Screening & Diagnosis

When breast cancer is found and treated early, a woman has more treatment options and a better chance for a cure.

• Screening tests identify signs of breast cancer that might otherwise go unnoticed. 
• Diagnostic imaging procedures help doctors see details within the breast.
• Biopsies confirm when breast cancer is present.

Screening Tests

The following screenings are recommended as a routine part of every woman’s healthcare.

Breast Self-Examination

Your health-care provider can show you how to effectively examine your own breasts. When you are familiar with how your breasts normally feel, you are much more likely to identify lumps or other changes that may be symptoms of breast cancer. If you notice any changes, see your health-care provider. Usually breast changes are not cancer, but it’s important to find out for sure.

Clinical Breast Examination

This physical exam is performed by a health-care provider, such as a doctor or a nurse practitioner, often as a part of a woman’s annual check-up. The American Cancer Society (ACS) recommends that women in their 20s and 30s have a clinical breast exam at least every three years and that women over 40 have a clinical breast exam every year.

Screening Mammogram

A mammogram uses X-rays to produce an image of the breast and to detect abnormalities in the breast that may be too small to see or feel. On average, mammograms detect breast cancer in 80 to 90 percent of women who have the disease but don’t have any symptoms. The ACS recommends that women age 40 or older have a screening mammogram every year. For women with a 20 percent or greater lifetime risk for breast cancer, ACS recommends having an annual screening breast MRI (magnetic resonance imaging) scan in addition to a mammogram. Talk with your health-care provider about your risk.

Seattle Cancer Care Alliance (SCCA) was the first in the region offer digital mammography, a technique that captures X-ray images digitally for a more accurate diagnosis. Studies have shown that digital mammography detects up to 28 percent more cancers than traditional mammography. For more information about mammography at SCCA, check out the digital mammography section of our Web site.

Diagnostic Imaging

Once breast cancer is suspected, the following diagnostic tests may be used.

Diagnostic Mammogram

A diagnostic mammogram is used to evaluate a woman with a breast problem or symptom or an abnormal finding on a screening mammogram. It usually includes additional views of one or both breasts. 

Ultrasound

Ultrasound uses high-frequency sound waves to form an image that is displayed on a video screen and photographed for analysis. Because of the ways different substances interact with sound waves, ultrasound can often reveal whether a lump is a solid mass or a fluid-filled, non-cancerous cyst. As a result, breast ultrasound is generally used to examine a suspicious area found on a mammogram.

Magnetic Resonance Imaging

SCCA has long been a leader in the diagnosis and care of breast cancer, most recently in the use of MRI as a diagnostic tool. According to a study led by SCCA’s Dr. Constance D. Lehman, MD, PhD, MRI scans of women who were diagnosed with cancer in one breast detected over 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis. In conjunction with this news, the ACS announced new recommendations for use of MRI for women at increased risk for breast cancer. An expert panel, of which Lehman is a member, recommended annual screening using MRI in addition to mammography for women with a 20 percent or greater lifetime risk for the disease. For more information about the use of MRI to detect breast cancer, see magnetic resonance imaging in our digital mammography section.

Biopsy

When a screening or a diagnostic procedure finds an abnormality that could be cancer, a biopsy may be performed. In a biopsy, a doctor removes a sample of cells from the suspicious area. That sample is then examined under a microscope.

A biopsy is the only way to tell if cancer is really present. A biopsy can also reveal details about the cancer, such as the grade and whether the cancer is hormone-receptor positive. These details influence treatment decisions.

Fine Needle Biopsy

A fine-needle biopsy involves extracting fluid or cells from a lump that can be felt or seen with ultrasound or on a mammogram. A local anesthetic numbs the area before the needle is inserted. If you have a cyst, fluid will come out and the lump will disappear. If the needle extracts cells, the sample is inspected by a pathologist to determine if it is benign (not cancer) or malignant (cancer).

Core Biopsy

A core biopsy is nearly the same as the fine needle biopsy, but a larger needle is used to remove a small cylinder of breast tissue.

Stereotactic Needle Biopsy

This type of biopsy is done when the lump is so small that the doctor cannot insert the biopsy needle accurately. In this procedure, you lie face down on a special table with an opening that lets your breast hang down. A mammogram shows the location of the lump and a computer guides the needle.

Surgical Biopsy

In this type of biopsy, all or part of a breast lump is removed surgically for microscopic examination to determine whether cancer is present.

During surgery for breast cancer, women may also have one or more lymph nodes removed and biopsied to check whether cancer cells have spread into the lymph system.

Updated 8/10/2011