviews the tissue samples under a microscope to determine if there are any cancer cells. The pathologist makes the diagnosis of whether a patient has breast cancer. Currently, the only way to know for sure that a woman has breast cancer is by looking at a sample of breast tissue under a microscope.