Breast cancer examinations and diagnosis

If you notice a change when observing your breasts, or if you’re unsure, the first step is to consult a general practitioner, gynecologist or specialized nurse as soon as possible, without waiting for your next medical appointment or mammogram.

During the consultation, the healthcare professional may perform a clinical breast examination, which involves observing and feeling the chest, breasts and armpits to check for abnormalities. It may be used to check for certain signs or symptoms, as part of a routine follow-up, or for other medical reasons. 

Following this examination and the assessment of your personal risk for breast cancer, the health professional may prescribe diagnostic tests, if deemed necessary.

The signs and symptoms of breast cancer can also be caused by non-cancerous (benign) conditions. The purpose of diagnostic tests is to determine the cause of the signs or symptoms observed in order to make a diagnosis.

If breast cancer is diagnosed, certain tests can help determine the characteristics of the disease, so that a treatment plan can be set up.

Various tests may be used during the breast cancer diagnosis process. The medical team decides on the best strategy for each individual, depending on a number of factors.

Diagnostic mammography

Mammography is a low-dose X-ray that provides a detailed image of breast tissue, called a mammogram.

A diagnostic mammogram may be prescribed following a clinical examination of the breasts that reveals abnormalities or a screening mammogram with abnormal results. Diagnostic mammography is more thorough and takes longer than screening mammography, allowing for more complementary breast images from different angles.

For more information on mammography, see our blog post titled Mammography: who, why and how? 

Breast ultrasound

Breast ultrasound uses ultrasonic waves to produce images of the inside of the breast. Ultrasound is used as a complementary examination in the pre-diagnosis process. A doctor may recommend this test to:

• examine a lump or abnormality, in some cases before a mammogram;
• examine a lump or abnormality detected by a mammogram;
• determine if a mass is solid (tumour) or a fluid-filled cyst; and
• pinpoint the area of the chest or breast where the abnormality is located to do a biopsy.

How is breast ultrasound performed?

This test can be done in a doctor’s office, clinic, hospital or outpatient clinic.

The patient lies on an ultrasound table and a technologist applies a lubricating gel to the skin over the area to be examined, which improves sound-wave transmission. A healthcare professional then slides a transducer (a microphone-like probe) directly on the skin. The high-frequency sound waves emitted by the transducer are reflected as echoes, which a computer analyzes to produce images on a screen.

Breast ultrasound doesn’t require anesthesia and causes no side effects or pain.

For more information, see our blog posts entitled Breast ultrasound: what you need to know and Five frequently asked questions about breast cysts.

Ultrasound cannot be used to make a definitive diagnosis of breast cancer. If there’s a solid mass (tumour), the doctor will recommend a biopsy to determine whether it is benign or cancerous.

Biopsy

Only a biopsy can confirm or rule out a breast cancer diagnosis beyond all doubt. This involves removing cells or tissues from the breast(s) or lymph nodes and examining them in the laboratory to confirm whether or not cancer cells are present. 

A biopsy of the breast skin may also be done if inflammatory breast cancer is suspected, or a nipple biopsy may be done if it’s thought that Paget’s disease, a rare form of breast cancer, is involved.

There are, in fact, several types of breast biopsies, and the doctor’s choice depends on the type of abnormal sign on the breast. Some biopsies require imaging techniques and local or general anesthesia, while others don’t. 

Once the diagnosis of breast cancer has been confirmed, other tests and imaging techniques can provide information about the characteristics of the disease, in particular whether it has spread to other parts of the body. These tests generally don’t require anesthesia and are painless.

Find out more about the different types of breast cancer here.

X-rays

X-rays may be used after a breast cancer diagnosis to determine whether it has spread to the lungs (pulmonary metastases).

They are one of a wide range of imaging techniques, including computer tomography (CT), ductography, scintimammography, bone scan, magnetic resonance imaging (MRI) and ultrasound.

Ultrasound

An ultrasound may be used after a breast cancer diagnosis to find out if the cancer has spread to the liver (liver metastases).

Magnetic resonance imaging

More specifically, MRI is an imaging test that uses radio waves and a strong magnetic field to see contrasts within tissues. There are certain contraindications, but no known harmful effects. It’s mainly used to detect metastases and help choose a treatment.

Laboratory tests

When a biopsy contains cancerous cells, more in-depth laboratory analysis of the samples is often required to better understand the status of the breast cancer and plan the best possible treatments. Some of the main laboratory tests available are cell visualization, evaluation of the proliferation rate through ki-67 expression, analysis of the tumour’s hormone receptor status, HER2 gene testing, genetic analysis of cancer cells and blood tests. 

For more on biopsies, see our blog post Biopsy: for a definitive diagnosis.

Blood tests

In some cases, blood tests may be needed to assess the quantity and quality of different types of blood cells (white blood cells, red blood cells, platelets). They can also be used to check the levels of certain substances to determine whether certain organs are working properly and if the cancer has spread to other parts of the body.

The results provide an indication of the patient’s general state of health before a personalized treatment plan is drawn up. They also provide baseline levels, making it possible to monitor changes during and after treatment.

Sentinel lymph node biopsy

This procedure involves finding and removing a sentinel lymph node, the first in a chain of lymph nodes, to check whether it contains cancer cells. It’s the first to filter and receive cancer cells.

Before the sentinel lymph node is biopsied, a low-level radioactive substance (a radiotracer) is injected. This substance is transported by the lymphatic system and enables the surgeon to see the lymph nodes and find the sentinel lymph node. This type of biopsy is simpler than axillary lymph node dissection and involves fewer side effects.

Are you experiencing anxiety while waiting for or following the results of medical examinations? You’re not alone. Call our free, confidential helpline from anywhere in Quebec Monday to Friday from 9 a.m. to 5 p.m. at 1 855 561-ROSE (7673) or write to us at info@rubanrose.org.

References

• Société canadienne du cancer  
• Ministère de la santé et des services sociaux du Québec 
• Institut national de santé publique du Québec  
• American College of Radiology 
• Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie du Québec (OTIMROEPMQ)