On this page: Physical examination | Mammogram | Ultrasound | Breast MRI | Biopsy | Testing the tumour cells for hormone receptors and genes | Further tests | Staging breast cancer | Grading breast cancer | Prognosis | Which health professionals will I see? | Key points
Several tests are commonly used to find out if your breast change is due to cancer.
Your doctor will feel your breasts and the lymph nodes under your arms. They will take a full medical history and ask about your family history.
A mammogram is a low-dose x-ray of the breast tissue. This x-ray can find changes that are too small to be felt during a physical examination. Your breast is pressed between two x-ray plates, which spread the breast tissue out so clear pictures can be taken. Both breasts are checked. This procedure can be uncomfortable, but it’s over in about 20 seconds.
If the lump your GP could feel during the physical examination is not shown on a mammogram, other tests will need to be done.
An ultrasound is a painless scan that uses soundwaves to create a picture of your body. A gel is spread on your breast and a small device called a transducer is moved over the area. This sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. The scan takes about 15–20 minutes.
This form of breast imaging uses a large magnet in a scanner to image breast tissue. Breast MRI (magnetic resonance imaging) is more sensitive than mammography or breast ultrasound. It is commonly used to screen women at high-risk of breast cancer, but it can also be used in women with very dense breast tissue. Breast MRI is becoming more widely available, however it requires special expertise to interpret the results.
During the scan, you may have an injection of a contrast dye to make any potential cancerous breast tissue easier to see. To have the breast MRI, you will lie facedown on a screening table with cushioned openings for your breasts. The table slides into the machine. This test can take 30–60 minutes.
Your doctor will suggest a biopsy if an abnormal or unusual area is felt in your breast. During a biopsy, a small amount of tissue is removed from your breast. A pathologist examines the removed tissue and checks for cancer cells under a microscope. There are a few ways of taking a biopsy, and you may need more than one.
A thin needle is used to take some cells from the breast lump or abnormal area. Sometimes an ultrasound is used to help guide the needle. The test is a bit uncomfortable – it can feel similar to having blood taken. It is usually done in a specialist’s rooms, by a pathologist in a hospital outpatient department or at a radiology practice.
A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area. It is usually done under local anaesthetic, so your breast is numb, though you may still feel some pain or discomfort. During this procedure, a mammogram, ultrasound or MRI is used to help guide the needle.
"I had a core biopsy by ultrasound and didn’t find it very painful. Afterwards I had a small amount of bruising. I have heard other women say I was lucky, and they experienced more pain and bruising."
This is also performed under local anaesthetic. Lots of small tissue samples are removed using a suction-type instrument and computerguided technology.
If the abnormal area is too small to be biopsied using the methods above, a surgical biopsy is done. Before the biopsy, a guide wire may be put into the breast to help the surgeon find the abnormal tissue. You will be given local anaesthetic, and the doctor may use an ultrasound or mammogram to insert the wire. This is done in the radiology department.
The biopsy is then done in a separate operation using a general anaesthetic. The lump and a small area of breast tissue around it are removed, along with the wire. This biopsy is usually done as day surgery, but some women have an overnight stay in hospital.
A pathologist will examine the breast tissue. The sample comes from a biopsy or tissue removed during surgery. The findings of these tests will be outlined in a pathology report, which will include the size and location of the tumour, the grade of the cancer, whether there are cancer cells close to the edge of the breast tissue and whether there are cancer cells in your lymph nodes. The pathology report will help your doctor decide what treatments are best for you. Additional tests will be done to show if the cancer has receptors for hormones or growth factors.
Hormones affect some types of breast cancer. Hormones are chemical messengers in the body that transfer information. Before menopause, the ovaries produce the hormones oestrogen and progesterone. These hormones can cause cancer to grow.
A hormone receptor is a protein in a cell. In breast cancer, hormone receptors receive signals from oestrogen and progesterone to promote cancer cell growth. There are two types of hormone receptors: oestrogen receptors and progesterone receptors. About two out of every three breast cancers contain hormone receptors.
A cancer that is ER+ or PR+ is more likely to respond to hormone treatments.
The HER2 (human epidermal growth factor receptor 2) test looks for a protein that is found on the surface of cells. This protein causes the cell to grow and divide in an uncontrolled way. Tumours that have high levels of these receptors are referred to as HER2-positive (HER2+).
About one in five women have HER2+ cancer cells. Treatment with targeted therapies, such as Herceptin® is usually recommended.
The use of the Oncotype DX Breast Cancer Assay or Oncotype DX test is still new in Australia, but it is widely used in the United States.
In Australia, this test costs $5000, and is not currently covered by either Medicare or private health funds.
The Oncotype DX test uses a sample of breast tissue to analyse a group of 21 genes. These genes help predict the risk of breast cancer coming back after treatment and if you are likely to benefit from chemotherapy after surgery (adjuvant chemotherapy).
Women who are suitable for this test include:
Talk to your doctor if you would like to know more about this test. A pathologist will take a portion of the tumour tissue, which will be sent to America, where all Oncotype DX testing is currently done. Your doctor will usually receive the results within 2–3 weeks.
If the tests described above show you have breast cancer, one or more tests may be done to see if the cancer has spread to other parts of your body. The test and scan results will be written in a pathology report.
Blood samples may be taken to check your general health, and also to look at your bone and liver function for signs of cancer.
