Breast cancer testing plays a key role in addressing the many
aspects of the disease. There are tests to determine genetic risks, to detect
cancer at an early stage, and to determine characteristics and possible spread
of the disease.
These tests guide treatment plans and monitor their effectiveness.
They also check for recurrences among long-term cancer survivors. It’s
important to understand the various screening and diagnostic tests used in
cancer detection and treatment. Talk to your doctor if you have any concerns.
Monthly breast self-exams are important in helping women more
easily recognize if there are any changes in their breasts from month to month.
It’s important to note that most early cancers of the breast cannot be detected
by everyday look and feel.
Step 1: Positioning. It’s usually better to be on your back rather than standing
for the feeling (palpation) part of the test.
Step 2: Preparation. Begin with your right hand above your head.
Lying on your back and raising your arm spreads the breast tissue across the
chest wall for optimal thinness.
Step 3: Movement. Using the three middle fingers of your left hand, make small,
overlapping, circular motions on your right breast. Move up and down the breast
from rib cage to collarbone, armpit to sternum.
Step 4: Pressure. Change pressures on each spot to examine
different depths of tissue. Use light pressure for the surface, medium in order
to feel about a quarter-inch to a half-inch deeper, and firm to feel close to
the chest and ribs.
Repeat on the other side. There likely will be a hardened ridge on
the lower curve of each breast, but any other lumps, swellings, or changes
should immediately be brought to the attention of your doctor.
Step 5: Visual. Stand in front of the mirror and press firmly down on your
hips with the heels of your palms (to tighten chest muscles for maximum
visibility of abnormalities). Look for any skin or nipple changes including
shape, contour, size, color, or skin texture (such as scales, sores, rashes,
dimples, or puckering of the skin). Slightly raise each arm to easily feel the
underarm areas for lymph node lumps.
Your doctor, nurse, or physician assistant can provide further
instruction perfect on how to perform a BSE if you don’t feel confident about
A CBE is much the same as the BSE. The caregiver will look at your
breast for any unusual shapes or changes in size, color, texture, etc. They
will also palpate (touch) your breasts with the same circular three-finger
motion that is recommended for a BSE.
In many cases, routine CBE is a good screening test option. However,
for women over age 40, mammograms are usually recommended in addition to the
A mammogram, or breast X-ray, can be used to screen for breast
cancer in women who may or may not have signs of the disease. This test
can reveal breast irregularities that are too small to be felt with a manual
exam. Mammograms alone cannot provide definitive proof that cancer is
Some women are concerned about the radiation used in mammograms. Modern
equipment uses very little radiation in the tests. In fact, one mammogram gives
off about the same ionizing radiation that an airline passenger would receive
on a cross-country flight.
Regular screening mammograms every two years are commonly
prescribed for an additional measure of detection for women between the ages of
50 and 74. A mammogram every two years (or the frequency recommended by your
doctor) can reveal any changes over time. Women who have a higher-than-average
risk of breast cancer may be advised to have a mammogram before age 40, and
annually after that.
During a mammogram, each breast is squeezed between two
photographic plates. This can cause some discomfort but is required in order to
produce the best possible image for a radiologist to read correctly. An entire
mammography session takes less than a half-hour to complete.
The radiologist viewing your mammogram will look for changes in
your breast tissue such as the following:
Calcifications. These mineral deposits may be
small (microcalcifications) or large (macrocalcifications). Macrocalcifications
occur in about half the women over age 50 and one-tenth of those under age 50.
These are almost always noncancerous. Microcalcifications, tiny specks of
calcium in the breast tissue, may be of more concern to doctors, depending on
how they are shaped and clustered. In some cases, cancer may be suspected and a
biopsy will be ordered.
Masses. These can be non-cancerous cysts or solid benign
tumors (fibroadenomas). Or they could be cancerous tumors that may or may not
be accompanied by calcifications. Cysts, fluid-filled sacs, can be confirmed by
an ultrasound or by removing the fluid with a thin, hollow needle. Masses that
are not cysts will usually be biopsied. The size, shape, and edges of a mass
may help a radiologist determine if cancer is likely present.
The American Cancer Society provides the following useful suggestions to
help ensure that your mammogram meets a high standard:
- An X-ray
facility may not perform mammography without special certification from
the U.S. Food and Drug Administration (FDA). Make sure the
certificate is viewable in the office. Ask to see it if it’s not
- Only go to a
facility that either performs many daily mammograms or does them
- When you find a
good facility, continue to go there. This will make comparison studies
with older mammograms more convenient.
