Mammography
This is an x-ray of the breast. It is especially useful for detecting early changes in the breast when it may be difficult to feel a lump. It is usually used for women over the age of 40. Younger women’s breast tissue is more dense and this can make mammograms less able to detect any changes. Some women find mammography uncomfortable or even painful because pressure is put on the breasts. The discomfort should last only a few seconds and is not harmful to the breasts.
Ultrasound
Ultrasound is used to see if a lump is solid or contains fluid. If the lump contains fluid it is known as a cyst. A special gel is spread onto the breasts and a small device is passed over the area. This device is like a microphone and produces sound waves. The echoes are converted into a picture of the breast tissue by a computer. This test is painless and takes a few minutes.
Colour Doppler
Certain types of ultrasound machine show the blood supply to the lump. This may help to distinguish between a cancer and a benign lump. The blood supply shows up as patches of red or blue colour on the scan.
Fine-needle aspiration
This is a quick, simple procedure done in the outpatient clinic. Using a fine needle and syringe, the doctor takes a sample of cells from the breast lump. The sample is sent to the laboratory to see if it contains any cancer cells. This technique may also be used to drain a benign cyst. As the breast is sensitive the needle aspiration can be quite uncomfortable.
Sometimes (especially if the lump is small) a needle aspiration may be carried out in the x-ray department. The doctor uses x-ray or ultrasound guidance to make sure that the exact area of the breast is sampled with a special needle. Your doctor will discuss with you which type of needle aspiration you may have.
Needle (core) biopsy
This test uses a slightly larger needle than the one used for needle aspiration. It is done under a local anaesthetic which numbs the area and allows the doctor to take a biopsy (a small piece of tissue from the lump). The sample is examined in the laboratory to check for signs of cancer.
Blood tests
Samples of your blood will be taken to check your general health. The blood samples show the number of cells in your blood (blood count). Other blood tests will show how well your kidneys and liver are working. Your blood may also be tested to see whether it contains particular proteins (called markers) which are sometimes produced by cancer cells.
Excision biopsy
In this biopsy the whole lump is removed under a general or local anaesthetic and sent to a laboratory for examination. This may mean an overnight stay in hospital but in some hospitals this is not necessary. If a lump is too small to be felt but has shown up on mammography or ultrasound, it may be necessary for the radiologist to mark the area for the surgeon. This is done by inserting a very small wire under local anaesthetic, using x-ray or ultrasound guidance.
Many hospitals have a special ‘one-stop’ breast cancer clinic. This means you will have all the necessary tests and some of the laboratory results on the same day. It may take longer in general hospitals for the results to come through. This waiting period can be an anxious time for you and it may help to talk about your worries with a partner, close friend, relative or counsellor. You can also call CancerBACUP to speak to one of the nurses.
Further tests
If the tests show that you have breast cancer your doctor may want to do some further tests to see if there has been any spread of the cancer. These help the doctor to decide on the best type of treatment for you. The tests will usually consist of a chest x-ray and some of the following:
Liver ultrasound scan : You may be asked to have a liver ultrasound scan to check your liver. This is a painless test and only takes a few minutes. It will probably be done in the hospital scanning department. You will be asked to lie on a couch. A gel will be spread on your abdomen and a small device like a microphone will be passed over the area. The echoes are converted into a picture by a computer.
Bone scan : A very small amount of a mildly radioactive liquid is injected into a vein, usually in your arm. After about three hours a scan is taken. Abnormal bone shows up on the scan as highlighted areas. This happens because it absorbs more of the radioactive substance than normal bone.
MRI scan (magnetic resonance imaging) : This test uses magnetism to build up a three dimensional picture of your body.
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