Screening tests such as mammograms or ultrasound can only lead doctors to suspect breast cancer.
To determine if cancer is actually present a doctor will need to take a biopsy of the breast tissue and then examine this tissue under a microscope to see if cancer cells are present.
A biopsy involves a small operation to remove some of the breast tissue. Your doctors will generally try to use the least invasive method possible to minimise scarring. However, this may not always be possible.
There are several different kinds of biopsy. The most common are:
Other tests may also be done to determine whether the cancer has spread to other parts of the body.
Fine Needle Aspiration
With this procedure you will have a local anaesthetic to numb the breast area. The doctor then uses a very fine hollow needle which is attached to a syringe. The doctor uses an ultrasound image to guide the needle into the lump or area of concern. Breast cells are then sucked up through the syringe and sent to a laboratory for analysis.
Core Needle Biopsy
This procedure uses a larger hollow needle than Fine Aspiration does and is often used when the lump is solid rather than fluid.
Again your breast will be injected with local anaesthetic. The doctor will make a small cut in the skin of your breast to allow the needle to pass through. The needle is then guided to the area of concern and several samples of tissue are withdrawn. These are sent to the laboratory for analysis and a report will be sent back to your doctor within a few days.
Both fine needle aspiration and core needle biopsy provide quick results and mean that you can discuss your treatment options with your doctor before you have surgery.
The procedure only takes a few minutes and can be done in your doctor’s rooms. Results are usually sent back to your doctor within a couple of days.
Stereotactic core biopsy or Mammotome
This procedure is often used in women whose mammograms have identified a large number of calcifications in the breast. Calcifications can be an early indication of cancer, though most are nothing to worry about.
You will have a local anaesthetic and your breast will be compressed in the mammogram. A needle will then be inserted into the calcifications or area of concern and tissue samples will be taken. These are then sent to the laboratory for analysis.
This procedure can take a few hours, but can still be done in your doctor’s office or radiologist’s rooms.
This procedure is performed in the operating theatre and you will need a general anaesthetic. The surgeon then uses a scalpel to cut away the area of suspected tissue for analysis. The cut is usually made near the nipple area to minimise scarring.
If the surgeon needs help in locating the area of concern, a “hookwire” or “wire localization” biopsy may be used.
This involves having a local anaesthetic in the breast before surgery. The surgeon then uses an ultrasound or mammogram to guide a small wire into the breast to pinpoint the exact area of concern. This helps the surgeon to find the area of concern once you are on the operating table for an open biopsy.
This procedure may take up to three or four hours and you should have someone available to drive you home. Your breasts are likely to be tender for a couple of weeks, but you should be able to resume normal activities, such as exercise, after this time.
Other tests used to determine whether cancer has spread
A CT or CAT scan stands for computerised tomography and is another kind of x-ray. It takes a cross sectional image of the body and can be useful in showing whether the cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver, brain or spine.
When you have a CT scan you lie on an examination table which then passes through a hollow cylinder. The procedure should only take a few minutes.
A chest x-ray is often done at the beginning of treatment for breast cancer to determine whether the cancer has spread to the lungs. It may also be used to asses the state of the heart and lungs before you begin intensive treatment which could put stress on these organs.
This stands for Positron Emission Tomography and is one of the newest imaging technologies available. Only some centres in New Zealand offer this service.
If you have a PET scan you are injected with a small amount of radioactive material before images are taken with a special camera. Cancer cells are more active than ordinary cells and so absorb more of this radioactive material. These cells then show up on the images.
PET scans can be useful in detecting whether cancer cells have spread beyond the breast to the lymph nodes or other parts of the body or to determine whether you are responding well to treatment.