- When visiting a
facility for the first time, bring a list of past mammograms, facilities,
biopsies, or other breast treatments. Dates, places, and doctors’ names
are helpful to
- Avoid scheduling
your mammogram the week right before your period. Pick a time of the month
when your breasts are neither tender nor swollen. This may help make
the mammogram less uncomfortable and produce a better quality
- Don’t wear
antiperspirants or deodorants the day of the exam. They can interfere with
- Tell the
mammogram tech about any breast symptoms or issues you have at the time of
Keep in mind that less than one-tenth of one percent of standard
mammograms led to a cancer diagnosis. According to Breastcancer.org, about 10 percent of
women who have a mammogram will require further testing. And less than 10
percent of those will require a biopsy and about 80 percent of those biopsies
will not show cancer.
Magnetic Resonance Imaging
For women at high risk for breast cancer, magnetic resonance
imaging (MRI) may be used along with a standard mammogram. MRIs use radio waves
and magnets to study areas that the mammogram flagged as unusual. MRIs may be
especially useful for younger women at high risk because of a family history of
cancer. If their breast tissue is already dense, standard mammograms are often not
With an MRI, a contrast dye (gadolinium) is often injected into a
small vein to help breast tissue be seen more clearly.
MRIs are so sensitive that they are not recommended as a primary
screening tool. They can result in false positives, meaning more tests and
unnecessary scares for women with average risks. However, for some high-risk
women, MRIs are essential.
Ultrasound uses sound waves to produce images. A small, handheld
metal device (transducer) is coated with ultrasound gel and moved around over
the breast. The transducer emits sound waves that bounce back to the device.
This painless test produces computer images that can be studied on the monitor
or in printouts.
Ultrasound is mainly used to study anything found during a
mammogram. Ultrasounds are not for primary screening. Some doctors find
ultrasounds help with reading mammograms of women with dense breast tissue.
Ultrasound can also be a valuable tool for examining breast cysts
or lymphomas. Ultrasound can distinguish a cyst from a tumor without aspirating
the breast, and is often less expensive than MRI or CT scanning. It can also be
useful as a companion test for needle biopsies. Ultrasound is widely used and
very safe, but it is only truly useful in the hands of an experienced
A ductogram, or galactogram, can help diagnose the cause of nipple
discharge. Most nipple discharges are the result of an injury, infection, or
benign growth. When these discharges are red or brownish-red they might be
cancerous. If the discharge is milky or clear green, cancer is unlikely.
In a ductogram, a micro thin tube is placed into the end of the
duct at the nipple. With the help of contrast material, an X-ray image is
created that will show any growth inside the duct.
Blood and tissue tests analyzed in medical labs can serve numerous
purposes. They help to determine genetic risk, diagnose, assess treatment
options, and monitor post-treatment. The following are the major lab tests for
Breast Cancer Gene 1 (BRCA1) or Breast Cancer Gene 2 (BRCA2) Gene Mutation
Women at high risk because of family history of breast or ovarian
cancer can learn whether they have a BRCA mutation. BRCA genes are tumor
suppressors. According to Breastcancer.org, if a mutation on one of
these genes is found, the risk for breast cancer will increase up to 80
percent. Nonetheless, less than 10 percent of breast cancer cases occur in
women with BRCA mutations.
This is a test in which a small bit of tissue is removed and
studied under a microscope. Biopsies are virtually painless and rapid results
can be obtained from a well-run lab. Changes in cells, such as the size of the
nuclei or speed of cell division, can indicate whether they are malignant. The
pathologist carefully records anything abnormal as this information can help
determine appropriate cancer treatment.
Three kinds of biopsies together form the gold standard for tissue
aspiration biopsy is used when the lump is solid. The doctor
inserts a thin needle and retracts a tiny piece of tissue for study by the
pathologist. In some cases, the doctor may want to examine a suspected cystic
lump to confirm that there is no cancer in a cyst.
- Core needle
using a larger needle and tube to extract a sample of tissue up to the
size of a pen. The needle is guided by feel, mammography, or ultrasound. A
computerized version that is gaining popularity for its accuracy is called
- Surgical (or
“open”) biopsy is when a surgeon removes part (incisional
biopsy) of all (excisional biopsy, wide local excision, or lumpectomy) of
a lump for evaluation under a microscope. If the lump is small or hard to
locate by touch, the surgeon may use a procedure called stereotactic wire
localization to map out a route to the mass prior to the surgery.
Prognosis and Monitoring Tests
There are several blood and tissue tests that can be used to
provide a prognosis or help assess ongoing status of the cancer patient.
Oncotype DX and MammaPrint tests, for example, together measure up to 90 tumor
genes and can be used in specific types of patients to determine the risk for
recurrence, risk for metastatic cancer, and possible usefulness of certain
chemotherapies or hormone therapy. DNA ploidy and Ki-67 antigen tests can
measure the rate of tumor cell growth. The faster such growth, the worse the
prognosis. Finally, CA15-3 and CA27.29 are blood tests that measure levels of
cancer antigens expressed. If the initial tumor had expressed these antigens, these
monitoring tests can indicate whether the cancer has recurred.