How Is Breast Cancer Diagnosed?

Breast cancer diagnosis often begins with abnormal findings on a screening mammogram. It can also begin with breast changes, such as a lump that you detect, especially for men.

A healthcare provider will order one or more diagnostic tests and procedures to confirm a breast cancer diagnosis. Imaging and tissue biopsy are the main tools for diagnosing breast cancer in men and women.

Mammogram

Mammograms are X-rays that allow a healthcare provider to see changes in your breast tissue. This test takes low-dose X-rays using a machine that compresses each breast between two plates to show breast changes like:

• Asymmetries (increased tissue density)
• Deposits of calcium (known as calcifications)
• Distortion in breast tissue (called architectural distortion)
• Solid masses and cysts

The breasts are flattened during this procedure to spread out breast tissue. It can be a bit uncomfortable, but it shouldn't be painful. Men have less breast tissue, so the use of diagnostic mammography may be limited.

Many women are familiar with routine screening mammograms, which are encouraged even if they have no signs or symptoms. A diagnostic mammogram works the same way but involves more images than a screening mammogram and takes longer.

A healthcare provider will likely send you straight for a diagnostic mammogram if you have symptoms that could indicate breast cancer, like lumps, nipple discharge, and breast pain. They can also send you for this test if a screening mammogram finds anything they want to investigate further.

Mammograms expose you to a very low dose of radiation. This test can still be performed if you're pregnant, but let a healthcare provider know beforehand.

Ultrasound

An ultrasound uses sound waves and echoes to take images inside your breasts. The technician will apply a gel to your breasts and move a wand called a transducer around to capture images. A healthcare provider will review those images later on.

Ultrasounds can capture breast changes in more detail than a mammogram. This test allows a healthcare provider to better see cysts, lumps, or other suspicious areas. Ultrasounds are particularly useful for imaging dense breasts, which can be harder to evaluate with a mammogram.

An ultrasound doesn't use radiation and should not be painful. The gel might feel cold at first. You may experience some pressure from the transducer. Tell a healthcare provider right away if you feel pain during the procedure.

MRI

Magnetic resonance imaging (MRI) uses radio waves and magnets to take very detailed images from multiple angles inside your breasts. A device called a breast coil helps the MRI get better images. This test often requires you to receive intravenous (IV) contrast dye. This dye helps highlight changes in your breasts.

An MRI should not be painful. Some people are squeamish about needles and might feel a bit claustrophobic during the test. Try to remain as still as possible and breathe normally, as this will help the quality of the images. Breast MRIs can take 30 minutes or more.

MRIs may be used when you have symptoms that could be breast cancer. This test can also figure out the size and location of already-diagnosed breast cancer.

Biopsy

A breast biopsy will be performed if your mammogram, ultrasound, or MRI suggests you might have breast cancer. Keep in mind that requiring a biopsy doesn't necessarily mean you have cancer. Most biopsies come back benign (non-cancerous).

A healthcare provider will take small bits of your breast tissue for further testing, either with a needle or surgery. What type of biopsy you get depends on several factors, including:

• The size of the breast change
• What symptoms you're experiencing
• What you and a healthcare provider prefer
• Where the breast change is located
• Whether you have changes in more than one area

The amount of discomfort you're in during and after the biopsy will also depend on several factors, like how much tissue was extracted and healing time. Talk to a healthcare provider before the procedure about what to expect and what options you have for sedation and pain management.

Stages of Breast Cancer

A healthcare provider will stage breast cancer if the above tests confirm a diagnosis. The stages of breast cancer are:

• Stage 0: This stage is also known as ductal carcinoma in situ (DCIS). Stage 0 is a pre-cancerous stage in which abnormal cells are confined to the lining of the breast duct. About one in five breast cancers are diagnosed as DCIS.
• Stage 1: This stage means that a small tumor has grown in the breast but has not spread.
• Stage 2: There are different subtypes of stage 2 breast cancer. You might have a small tumor that has spread to the lymph nodes or a large tumor that's confined to the breast.
• Stage 3: This stage also includes several subtypes. People with stage 3 breast cancer typically have larger tumors that have spread to the lymph nodes or tissues near the breast.
• Stage 4: This is the most advanced stage of breast cancer. Cancer cells have spread to other body parts, like the brain, bones, liver, or lungs. There's no cure for stage 4 breast cancer, but treatments can prolong life expectancy.

A Quick Review

Breast cancer is diagnosed using imaging tests like mammograms, ultrasounds, and MRIs. A tissue biopsy can confirm or rule out a diagnosis. 

The next step is to meet with a healthcare team to discuss treatment options if you're diagnosed with breast cancer. You will undoubtedly have a lot of questions. Write down everything you want to ask before your appointment and bring an advocate, such as a family member or friend, with you.