Your doctor may take an x-ray of your chest to check your lungs for signs of cancer.
A CT (computerised tomography) scan is a type of x-ray procedure that takes pictures of the inside of the body. Unlike a standard x-ray, which takes a single picture, a CT scan uses a computer to compile many pictures of the body. It can show if the cancer has spread to the lymph nodes or other organs.
To make the scan pictures clearer and easier to read, you may have to fast (not eat or drink). You will also be asked to drink a liquid and have an injection of a dye into a vein in your arm. This can make you feel hot all over for a few minutes.
You will lie flat on a table while the CT scanner, which is large and round like a doughnut, takes pictures. This painless test takes about 30–40 minutes.
A bone scan may be done to see if the breast cancer has spread to your bones. A small amount of radioactive material is injected into a vein, usually in your arm. This material is attracted to areas of bone where there is cancer.
After a few hours, the bones are viewed with a scanning machine, which sends pictures to a computer. This scan is painless and will not make you radioactive. You should drink plenty of fluids on the day of and the day after the test.
A PET (positron emission tomography) scan is a specialised test, which is rarely done for breast cancer. It uses low-dose radioactive glucose to measure cell activity in different parts of the body.
A small amount of glucose is injected into a vein, usually in your arm. You will need to wait for about an hour for the fluid to flow through your body.
You will then lie on a treatment table that moves through a scanning machine. This body scan will show ‘hot spots’ where the fluid has accumulated – this happens where there are active cells, like cancer cells
While a PET scan is not a routine test, it may be used if other types of scans don’t give doctors the information they need.
There are extra costs associated with some tests and scans, depending on whether you are treated in a public or private hospital. Talk to your medical team for information about how much you will be charged.
The tests described on above show if the cancer has spread to other parts of the body. Working out how far the cancer has spread is called staging. Stages are numbered from I to IV.
|Stages of early breast cancer|
||The tumour is less than 2 cm in diameter and has not spread to the lymph nodes in the armpit.|
||The tumour is less than 2 cm in diameter and has spread to the lymph nodes in the armpit.
|The tumour is between 2 cm and 5 cm in diameter and has not spread to the lymph nodes in the armpit.
|Stage IIB (early)
||The tumour is 2-5 cm in diameter and has spread to the lymph nodes.
|Stages IIB (advanced), III and IV refer to advanced breast cancer. For information about these stages, call Cancer Council 13 11 20 or visit Cancer Australia.
The cancer will also be given a grade. The grade describes how fast the cancer is growing.
|Cancer cells look a little different from normal cells. They are usually slow growing.|
|Cancer cells do not look like normal cells. They are growing faster than grade 1 but not as fast as grade 3.|
|Cancer cells look very different from normal cells. They are fast growing.|
Prognosis means the expected outcome of a disease.
Most people with early breast cancer can be treated successfully. Survival rates have increased significantly over time due to better diagnostic tests and scans, earlier detection and improvements in treatment methods. According to recent statistics, the five-year survival rate for women with IDC, the most common type of breast cancer, is 90%.
A cure may still be possible for people with other types of breast cancer. For many, treatment can improve quality of life.
You will be cared for by health professionals who specialise in different aspects of your treatment. You may also see other allied health professionals who work alongside the doctors and nurses.
Allied health professionals provide important care and support services. The following health professionals may be in your multidisciplinary team (MDT).
|Specialist health professionals|
||specialises in surgery and performs biopsies; some breast surgeons also perform breast reconstruction and specialised oncoplastic procedures as part of the breast cancer surgery|
|oncoplastic breast surgeon
||specialises in the use of plastic surgery techniques
to achieve good appearance after surgery
||examines cells and tissue that is removed from the breast
to determine the type and extent of the cancer
|breast care nurses
||specialist nurses who are trained in breast cancer care
and provide information and support through all stages
of treatment and ongoing care
||specialises in reading x-rays, such as mammograms
||prescribes and coordinates radiotherapy
||plans and delivers radiation treatment
||prescribes and coordinates chemotherapy, hormone therapy and targeted drug therapies
|GP (general practitioner)
||explains information provided by specialists, helps
you with treatment decisions, assists you in obtaining
practical and emotional support, and works in partnership
with your specialist in providing your ongoing care
|reconstructive (plastic) surgeon
||performs breast reconstruction for women who have
had a mastectomy
||educates patients about lymphoedema management and provides treatment if lymphoedema occurs
|physiotherapist, occupational therapist
||assist in restoring range of movement after surgery
||support and help you through all stages of your treatment
||provides advice for people with a strong family history of breast cancer
|counsellor, psychologist, psychiatrist
||provide emotional support and help manage anxiety and depression
Information reviewed by: Dr Carolyn Cho, Breast and General Surgeon, Surgical Oncology, Deakin, ACT; Lynn Buglar, Breast Physician, BreastScreen, NSW; Mena Crew, Consumer; Elizabeth Jacobson, Consumer; Jane Marsh, Clinical Manager, Breast Centre, Brian Fricker Oncology Centre and Burnside War Memorial Hospital, SA; Marie Murdoch, Breast Care Nurse, Cancer Council Queensland, QLD; and Marion Strong, Clinical Nurse Consultant Breast Care Nurse and Cancer Care Coordinator, Toowoomba Hospital, QLD.