Breast Cancer Diagnosis

There are several methods of screening for breast cancer: breast self-examination (BSE), magnetic resonance imaging (MRI), ultrasound, estrogen and progesterone receptor tests, genetic testing, mammography every 1-2 years, and Biopsy.

Breast self-examination (BSE) - a monthly breast self-exam is the easiest way to find breast cancer at an early stage. Women who practice regularly self-breast examination have more chances to discover a smaller and less developed breast cancer than those who do not. They have more chance of being cured or live longer with the disease. You can start practicing regular self-exam from the age of 20. By doing so, you will become familiar with specific texture of your own breasts and know discover precancerous abnormalities or early cancerous growth at an earlier stage.

It is recommended to do a breast self-exam during non hormonal stimulation, or 7 to 10 days after the end of your menstruation. If you are irregular or postmenopausal, you can chose a specific date to do the test; chose a date easy to be remembered. During the examination, you can find the following signs if you have breast cancer:

nipple discharge
sensation of a lump or thickening of the breast
sensation of a nodule in the armpit or neck
localized retraction of the skin (like an orange peel) or the nipple
persistent and painful inflammation of the skin of the breast
eczema, redness or other abnormalities in the nipple
visible or palpable change of breast

Although you should always take seriously any recent change in appearance of your mammary gland, a palpable nodule is not necessarily cancer. It may be another breast disease such as mastitis, cyst or fibroadenoma, the most common noncancerous breast tumor in young women. A change in your breast may also simply a hormonal change. Consult your doctor before you panic or assume anything.

Clinical breast exam – your “self-breast exam” is not always enough to detect abnormalities in your beast; you may need a breast examination by your doctor. It is an important consideration; in fact, the American Cancer Society recommends this test once every three years until age 40 for even women who are not at risk. The monthly self breast exam, clinical breast examination (by your doctor) and mammography are three key tests in early detection of breast cancer.

Mammogram – this medical technique is often performed in breast cancer diagnosis. It allows your physician to study your mammary gland and possibly detect anomalies, lesions and breast cancer even at an early stage. This examination is recommended to be performed when the breasts are not congested due to menstrual cycle; the breasts are less sensitive to pressure from the mammogram and require lower doses of x-rays. The mammogram test is the most reliable in detecting breast cancer at a very early stage. In fact, early mammography can increase your chance of healing up to 90%.

Other tests such as clinical palpation, ultrasound, scintigraphy, CT scan, and magnetic resonance are often complementary to mammography and can in no way replace it. However, although the risk of developing breast cancer due to mammogram is negligible, excessive use can contribute to the development of breast cancer.

Digital mammography (Senographe 2000D) - this screening method is a little bit recent, but effective. Invented by General Electric, senographe 2000D is approved by the FDA in January 2000 for the diagnosis of breast cancer. Digital mammography can detect breast cancer even when they are not palpable, but already manifest by fine calcifications or discrete changes in the anatomy of the breast. The image obtained with the Senographe 2000D is often more excellent than the standard imaging techniques.

Computer-aided detection (CAD) – this radiological procedure is a recent advance in the diagnosis of breast cancer. It highlights micro calcification clusters and hyperdense structures in the soft tissue of the breast. However, CAD seems less effective in detecting early breast cancer than the digital mammography; therefore, it is often used complementary to a mammogram exam. In addition, the CAD is more sensitive for microcalcifications than for masses.

Scintigraphy - Scintigraphy is a medical technique consists of using radioactive materials to produce images of the breast. This examination is very specific in detecting malignancy, but it cannot detect lesions that are not larger than 1 cm. scintigraphy presents no risk to your health because the injected fluid is quickly excreted in your urine. Scintigraphy is complementary to mammogram and it is recommended:

1) when the mammogram indicates the possibility of a malignancy

2) in cases of dense breasts that make difficult the interpretation of the mammogram

3) when the results of the needle biopsy is not sufficiently conclusive - showing little cancerous cells

4) in case the patient has had cosmetic surgery or breast implants

5) in case of complications of a local cancer following a chemotherapy

6) if during the palpitation, your doctor has discovered a mass that is not visible on mammography – scintigraphy is used to determine if the mass is tumoral or not.

Magnetic resonance imaging (MRI) - emerged in the early 1980s, MRI has become an important tool in the diagnosis of many diseases including breast cancer. It is based on the principle of nuclear magnetic resonance (NMR) which allows your doctor to take picture of the soft tissue of your breast. Unlike CT-scan, MRI is noninvasive procedure that does not radiate. In addition, it can visualize small sized-cancers through their neovascularization.

MRI participates widely in the diagnosis of tumors and their extension, and plays an active role in many forms of biopsy. It is involved in treatment decisions, and sometimes even directly involved in the treatment. An MRI helps your doctor to monitor the evolution of the cancer during and after treatment. However, MRI can give false-positive results; therefore, it is often used in complementary to mammography.

Breast ultrasound – a breast ultrasound is medical procedure that allows your doctor to obtain images of your breasts by using sound waves of high frequency. Images obtained give your doctor the possibility to evaluate abnormalities found during the mammogram or clinical exam. A breast ultrasound involves no radiation, poses no health problem.

Biopsy – the imaging techniques can reveal a cancerous mass, but they can’t confirm the presence of cancer cells in your breast. Your physician will perform a biopsy to accurately confirm the diagnosis. In general, the biopsy consists of removing a sample from the breast tissue or cells where the tumor is suspected. The sample will be microscopically studied to obtain accurate information on the overall structure of the fragment removed. Biopsy is often associated with a bacteriological, immunological or biochemical study. There are different types of biopsy that your doctor can perform:

Thin Needle aspiration biopsy(NAB) – also called fine needle aspiration cytology, NAB is a simple and fast procedure, yet reliable in detecting cancer cells. Usually, the pathologist uses a thin needle to extract tissue or fluid samples from the lump in the breast to examine under microscope. The entire procedure can last 30 minutes or less.
Large needle aspiration biopsy (LNAB) – this procedure is nearly the same as the fine needle aspiration cytology. The difference is that the needle is bigger and it takes more tissue for analysis, which allows a definitive diagnosis.
Surgical biopsy - performed under local or general anesthesia, a surgical biopsy is the most reliable method to accurately confirm a breast cancer diagnosis. The surgeon removes either a portion of the tumor (incisional biopsy) or the entire tumor plus the surrounding tissue (excisional biopsy) to allow a pathologist to do a microscopic examination. After analysis, your oncologist will be able to determine if your condition is cancer or a benign tumor.
Stereotactic biopsy - this it is a painless removal of samples from a lump in your breast that is visible only by mammogram or ultrasound. During the procedure, your pathologist will use special computer to guide the needle to the lump from which he will take the samples. It is an outpatient procedure done under local anesthesia, which can replace surgical biopsy with comparable reliability. A stereotactic biopsy can be performed by a certified technologist, but it requires interpretation of a physician or a board certified radiologist.