Dr. Spiegel feels breast cancer screening should be explained since early detection is very beneficial when it comes to the treatment of breast cancer. When a lump or change in the breast is found, many individuals suspect breast cancer right away, however, most of the time these findings do not turn out to be cancerous. The only way to know for sure though is through follow-up testing.
If breast cancer is discovered, then the results of these tests will help guide your treatment plan. Below you will find brief overviews of some of the common breast cancer screening and diagnostic tests that you may encounter.
Mammogram – A mammogram is a low-dose radiograph (X-ray photograph) of the breast used to screen for and evaluate breast cancer. A standard screening mammogram is used to detect potential cancer when it is too small to be felt by the individual or her physician. In addition to conventional mammography, there are two other types available at some hospitals. These include computer assisted detection (CAD) and the digital mammogram. These exams are usually employed due to a suspicious screening mammogram or lump. These diagnostic mammograms are used to get more information about a specific area (or areas) of concern. Digital mammography is different from a standard screening mammogram in how the image is viewed and manipulated. This specialized mammography technique uses digital receptors and computers instead of x-ray film to capture images of the breast. Once images are in the computer, a radiologist can then closely examine images by magnifying them, altering orientation, adjusting brightness and contrast, etc. Computer-aided detection (CAD) can be used on digital mammography images to help doctors analyze the images overall and flag areas that require further examination. CAD is essentially a second set of eyes that marks areas of interest in order to call them to the radiologist’s attention.
Ultrasound – An ultrasound is not used on its own as a screening test for cancer. Instead, it is utilized to complement other screening tests. For instance, if an abnormality is detected on mammography or felt during a physical exam, then an ultrasound can be employed to determine whether the abnormality is a solid mass or a fluid-filled cyst. During this test, a technician moves a handheld device over the breast, which uses sound waves to create a picture of the inside of the breast. Information about the contents of a lump is transmitted back to a computer, where a sharper image of the breast tissue is generated for analysis.
MRI (magnetic resonance imaging) – Breast MRI scanning is a highly sensitive test that may over-detect changes in breast tissue. This type of test is not recommended as a routine screening tool for all women. It is recommended for screening women who are at high risk of developing breast cancer, typically due to a strong family history of the disease. If you are considered high risk, or are BRCA positive, you would have breast MRI in addition to your annual mammograms. Although breast MRI is generally considered more sensitive for picking up breast cancer than mammography, it is not a perfect tool and can miss some cancers that would be detected by a traditional mammogram. For this reason, MRI is only recommended as a complement to other tests rather than a standalone testing method. MRI tests can also be useful for women who have dense breast tissue.
Biopsy – A biopsy is a procedure that removes a small amount of breast tissue for examination under a microscope. While other tests can suggest that cancer is present, only a biopsy can provide a definite diagnosis. Once the sample is removed, a pathologist then analyzes the cells. There are different types of biopsies and the one you require depends on your specific condition.
MRI-Guided Biopsy – This type of biopsy uses computer technology to guide a needle to an abnormality detected on MRI. Using a minimally invasive procedure, a sample of the suspicious cells is then extracted for examination.
Core Needle Biopsy – This test is normally utilized when lumps or clusters of calcifications are seen on mammogram or ultrasound results, but are too small to feel by hand. During this procedure, local anesthesia will usually be injected first to numb the breast. Then, using either stereotactic or ultrasound technology, a hollow-core needle is guided to the abnormality. Several cylinder-shaped samples of tissue are then removed from the suspicious area. This needle functions not unlike the puncher that’s used when piercing ears. Several passes are done to ensure that enough tissue is collected for pathology testing.
Needle Localized Excision Biopsy – This biopsy is performed when the patient has an abnormality seen on a mammogram or ultrasound that cannot be felt. In the X-ray department, the patient’s breast is cleaned and numbed with a local anesthetic. The radiologist then utilizes a mammogram or ultrasound to guide a small needle and wire to the abnormal region. Once proper placement has been verified, the needle is removed and the wire is left in place. The second step in this process occurs on the same day and involves the patient undergoing a surgical procedure to excise the affected breast tissue. The surgeon uses the wire implanted earlier to locate the abnormality and remove it in the operating room.
Fine Needle Aspiration – This type of biopsy is the least invasive method for extracting cells from a suspicious breast lump. The needle used for this procedure is thinner than the needle used in a core needle biopsy, and thus has limitations since it can collect so few cells. It can diagnose cancer, but provides little additional information about it. This method is sometimes used as a quick method to sample a breast lump felt during a clinical breast exam. Fine needle aspiration is only used for palpable masses (lumps that can be felt). The whole procedure only takes a few minutes. This technique is also commonly used to drain a breast cyst that feels tender or sore.
Sentinel Node Biopsy – This diagnostic procedure is a minor surgery and can usually be performed on an outpatient basis. The procedure begins with the injection of a labeling substance (radiotracer material and/or blue dye) into the area around the breast tumor. The first 1-3 lymph nodes to receive the dye are then extracted and tested to conclude whether or not cancer cells are spreading from the tumor to the lymph system.