Taking Charge: How Is Breast Cancer Diagnosed?

If you find a lump in your breast, notice changes in breast skin, find a swollen lymph node in your armpit, develop a nipple discharge, or if your doctor finds an abnormality on a screening mammogram, you will need to have tests to find out if you have breast cancer.

  • Diagnostic Mammography — Diagnostic mammograms focus on a specific area of the breast. A number of different views may be taken, including some that magnify the abnormality.
  • Breast Ultrasound — Ultrasound, also called sonography, uses high-frequency sound waves to outline a part of the body. No radiation is involved in the procedure. Ultrasound is most often used to distinguish a solid mass from a cyst. It may also be used to guide a breast biopsy.
  • Ductogram — This X-ray test can be helpful in finding the cause of a nipple discharge. A fine plastic tube is placed into the opening of the duct at the nipple. A small amount of contrast dye is injected, which outlines the shape of the duct when an X-ray image is taken.
  • Magnetic Resonance Imaging (MRI) — Doctors are just starting to learn about how this imaging tool can be used to evaluate breast cancer. Your physician may recommend that you have a MRI of the breast, usually as part of a research study, to add to the information available from other tests.
  • Nipple Discharge Examination — Some of the fluid may be collected and examined under a microscope to see if cancer cells are present. A red or red-brown discharge suggesting blood may be due to cancer. A clear or milky secretion is very unlikely to be cancer.
  • Biopsy — A biopsy, a procedure in which a tissue sample is taken, must be performed to make sure that you have cancer. The diagnosis will be made by looking at the biopsy specimen under a microscope. There are several ways of performing biopsies, depending on where the suspicious area is located and whether it can be felt or seen with mammograms or ultrasound.
  • Fine Needle Aspiration (FNA) Biopsy — In this procedure, a thin needle is guided into the abnormal area of the breast and a small amount of fluid or tissue is drawn out. To guide the needle, the physician will either palpate (feel) the lump, or use ultrasound.
  • Core Needle Biopsy — This type of biopsy uses a larger needle than FNA. It removes a small cylinder of tissue from the breast abnormality. If the lump can be felt, it is performed with local anesthesia in the doctor's office. The needle is guided into position in the same way as for a FNA.

    If the abnormality cannot be felt, a stereotactic core biopsy is performed with computerized mammography.
  • Surgical Biopsy — Surgery may be needed to remove all or part of a lump for examination. An excisional biopsy removes all of the lesion, and a surrounding margin of normal-appearing tissue. This is usually performed in a hospital outpatient department with local anesthesia and a sedative.

    Sometimes the surgeon will have the radiologist mark the area right before surgery with a wire for localization. The area is numbed with local anesthetic and a thin hollow needle is placed with X-ray guidance in the suspicious area. Then a thin wire is inserted through the needle, with a small hook on the end to keep it in place. The needle is then removed and the wire is used to guide the surgeon to the area that must be removed.

Get a Second Opinion

It is recommended that you seek another doctor's opinion of your diagnosis and treatment choices. If you receive conflicting opinions you may want to have your medical story presented to a group of physicians meeting as a "tumor board."

A tumor board will discuss your case from the perspective of pathology, radiology, surgery, medical oncology and radiation oncology, and make treatment recommendations. It is possible that the tumor board recommendation may include differences of opinion that will need to be discussed with your doctor. UCSF offers a Breast Cancer Second Opinion Tumor Board.

Make Sure You Understand the Information

If you are told you have breast cancer, you will feel overwhelmed with emotion and technical information. It is important and medically safe for you to take some time to make an informed choice about your treatment. Discuss with your doctor how soon you need to make your decision.

Bring someone along when you meet with your doctor to talk about your diagnosis and treatment. When you are emotionally upset, it can be hard to understand even simple information. Breast cancer treatment is not a simple subject.

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Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.