For most women, breast cancer is discovered before symptoms are noticed. During your annual office visit, your doctor should perform a physical breast exam. The American College of Radiology (ACR) and Society of Breast Imaging (SBI) now recommend that ALL women be evaluated for breast cancer risk no later than age 30. This includes a review of personal and family health history and a complete risk assessment. Women age 40 and older should have annual mammograms to look for breast cancers that are too small to feel on an exam. OHC maintains a list of the most up-to-date screening guidelines. Studies have proven that early detection leads to better patient outcomes.
Become familiar with how your breasts normally look and feel by conducting a monthly breast self-exam and report any changes to your doctor.
Clinical Breast Exam
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your healthcare provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for rashes, dimpling, or other abnormal signs, and the nipples are also assessed for any fluid/discharge.
Using the pads of the fingers to feel for lumps, your healthcare provider checks your entire breast, underarm, and collarbone area. The exam is done on one side and then on the other. Your healthcare provider also checks the lymph nodes near the breast to see if they are enlarged.
If you have a lump, your healthcare provider will feel its size, shape, and texture. Your healthcare provider will also check to see if the lump moves easily. Benign (noncancerous) lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests are necessary to make a diagnosis.
A mammogram is an x-ray picture of each breast and part of the chest wall. Mammograms can often show a breast lump when it is very small before it can be felt on an exam. They can also show tiny specks of calcium which are called calcifications. Lumps or calcifications can be caused by cancer, pre-cancerous cells, or other benign (non-cancerous) conditions. Usually, additional tests are necessary to find out if abnormal cells are present.
If a screening mammogram shows an abnormal area in the breast, your doctor may order extra, more detailed images of that area. Doctors also order diagnostic mammograms if a woman has symptoms like a lump, persistent pain, thickening, or nipple discharge. Depending on the screening mammogram results or on a woman’s symptoms, diagnostic mammograms can be done on both breasts, or they might focus on a specific area in one breast.
Other Breast Cancer Diagnostic Imaging
If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may also order other imaging tests:
- Ultrasound: An ultrasound device sends out sound waves that bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both.
- MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.
A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to definitively tell if cancer is present. Your healthcare provider may recommend a biopsy performed by a breast cancer surgeon or radiologist if an abnormal area is found on your imaging, or if there are concerning skin changes on your breast or nipple. There are different ways to perform these biopsies including:
- Core needle biopsy: This uses a needle to remove a small sample of breast tissue. This is usually performed by a breast radiologist in the office using numbing medication. Needle biopsies do not cause cancer cells to spread. In most cases, when possible, a needle biopsy should be done prior to a surgical biopsy. At OHC, our breast surgeons work very closely with breast radiologists to ensure comprehensive care.
- Surgical biopsy (also called an excisional biopsy or a lumpectomy): A breast surgeon removes a lump of breast tissue in the operating room.
- Punch biopsy: A breast surgeon removes a small sample of skin or the nipple. This is usually performed in the office.
The tissue from your biopsy will then be sent to a pathologist, who will check it under a microscope. They will be able to tell if cancer cells are present or not.
Determining Hormone Receptors and HER2 Status
If biopsy results do show breast cancer, additional tests will be done in the lab:
- Hormone receptor tests: Some breast cancers need hormones to grow. These tumors have receptors for the hormones estrogen and/or progesterone. They are called “hormone-positive” breast cancers. Hormone-positive breast cancers are more common than hormone-negative breast cancers. If a cancer is hormone-positive, then endocrine therapy (hormone therapy) is often recommended as part of cancer treatment.
- HER2 test: HER2 (human epidermal growth factor receptor 2) is a protein found in or on some breast cancer cells that fuels growth and can make breast cancer spread quicker. If testing shows that the cancer is HER2 positive, a special drug targeting the HER2 protein is typically recommended as part of cancer treatment.