Diagnosing Breast Cancer: Common Tests and Procedures

The journey to diagnose, or rule out, breast cancer often begins (for women) with abnormal findings on a screening mammogram. Sometimes it begins with breast changes, such as a lump that you detect (especially for men).

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

Here's what to expect during some of the most common diagnostic tests and procedures.

Mammogram

Mammograms are X-rays that allow your doctor to see changes in your breast tissue. Using a machine that compresses each breast between two plates, a mammogram takes low-dose X-rays that show breast changes like:

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

Because the breasts are flattened during this procedure to spread out breast tissue, it can be a bit uncomfortable, but it shouldn't be painful. Since men have less breast tissue, 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—compressing the breasts between plates—but involves more images than a screening mammogram and usually takes longer.

Your doctor will likely send you straight for a diagnostic mammogram if you're a woman having symptoms that could indicate breast cancer (including lumps, nipple discharge, breast pain, changes in breast shape, or thickening of breast skin), or if a screening mammogram finds anything that your doctor wants to investigate further.

Mammograms expose you to a very low dose of radiation. And while mammograms can still be performed if you're pregnant, let your provider know beforehand.

Ultrasound

An ultrasound uses sound waves and echoes to take images inside your breasts. Using a wand called a transducer, the ultrasound technician will apply a gel to your breast(s) and move the wand around to capture images. Afterward, your doctor will review those images.

Ultrasounds can capture breast changes in more detail than a mammogram, helping your doctor to better see things like cysts, lumps, or other suspicious areas. They are particularly useful for imaging dense breasts, which can be harder to evaluate via mammogram.

A breast ultrasound doesn't use radiation and should not be painful. The gel might feel cold at first and you may experience some pressure from the transducer, but tell your provider right away if you feel pain during the procedure.

MRI

Magnetic resonance imaging, or 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. Additionally, MRIs often require you to receive IV contrast dye, which helps highlight changes in your breasts. This should not be painful, though 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 a patient has symptoms that could be breast cancer, or to 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. (It's important to note here that requiring a biopsy doesn't necessarily mean you have cancer. In fact, most biopsies come back benign.)

During a biopsy, your doctor will take small bits of your breast tissue for further testing either via needle or surgery. What type of biopsy you get depends on several factors, including the size of the breast change, where the breast change is located, whether you have changes in more than one area, what symptoms you're experiencing, and what you and your doctor prefer.

The amount of discomfort you're in during and after the biopsy will also depend on several factors, like how much tissue was extracted, as will the time required for healing. You should talk with your doctor before the procedure about what to expect, as well as what options you have for sedation and pain management.

Recap

Breast cancer is diagnosed via imaging—diagnostic mammograms, ultrasounds, and MRIs—and tissue biopsy. If you are diagnosed with breast cancer, the next step is to meet with your healthcare team to discuss treatment options. You will undoubtedly have a lot of questions, so write down everything you want to ask before your appointment and bring an advocate (family member, friend, other support-giver) with you.

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