Diagnostic procedures

Breast cancer is diagnosed either by finding a mass which is shown to be malignant or by biopsy of mammographic abnormality which proves to malignant, although most breast lumps are benign.

Diagnosis of breast cancer is made though a process called triple assessment, which includes:

clinical examination
imaging procedures such as mammogram, breast ultrasound or magnetic resonance
biopsy, which is a surgical removal of tissue for microscopic examination, that doctors do of a mass detected by physical examination or mammogram (x-ray of the breast)

The clinical examination:

Most doctors recommend physical examinations by a doctor every three to four months. Breast self-exams should remain an important part of your routine.

The mammography:

Mammography is the process of using low-dose X-rays to examine the human breast. It is used to look for different types of tumours and cysts. Mammography has been proven to reduce mortality from breast cancer by detecting breast cancer at its early stage. No other imaging technique has been shown to reduce risk, but self-breast examination (SBE) and physician examination are essential parts of regular breast care. In some countries routine (annual to five-yearly) mammography of older women is encouraged as a screening method to diagnose early breast cancer. Screening mammograms were first proven to save lives in research published by Sam Shapiro, Philip Strax and Louis Venet in 1966.

This process assists also in assessment of a breast lump since most malignant tumours have signs on the X-ray suggesting a malignant nature. It is however different for older woman because only ten percent of malignant tumours will not be seen on mammography. This mean stays helpful and is recommended to any women at any age.

The biopsy:

A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. The tissue is often examined under a microscope and can also be analysed chemically (for example, using PCR techniques). There are 3 kinds of biopsy:

only a sample of tissue is removed (incisional biopsy or core biopsy; a sample of tissue
or fluid is removed with a needle (needle biopsy or fine-needle aspiration);
a whole tumour or lesion is removed (excisional biopsy).

A biopsy is a very small operation that removes tissue from an area of concern in the body and is necessary to distinguish normal tissue from cancer tissue. Biopsies are performed on any kind of abnormality that the doctor can feel or that looks suspicious. A radiologic study (mammogram, ultrasound, etc.) is not enough to establish an initial diagnosis of cancer. A diagnosis of cancer must be proven by the presence of cancer cells as seen under a microscope. This is why a biopsy is required to get the cells for microscopic analysis.

Calcium Deposits / Calcification:

Calcium deposits show up as white spots on a mammogram. They may be caused by benign or cancerous conditions. A large percentage of deposits are recognised to be benign by the radiologist and do not need biopsy. Others are often caused by cancer developing in the milk ducts and should be removed by a surgical biopsy.

Other methods:

There are been considerable interest in methods of detection of non-palpable abnormalities in the breast that do not use ionizing radiation. Such methods include thermography, ultrasound diaphonography and magnetic resonance imaging (MRI) but the screening of asymptomatic women, none of these techniques approach the sensivity or the specificity of mammography and cannot be recommended at the present time. MRI is being studied in high risk women to assess its role in this group.

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